Spatial distribution and cluster analysis of a leishmaniasis outbreak in the south-western Madrid region, Spain, September 2009 to April 2013

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Outbreak of cutaneous leishmaniasis in Fuenlabrada, Madrid

BACKGROUND

Leishmaniasis, an endemic infection in Spain, is caused by protozoan parasites of the Leishmania genus. Between 2010 and 2012, there was an outbreak of cutaneous and visceral leishmaniasis in Fuenlabrada, Madrid.

OBJECTIVES

To describe the cases of cutaneous leishmaniasis diagnosed over a 17-month period at the dermatology department of Hospital de Fuenlabrada.

MATERIAL AND METHODS

We analyzed the epidemiological, clinical, histological, and microbiological features of each case and also evaluated the treatments administered and outcomes.

RESULTS

We studied 149 cases. The incidence of cutaneous leishmaniasis showed a peak in the age range between 46 and 60 years and was similar in men and women. At the time of consultation, the lesions had been present for between 2 and 6 months in the majority of patients. The most common clinical presentation was with erythematous plaques and papules without crusts (52% of cases). Lesions were most often located in sun-exposed areas and were multiple in 57% of patients. In 67% of cases, the histological study showed non-necrotizing granulomatous dermatitis with no evidence of parasites using conventional staining methods. Diagnosis was confirmed by polymerase chain reaction (PCR) in 98% of patients. In the remaining cases, the histological study revealed Leishman-Donovan bodies in the skin. Intralesional pentavalent antimonials were the most commonly used drugs (76% of cases) and produced satisfactory results.

CONCLUSIONS

We have presented a large series of cases of cutaneous leishmaniasis diagnosed in the context of an outbreak. Multiple papules were the most common clinical presentation, with histology that showed non-necrotizing granulomatous dermatitis with no evidence of parasites. PCR of skin samples was the test that most frequently provided the diagnosis.

Delayed allergic skin reactions due to intralesional meglumine antimoniate therapy for cutaneous leishmaniasis

BACKGROUND

The pentavalent antimonials are considered the first-choice drugs for treatment of leishmaniasis. Intralesional therapy is used to minimize the systemic effects of the drug.

METHODS

Seventy patients were treated with weekly intralesional infiltrations of Glucantime(®) (meglumine antimoniate) for cutaneous leishmaniasis. Nine of them had infiltrated itchy erythematous and vesiculous plaques at the injection sites. Cutaneous tests were undertaken in eight patients.

RESULTS

Prick tests were negative and seven of the eight patients showed positive intradermal tests with Glucantime(®) dilutions reading at D2 and D4. Only one patient had positive patch test to Glucantime a.i. Local reactions at the site of injection have been briefly mentioned in some reported series of leishmaniasis treated with intralesional or intramuscular meglumine antimoniate but the mechanism has never been explained before.

CONCLUSIONS

We report the first series of patients with local reactions at the injection sites of meglumine antimoniate in whom type IV hypersensitivity could be involved.

Creation, manipulation, and detection of Abelian and non-Abelian anyons in optical lattices

Anyons are particlelike excitations of strongly correlated phases of matter with fractional statistics, characterized by nontrivial changes in the wave function, generalizing Bose and Fermi statistics, when two of them are interchanged. This can be used to perform quantum computations [A. Yu. Kitaev, Ann. Phys. (N.Y.) 303, 2 (2003)]. We show how to simulate the creation and manipulation of Abelian and non-Abelian anyons in topological lattice models using trapped atoms in optical lattices. Our proposal, feasible with present technology, requires an ancilla particle which can undergo single-particle gates, be moved close to each constituent of the lattice and undergo a simple quantum gate, and be detected.

The role of the DNA mismatch repair system in the cytotoxicity of the topoisomerase inhibitors camptothecin and etoposide to human colorectal cancer cells

The DNA mismatch repair (MMR) system is involved in the correction of base/base mismatches and insertion/deletion loops arising during replication. In addition, some of the MMR components participate in recombination and double-strand break repair as well as cell cycle regulation and apoptosis. The inactivation of MMR genes, usually hMSH2 or hMLH1, is associated with human colorectal cancers and is responsible for the characteristic microsatellite instability (MSI)+ phenotype of these tumors. Because MMR is assumed to modulate cytotoxicity to various chemotherapeutic agents that act upon DNA, our objectives have been to define its possible involvement in the cytotoxicity of topoisomerase inhibitors. We have shown that colorectal cancer cell lines defective in DNA MMR exhibit an increased sensitivity to both camptothecin, a topoisomerase I inhibitor, and etoposide, a topoisomerase II inhibitor. Sensitivity to these drugs cannot be predicted by measuring endogenous levels of topoisomerase I and II. Our results also indicate that neither p53 status, nor cell cycle alterations correlate with the sensitivity of colorectal cancer cells to topoisomerase inhibitors. On the other hand, our data showing that resistance to these drugs can be achieved by the functional complementation of hMLH1 in an hMLH1-defective cell line have allowed us to establish that MMR is a critical determinant for chemosensitivity. Interestingly, our observations provide the rationale for the better responsiveness of MSI+ tumors to CPT-11, a camptothecin derivative, which we have observed in patients with metastatic colorectal cancers.

