In Serbia, in most cases, small family outbreaks of trichinellosis occur due to the consumption of untested infected meat from domestic pigs that are raised and slaughtered in the backyards of small individual farms. The aim of this study is to present data regarding 24 patients involved in two outbreaks that occurred in two neighbouring districts in Serbia during a closely related period of time in August 2014. The source of infection in the first outbreak was undercooked pork, while raw pork sausages caused the second outbreak. Meat samples and sausages were Trichinella spp. positive by artificial digestion. With the aim to obtain a second opinion and validate the serological findings discovered at the Public Health Institute Nis, all samples were sent to the National Reference Laboratory for Trichinellosis, INEP. Serodiagnosis showed that 21 persons were positive (87.5%) and three (12.5%) were negative for anti-Trichinella antibodies, while 15 patients fulfilled the trichinellosis case definition. Western blot analysis (using an epitope unique for the muscle larvae stage of the Trichinella genus) confirmed the diagnosis of trichinellosis in five patients. Six patients also had specific antibodies against Toxocara canis (T. canis). Due to the fact that in endemic foci in Serbia there is the presence of Trichinella spiralis and T. canis and that these two infections could be asymptomatic, we consider that trichinellosis cases were irrefutably proven. The dilemma about the existence of co-infection with T. canis remained open due to the lack of clinical findings.

Trichinellosis in humans is most often caused by the parasite Trichinella spiralis. The clinical course of the disease is diverse and the symptoms can vary from mild to severe. Symptoms usually disappear within a few months, but encysted larvae in the muscles can cause myalgia and weakness that last for years. However, the existence of chronic trichinellosis as a disease is still debatable. This study presents the results obtained at the National Reference Laboratory for Trichinellosis – INEP, Serbia. The study was conducted to assess the immunoserological, biochemical and symptomatic disease parameters of twelve patients who acquired trichinellosis 13 and 18 years ago, respectively. They were involved in two T. spiralis outbreaks in Serbia, at the village of Kumane and the city of Belgrade (nine and three patients, respectively). Results indicated the presence of specific anti-Trichinella antibodies in 83% of the total number of patients. However, while the humoral immune response to Trichinella lasted for more than a decade reaching almost two decades after the acute infection phase (7/9 and 3/3 respectively, in two outbreaks), persistence of chronic muscular pain, as the most prolonged symptom of trichinellosis, could be found in the majority of patients from the Kumane outbreak (7/9). As a consequence, these patients suffered from limitations in daily living activities for the same period of time. The results presented in this paper are our contribution to the view that trichinellosis as a chronic disease with symptoms exists and may be related to the severity of the disease in the acute phase.

Anorexia mentalis represents mental disorder followed by physical breakdown. We are talking about anorexia when it comes to the weight loss 20%-25%.

The disorder is caused by psycho-social factors.

The treatment includes the team of doctors coordinated by psychiatrist, internist, gynecologist, radiologist, nutritionist and psychologist.

The procedure of treatment begins with:

1. the assessment of mobility: in hospital, dispensary, or in combined treatment (the shorter treatment in hospital the better, with necessary achievement of physical balance, and afterwards obligatory treatment in dispensary)

2. in dispensary it is done:

A. by using therapy-in two tracks-we follow the input (highly energetic products and meals) and the curve of weight growth, i.e. simultaneous physical and mental state.

B. By using pharmaco-therapy (neuroleptics, antidepressants)

C. Psychoterapy(individual, family, behavioral, psychodynamical)

The treatment is done stage by stage and pervading, with individual corrections made by therapist, according to the specificity of particular patient.

From January to the beginning of May, 6 female patients aged 14-18 have been treated.

The impaired glucocorticoid receptor (GR) signaling has long been considered one of cornerstones in understanding the pathophysiology of depression. Phosphorylation of GR is very important for GR function, therefore we investigated: a) whether GR phosphorylation at serine 211 (pGR-S211) and serine 226 (pGR-S226) is altered in patients with episode of major depressive disorder (MDD); b) if neuroticism and negative affective states may be associated with altered GR phosphoisophorms of healthy adults. Phosphorylation at these sites is generally considered to be indicative of receptor activity. We studied leucocytes of :

1. a) 30 MDD patients and 35 controls, and

2. b) 37 healthy subjects, to assess the levels of nuclear total GR (tGR), pGR-S211 and pGR-S226 using Western blot technique.

Our results demonstrated increased phosphorylation of GR at S226 and, to a less extent, at S211 in MDD compared to controls. Also, pGR-S226 positively correlated with neuroticism and self report of stress in healthy. In MDD, the pGRS211/ pGR-S226 ratio was decreased (p < 0.05) implying reduced transcriptional activity of GR in patients. In healthy, pGRS211/ pGR-S226 was negatively correlated with self-repored subclinical depression. MDD had higher cortisol levels than others and cortisol concentrations positively correlated with S226 levels from the same blood samples.

We examined whether easily accessible peripheral markers of GR activity and disease status in depression exist. Although we examined leucocytes, we propose that reduced GR transcriptional activity could be one of mechanisms of impaired GR function in the brain, resulting in dysfunction of HPA axis observed as a risk for depression.