Cabergoline therapy for macroprolactinoma during pregnancy: a case report.

Background: We assessed the safety of Cabergoline therapy during pregnancy in a lady with hyperprolactinemia intolerant to Bromocriptine. Case presentation: We report the case of a 31 year old lady who presented to us with uncontrolled hyperprolactinemia. A pituitary Macroadenoma was demonstrated by MRI. Due to intolerance to Bromocriptine, Cabergoline was started. The patient improved and subsequently conceived. MRI in the second trimester demonstrated further reduction in the tumor size. It was decided to continue Cabergoline throughout pregnancy to ensure further reduction in tumor size until delivery and to hold Cabergoline during postpartum period to allow for an adequate interval of breastfeeding. At 37 weeks of gestation, the patient delivered a healthy baby. Conclusion: We were able to safely treat macroprolactinemia in our patient during pregnancy with cabergoline. This case report contributes to the relatively meager data available which advocates the safety of cabergoline therapy in pregnant hyperprolactinemic patients

Cryptic Leishmania infantum infection in Italian HIV infected patients

<p>Abstract</p> <p>Background</p> <p>Visceral leishmaniasis (VL) is a protozoan diseases caused in Europe by <it>Leishmania (L.) infantum</it>. Asymptomatic <it>Leishmania </it>infection is more frequent than clinically apparent disease. Among HIV infected patients the risk of clinical VL is increased due to immunosuppression, which can reactivate a latent infection. The aims of our study were to assess the prevalence of asymptomatic <it>L. infantum </it>infection in HIV infected patients and to study a possible correlation between <it>Leishmania </it>parasitemia and HIV infection markers.</p> <p>Methods</p> <p>One hundred and forty-five HIV infected patients were screened for the presence of anti-<it>Leishmania </it>antibodies and <it>L. infantum </it>DNA in peripheral blood. Statistical analysis was carried out by using a univariate regression analysis.</p> <p>Results</p> <p>Antibodies to <it>L. infantum </it>were detected in 1.4% of patients. <it>L. infantum </it>DNA was detected in 16.5% of patients. Significant association for PCR-<it>Leishmania </it>levels with plasma viral load was documented (p = 0.0001).</p> <p>Conclusion</p> <p>In our area a considerable proportion of HIV infected patients are asymptomatic carriers of <it>L. infantum </it>infection. A relationship between high HIV viral load and high parasitemic burden, possibly related to a higher risk of developing symptomatic disease, is suggested. PCR could be used for periodic screening of HIV patients to individuate those with higher risk of reactivation of <it>L. infantum </it>infection.</p

Noninvasive Diagnosis of Visceral Leishmaniasis:Development and Evaluation of Two Urine-Based Immunoassays for Detection of Leishmania donovani Infection in India

Visceral leishmaniasis (VL), one of the most prevalent parasitic diseasesin the developing world causes serious health concerns. Post kala-azar dermal leishmaniasis (PKDL) is a skin disease which occurs after treatment as a sequel to VL. Parasitological diagnosis involves invasive tissue aspiration which is tedious and painful. Commercially available immunochromatographic rapid diagnostic test such as rK39-RDT is used for field diagnosis of VL, detects antibodiesin serum samples. Urine sample is however, much easier in collection,storage and handling than serum and would be a better alternative where collection of tissue aspirate or blood is impractical. In this study, we have developed and evaluated the performance of two urine-based diagnostic assays, ELISA and dipstick test, and compared the results with serologicalrK39-RDT. Our study shows the capability of urinebased tests in detecting anti-Leishmania antibodies effectively for both VL and PKDL diagnosis. The ability of dipstick test to demonstrate negative results after six months in 90% of the VL cases after treatment could be useful as a test of clinical cure. Urine-based tests can therefore replace the need for invasive practices and ensure better diagnosi

Historical perspective on seismic hazard to Hispaniola and the northeast Caribbean region

This paper is not subject to U.S. copyright. The definitive version was published in Journal of Geophysical Research 116 (2011): B12318, doi:10.1029/2011JB008497.We evaluate the long-term seismic activity of the North-American/Caribbean plate boundary from 500 years of historical earthquake damage reports. The 2010 Haiti earthquakes and other earthquakes were used to derive regional attenuation relationships between earthquake intensity, magnitude, and distance from the reported damage to the epicenter, for Hispaniola and for Puerto Rico and the Virgin Islands. The attenuation relationship for Hispaniola earthquakes and northern Lesser Antilles earthquakes is similar to that for California earthquakes, indicating a relatively rapid attenuation of damage intensity with distance. Intensities in Puerto Rico and the Virgin Islands decrease less rapidly with distance. We use the intensity-magnitude relationships to systematically search for the location and intensity magnitude MI which best fit all the reported damage for historical earthquakes. Many events occurred in the 20th-century along the plate-boundary segment from central Hispaniola to the NW tip of Puerto Rico, but earlier events from this segment were not identified. The remaining plate boundary to the east to Guadeloupe is probably not associated with M > 8 historical subduction-zone earthquakes. The May 2, 1787 earthquake, previously assigned an M 8–8.25, is probably only MI 6.9 and could be located north, west or SW of Puerto Rico. An MI 6.9 earthquake on July 11, 1785 was probably located north or east of the Virgin Islands. We located MI < 8 historical earthquakes on April 5, 1690, February 8, 1843, and October 8, 1974 in the northern Lesser Antilles within the arc. We speculate that the December 2, 1562 (MI 7.7) and May 7, 1842 (MI 7.6) earthquakes ruptured the Septentrional Fault in northern Hispaniola. If so, the recurrence interval on the central Septentrional Fault is ∼300 years, and only 170 years has elapsed since the last event. The recurrence interval of large earthquakes along the Hispaniola subduction segment is likely longer than the historical record. Intra-arc M ≥ 7.0 earthquakes may occur every 75–100 years in the 410-km-long segment between the Virgin Islands and Guadeloupe