Divergent effects of an alpha2-adrenergic antagonist on lipolysis and thermogenesis: interactions with a beta3-adrenergic agonist in rats

This study was undertaken in order to test the hypothesis that selective beta3-AR stimulation and simultaneous blockade of alpha2-AR would result in an increase of lipolysis and thermogenesis in rats. Incubation of isolated white adipocytes with the alpha2-AR antagonist yohimbine produced a concentration-dependent increase in glycerol release (P<0.001) for all assayed concentrations (10-12-10-6 M) and potentiated the lipolytic effect of the beta3-AR agonist Trecadrine. However, in vivo administration of yohimbine produced a marked decrease in body temperature (1.3-1.5 degrees C, P<0.001) and blocked the thermogenic effect of Trecadrine when simultaneously administered. A similar response was observed for whole body oxygen consumption. Furthermore, yohimbine did not modify brown adipose tissue oxygen consumption, but blocked the beta3-AR-mediated increase triggered by Trecadrine. Brown adipose tissue UCP-2 and -3 mRNA expression was not changed by yohimbine. In conclusion, the present work indicates that in vitro alpha2-AR blockade by yohimbine potentiates the beta3-AR-mediated stimulation of lipolysis. On the other hand, in vivo alpha2-AR antagonism blocks the thermogenic effects mediated by beta3-AR stimulation, suggesting a possible interplay between the receptors.

A new NPY-antagonist strongly stimulates apoptosis and lipolysis on white adipocytes in an obesity model

Neuropeptide Y (NPY) is a 36 amino acid peptide released in central and peripheral mammalian neurons, which appears to contribute to adiposity regulation by increasing food intake, thus promoting weight gain on animals. Nevertheless, little is known about NPY direct actions on white adipocytes. This trial, which was designed to test the possible effects of a new NPY antagonist, S.A.0204, on white adipose tissue, revealed that the administration of this novel molecule strongly ex vivo stimulates apoptosis and lipolysis in animals fed on a high-fat diet.

Interactions between leptin and NPY affecting lipid mobilization in adipose tissue

Lipid turnover and deposition is under the control of developmental, nutritional, metabolic and neuroendocrine influences. The aim of the current investigations was focused on the study of the involvement of leptin and neuropeptide Y in lipid mobilization. The lipolytic rate was assessed through glycerol release after incubation with leptin and NPY at concentrations ranging from 10(-6) to 10(-12) M in isolated adipocytes obtained from female rats. The presence of leptin at concentrations of 10(-12) to 10(-7) M in the incubation medium of isolated fat cells significantly increased (p < 0.0001) glycerol release, except at the concentration of 10(-11) M, where the increase was (p < 0.01) as compared to the basal lipolytic activity. On the other hand, isolated fat cells of Wistar rats bathed in 10(-10) to 10(-6) M concentrations of NPY demonstrated a statistically significant decrease (p < 0.0001) in glycerol release. At equimolar concentrations of leptin and NPY (10(-12) to 10(-6) M) the observed lipolytic activity is comparable to the basal lipolytic activity, except at a concentration of 10(-9) M where upon a significant increase in lipolysis is observed. A further increase in the equimolar concentrations, beyond 10(-9) M results in a return to the basal lipolytic activity. Summing up, new evidence suggests that NPY and leptin may interact in a homeostatic loop to regulate body-fat mass and energy balance not only at the central nervous system level, but also directly at the adipocyte level.

A prospective randomized trial of granulocyte colony-stimulating factor therapy after autologous blood stem cell transplantation in adults