Clin Transl Sci

Adenosine boasts promising preclinical and clinical data supporting a vital role in modulating vascular homeostasis. Its widespread use as a diagnostic and therapeutic agent have been limited by its short half-life and complex biology, though adenosine-modulators have shown promise in improving vascular healing. Moreover, circulating adenosine has shown promise in predicting cardiovascular (CV) events. We sought to delineate whether circulating plasma adenosine levels predict CV events in patients undergoing invasive assessment for coronary artery disease. Patients undergoing invasive angiography had clinical data prospectively recorded in the Cardiovascular and Percutaneous ClInical TriALs (CAPITAL) revascularization registry and blood samples collected in the CAPITAL Biobank from which adenosine levels were quantified. Tertile-based analysis was used to assess prediction of major adverse cardiovascular events (MACE; composite of death, myocardial infarction, unplanned revascularization, and cerebrovascular accident). Secondary analyses included MACE subgroups, clinical subgroups and adenosine levels. There were 1,815 patients undergoing angiography who had blood collected with adenosine quantified in 1,323. Of those quantified, 51.0% were revascularized and 7.3% experienced MACE in 12 months of follow-up. Tertile-based analysis failed to demonstrate any stratification of MACE rates (log rank, P = 0.83), when comparing low-to-middle (hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.68-1.78, P = 0.70) or low-to-high adenosine tertiles (HR 0.95, 95% CI 0.56-1.57, P = 0.84). In adjusted analysis, adenosine similarly failed to predict MACE. Finally, adenosine did not predict outcomes in patients with acute coronary syndrome nor in those revascularized or treated medically. Plasma adenosine levels do not predict subsequent CV outcomes or aid in patient risk stratification

A historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies

Background The aim of this study is to describe the major evolutionary historical events among Leishmania, sandflies, and the associated animal reservoirs in detail, in accordance with the geographical evolution of the Earth, which has not been previously discussed on a large scale. Methodology and Principal Findings Leishmania and sandfly classification has always been a controversial matter, and the increasing number of species currently described further complicates this issue. Despite several hypotheses on the origin, evolution, and distribution of Leishmania and sandflies in the Old and New World, no consistent agreement exists regarding dissemination of the actors that play roles in leishmaniasis. For this purpose, we present here three centuries of research on sandflies and Leishmania descriptions, as well as a complete description of Leishmania and sandfly fossils and the emergence date of each Leishmania and sandfly group during different geographical periods, from 550 million years ago until now. We discuss critically the different approaches that were used for Leishmana and sandfly classification and their synonymies, proposing an updated classification for each species of Leishmania and sandfly. We update information on the current distribution and dispersion of different species of Leishmania (53), sandflies (more than 800 at genus or subgenus level), and animal reservoirs in each of the following geographical ecozones: Palearctic, Nearctic, Neotropic, Afrotropical, Oriental, Malagasy, and Australian. We propose an updated list of the potential and proven sandfly vectors for each Leishmania species in the Old and New World. Finally, we address a classical question about digenetic Leishmania evolution: which was the first host, a vertebrate or an invertebrate? Conclusions and Significance We propose an updated view of events that have played important roles in the geographical dispersion of sandflies, in relation to both the Leishmania species they transmit and the animal reservoirs of the parasites

Physics-Based Earthquake Ground Shaking Scenarios in Large Urban Areas

With the ongoing progress of computing power made available not only by large supercomputer facilities but also by relatively common workstations and desktops, physics-based source-to-site 3D numerical simulations of seismic ground motion will likely become the leading and most reliable tool to construct ground shaking scenarios from future earthquakes. This paper aims at providing an overview of recent progress on this subject, by taking advantage of the experience gained during a recent research contract between Politecnico di Milano, Italy, and Munich RE, Germany, with the objective to construct ground shaking scenarios from hypothetical earthquakes in large urban areas worldwide. Within this contract, the SPEED computer code was developed, based on a spectral element formulation enhanced by the Discontinuous Galerkin approach to treat non-conforming meshes. After illustrating the SPEED code, different case studies are overviewed, while the construction of shaking scenarios in the Po river Plain, Italy, is considered in more detail. Referring, in fact, to this case study, the comparison with strong motion records allows one to derive some interesting considerations on the pros and on the present limitations of such approach