In order to assess the potential clinical benefit of filgrastim (G-CSF) after peripheral blood stem cell (PBSC) autotransplantation a randomized study was begun in our center in July 1997: 62 patients were involved (30 received filgrastim after PBSC infusion and 32, the control group, received no cytokines). All were adults (median 40 years, range 18-65). Patients with one of three different pathologies were recruited: 28 had advanced breast carcinoma, 23 had lymphomas (12 Hodgkin's disease and 11 non-Hodgkin's lymphoma) and 11 had de novo AML. All of them were transplanted using myeloablative chemotherapy conditioning regimens. G-CSF was administered subcutaneously from day +5 in the treated group at a dose of 5 microg/kg body weight/day. The numbers of CD34+ and mononuclear (MNC) cells infused were similar in each group. Only minor differences regarding the use of G-CSF could be inferred from the analysis of the data. Faster granulocyte engraftment was evident in the treated group (mean of 10 vs 12 days to achieve >0.5 x 109/l granulocytes, P = 0.0008), without differences in incidence and severity of infections, days of fever or duration of antibiotic treatment between groups. There was slightly slower platelet engraftment (mean of 15 days in the group with G-CSF vs 12 days in the other group to achieve >20 x 109/l platelets, P = NS) in this series, but there were no differences in incidence and severity of haemorrhage or platelet transfusion support. Considering the economical costs, the median expenditure per inpatient stay was Eur5961 (range Eur4386-Eur17186) in the G-CSF group compared with Eur5751 (range Eur3676-Eur15640) in the control group (P = 0.47). From our data it could be concluded that for adult patients transplanted with PBSC there is no clear beneficial impact of post-infusion G-CSF administration.

Lipolytic effect of in vivo leptin administration on adipocytes of lean and ob/ob mice, but not db/db mice

The present study has examined the effect of a single in vivo intraperitoneal injection of the adipocyte-derived hormone, leptin, on the in vitro lipolysis of fat cells of different types of mice. Administration of 1 and 10 mg leptin per kg body weight to ob/ob mice significantly increased (P < 0.0001) the basal lipolytic activity compared to ob/ob mice receiving vehicle solution (phosphate-buffered saline, PBS). The highest leptin dose tested (10 mg/kg body weight) produced a threefold increase in basal lipolysis. In lean mice administration of 10 mg leptin per kilogram of body weight produced an increase in basal lipolysis of 52.7% (P < 0.01). However, in db/db mice none of the three leptin doses injected had a significant effect on the lipolytic activity of adipocytes relative to basal lipolysis observed in db/db mice injected with PBS only. These data provide evidence for a lipolytic effect of leptin on white adipose tissue, which operates independently from changes in food intake, body weight, and the size of the fat stores.

Leptin gene transfer into muscle increases lipolysis and oxygen consumption in white fat tissue in ob/ob mice

The effects of leptin production in ob/ob mice injected with a plasmid expression vector containing mouse leptin cDNA in the tibialis anterior muscle were investigated. A significant reduction in food intake (-18%, p < 0.01) along the experimental period was found after DNA injection, while differences in body weight gain were only significant (-41%, p < 0.05) when determined between days 2.9 of the study. Concerning adipocytes metabolism, there was a significant increase in oxygen consumption in vitro (+34%, p < 0.05) and in basal lipolysis (+151%, p < 0.05) in DNA-injected mice compared to PBS-injected animals. Our results confirm that functional leptin can be produced in muscle and released into the blood stream and give new support to the fact that leptin may have direct auto- or paracrine effects on adipocytes, possible contributing to the weight- and fat-reducing effects of leptin in ob/ob mice.

In vitro lipolytic effect of leptin on mouse adipocytes: evidence for a possible autocrine/paracrine role of leptin

The present study has examined the effects of the adipocyte-derived hormone, leptin, on lipolysis in fat cells of different types of mice. Exposure to leptin (1.25.10(-6) M to 1.25.10(-12) M) increased (P < 0.01) the lipolytic activity of fat cells obtained from lean mice. A greater stimulation was observed when adipocytes from ob/ob mice were examined. Throughout the concentrations tested, the leptin-induced lipolysis observed in fat cells of lean animals was smaller than that obtained in ob/ob mice. The maximal lipolytic effect in obese animals was observed with 10(-8) M of OB protein. The lipolytic activity following the addition of 1.25.10(-10) M to 1.25.10(-6) M was significantly increased (P < 0.01) in ob/ob mice compared to lean animals. Adipocytes from ob/ob mice responded in a dose-dependent manner to the OB protein, while the leptin-induced lipolysis observed in lean animals was dose-independent. In contrast to lean and ob/ob mice, leptin did not stimulate lipolysis in adipocytes from db/db mice, which have a mutation in the leptin receptor gene. These in vitro studies suggest an autocrine/paracrine action of leptin on white fat cells and envisages the involvement of the OB protein, not only in centrally mediated pathways, but also in physiological functions which take place peripherally.

[The content of the nursing consultation at a health center]

AIMS

To describe the care process in the Nursing Station. To analyse the length of a consultation and factors which affect the length.

DESIGN

Crossover study. Analysis of the length of the Consultation, using a multiple lineal regression model. SITE. Urban Health Centre. PATIENTS AND OTHERS TAKING PART: All the calls and consultations, both in the patient's home and in the Health Centre, undertaken by six nurses over a period of two weeks.

MAIN MEASUREMENTS AND RESULTS

There were 879 consultations. 65.41% of them took place in the treatment room. Ten health problems represented 72% of the work-load. Health education took un the greatest proportion of time. The average time of a consultation was of 10.40 +/- 0.3 minutes. The length of the consultation depended on the professional involved, on the place where it took place, on the number of problems which the patient had and on the nature of the main problem: multiple correlation coefficient = 0.74; F = 67.52 (p < 0.00000001).

CONCLUSIONS

The nurse faces a very limited number of health problems. Most of her activities are preventive or to do with prevention. The length of the Consultation in greatly conditioned by the amount of morbidity.

Non-Hodgkin's lymphoma after prolonged remission of Hodgkin's disease in an HIV-infected patient

Hodgkin's disease was diagnosed in a 22-year-old HIV-seropositive man in 1986. Alternate MOPP/ABVD chemotherapy induced a clinical remission. He was asymptomatic until 3 years later when fever and peripheral and mediastinal lymphadenopathy appeared. Lymph node biopsy showed a large-cell anaplastic lymphoma and EBV genome was identified in the malignant cells, suggesting that transformation might had been induced by EBV. The present case affirms that in patients with HIV-related lymphomas who present enlarging lymphadenopathy after stable remission, the development of lymphomas of higher malignancy needs to be ruled out.

Human marrow stromal cells in culture: changes induced by T-lymphocytes

Suspension cultures of human bone marrow mononuclear cells form colonies of fibroblastoid cells which expand to form confluent monolayers. These fibroblastoid cells are thought to represent elements of the bone marrow stroma. Fibroblastoid cells failed to proliferate when the cultures were initiated and maintained in the presence of 50% (v/v) of medium conditioned by phytohaemagglutinin (PHA)-stimulated blood mononuclear cells or supernatant media from one-way mixed lymphocyte reactions (MLR). Under these conditions, the cultures contained a pleomorphic population of macrophage-like cells. Some of the characteristics of the fibroblastoid and macrophage-like cells have been compared and a separate origin of the two cell types has been demonstrated. Further experiments indicated that T lymphocytes were the source of the factor(s) in the conditioned media which was responsible for the growth of the macrophage-like cells at the expense of the fibroblastoid cells and suggested that activation of the T cells was necessary for them to exert their effect. The results support the idea that T lymphocytes can influence the haemopoietic microenvironment of the bone marrow.

The enhancement of haemopoietic stem cell recovery in irradiated mice by prior treatment with cyclophosphamide

Studies are reported of the enhancement of stem cell recovery following whole body irradiation as a result of prior administration of cyclophosphamide. It is shown that the much larger enhancement of regeneration observed for the hosts own surviving stem cells, compared to the regeneration of injected bone marrow stem cells, is due to the different numbers of stem cells initiating the regeneration in conjunction with the time course of stem cell regeneration. The results show that the environmental changes produced by cyclophosphmide greatly enhance haemopoietic recovery even though at the dose used this agent is relatively toxic to stem cells. Furthermore it has been shown that the level of stem cell regeneration is nearly independent of the gamma-ray dose in the range 3-8 gray (300-800 rad). If human bone marrow should respond similarly it follows that regeneration produced by cytotoxic drugs administered prior to radiation embodies a considerable safety factor as far as recovery of the haemopoietic system is concerned.

Simultaneous assay by six methods of the effect on haemopoietic precursor cells of adriamycin, methyl CCNU, 60Co gamma-rays, vinblastine, and cytosine arabinoside

The spleen colony assay, three agar colony assays and two repopulating assays have been employed to measure the effect of single doses of adriamycin, methyl CCNU, 60CO gamma-rays, vinblastine and repeated injection of cytosine arabinoside on early haemopoietic precursors. The results show that there is no consistent correlation between the effect of these agents on the six assays, and the differences in proliferation rate of the cells contributing to the various assays could not be demonstrated by the phase specific agents vinblastine and cytosine arabinoside. The relatively high survival of granulocyte repopulating ability after adriamycin and methyl CCNU indicates that the capacity for differentiation and maturation can be influenced by cytotoxic agents so that colony assays while estimating the number of progenitor cells surviving do not necessarily provide a reliable guide to the capacity of the cells for restoring haemopoiesis. Comparison of colony formation by normal bone marrow cells with the three agar colony assays showed that the agar diffusion chamber method gave three times as many colonies and a much smaller variation between experiments compared to the in vitro agar assay with endotoxin mouse serum as colony stimulating factor. The thin layer feeder cell method gave an intermediate number of colonies.