Miracle-dz/UniFAR-FTUs huggingface dataset:
Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany

The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is increasing globally, also in Germany, although the cases are imported and still low in number. The current evidence for the different therapies has many limitations due to lack of sufficient studies on the different Leishmania species with differing virulence. So far there is no international gold standard for the optimal management. The aim of the German joint working group on Leishmaniasis, formed by the societies of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology (DDG), was to establish a guideline for the diagnosis and treatment of CL and MCL in Germany, based on evidence (Medline search yielded 400 articles) and, where lacking, on consensus of the experts. As the clinical features do not necessarily reflect the involved Leishmania species and, as different parasite species and even geographically distinct strains of the same species may require different treatments or varying dosages or durations of therapy, the guidelines suggest for Germany to identify the underlying parasite prior to treatment. Because of relevant differences in prognosis and ensuing therapy species should be identified in i) New World CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subgenus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic algorithm is presented. For recommendations on localized and systemic drug treatment and physical procedures, data from the accessible literature were adjusted according to the involved parasite species and a clinical differentiation into uncomplicated or complex lesions. Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3 infected lesions, infections in functionally or cosmetically critical areas such as face or hands, presence of lymphangitis), ii) lesions refractory to therapy, iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with L. major it encompasses miltefosine, fluconazole and ketoconazole, while antimony or allopurinol were here considered second choice. Local therapy was considered appropriate for i) uncomplicated lesions of OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with L. major it encompasses perilesional antimony, combined with cryotherapy, paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy. The group also stated that there is an urgent need for improving the design and the way of publishing of clinical trials in leishmaniasis.
Congenital syphilis re‐emerging

Worldwide, of the 12 million people infected with syphilis every year, two million are pregnant women. An estimated 50 % of these pregnancies will end in fetal or perinatal death, low birth weight babies or babies born with congenital syphilis. The World Health Organization is developing control strategies for the developing world. Cases of congenital syphilis are costly to health care systems but can be prevented through antenatal screening and treatment. The evolving European syphilis epidemic has resulted in an increased incidence of infection in reproductive age women and the emergence of cases of congenital syphilis. This reflects a failure of prenatal care delivery systems as well as syphilis control programs.
Smart meters and public acceptance: comparative analysis and governance implications

Although smart meters for electricity have received widespread acclaim as a means to achieve more resilient and sustainable electricity consumption, public opposition has emerged in several countries. In this article, I examine the reasons for public opposition in North America and the role of concern with health risks. The article provides an analysis of reasons given for opposing smart meters by 75 US and Canadian organisations listed in the 2013 EMF (electromagnetic field) Safety Network, a review of all news reports (499) in the Lexis-Nexis database relating to smart meters in seven US states and one Canadian province from 2010 to 2013 and case studies of policy responses in the same seven states and province. Thirty-one of the organisations in the EMF network focused mainly on health concerns about EMFs, and 44 organisations identified broader concerns as well as health risks. The more politically conservative groups focused on issues relating to privacy and government intrusion. Newspaper reports also identified health risks, although they also identified issues relating to cost overruns and privacy. The study of newspaper reporting in the seven US states and one Canadian province indicated that relevant agencies had responded to public concerns by developing opt-out provisions for meter installation, in some cases after protracted public campaigns. I consider possible patterns of opposition for future investigation: opposition may be higher where the roll-out of smart meters is rapid and without an opt-out provision; technological differences (for example, wired versus wireless) may contribute to levels of public opposition; and challengers to incumbent parties of either the right or left may also contribute to public opposition. In the ‘Conclusion’ section, I compare two policy strategies, one of which views public opposition as a lack of good communication from utilities, and the other which views it as an opportunity for innovation in systems design and improvements in governance policies.
Body Integrity Identity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethically Justified?

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.
Justice and the Reversal of the Healthcare Worker ‘Brain-Drain’

Statistics such as “Uganda has only 86 pediatricians for its 15 million children under the age of 15” years and “[Uganda has] only one doctor for about 24,000 people—one of the biggest patient/doctor ratios in the world” are all too common when analyzing the healthcare worker ‘brain drain’ in sub-Saharan Africa (Mwesigye 2008). The ‘brain drain’ is hardly a new phenomenon and has been documented back to the 1960s when mainly high-income countries experienced health worker emigration to other high-income countries, partly due to a perception at the time that medical graduates from low-income countries were inferior to those in more developed countries (Wright et al. 2008). The emphasis towards foreign-born and trained health workers as cost-effective resources evolved as high-income countries needed more health workers, thus contributing to the present where in Africa 3% of the world’s health workers confront 24% of the global disease burden with 1% of global health financing (World Health Organization 2006). As failures of the duties of beneficence and nonmaleficence, Snyder (2009) argues that by encouraging migration of health workers from lower-income countries destination communities (DC) can be charged with moral wrongs in part by undermining local health infrastructure in source communities (SC). I discuss ways in which DCs and SCs can minimize incentives for healthcare worker emigration while encouraging social responsibility in both by highlighting current policy and activism efforts that seek to reverse the ‘brain-drain’ through infrastructure and capacity-building in sub-Saharan Africa. In doing so, I consider the justice rationale behind these initiatives and discuss how migrant health worker agency can be positively shaped by DCs and SCs. If health is a human right, then by extension access to an adequate healthcare infrastructure, including an adequate healthcare worker force, is a requisite state obligation nested with individual responsibilities contributing to one’s health. In a global ‘brain drain’ that works counter to requisite components of health, we must define stakeholders and responsible parties implicated. At the SC level, health workers and their national governments shoulder some responsibility. Migrating health workers could be
Challenging assumptions about risk factors and the role of screening for violence risk in the field of mental health

Research demonstrates that mental illness is not a major cause of violence yet assumptions about a link and concern about the risks posed by mentally disordered people has resulted in the predominance of a public safety role for mental health services (Munro and Rumgay 2000). In consequence, screening, classifying and monitoring individuals considered to pose a potential risk to others due to their potential for violence has become a key responsibility. The purpose of healthcare screening is to identify a disease or condition, or its associated risk factors, to provide treatment or encourage preventative action on the part of ‘at risk’ individuals. Mental health screening differs since neither a disease entity nor a causal model to link mental disorder and violence exist (Leitner et al. 2006). Mental health service users are typically marginalised and screening may occur without their consent, knowledge or involvement. They may also disagree that they have the condition in question, i.e. a propensity to violence. The expectation upon professionals to promote service user involvement in care and treatment sits uneasily with these processes. This paper reviews the ongoing but unsuccessful efforts to develop effective screening for violence amongst people defined as mentally disordered and explores the implications for mental health services in the light of this evidence. It also considers the continuing lack of service user involvement in risk assessment. First however, the paper considers correlates for violence since screening depends for its efficacy upon risk factors thought to be positively associated with the condition of concern.
Research in practice: IL‐22 and IL‐20: significance for epithelial homeostasis and psoriasis pathogenesis

Psoriasis vulgaris is a frequent, chronically relapsing, immune‐mediated, systemic disease with characteristic skin changes. Despite the importance of this disease there are currently limited therapeutic options indicating a need for effective, long‐lasting treatment strategies with few side effects. The most recent discoveries regarding psoriasis pathogenesis, particularly our results regarding two cytokines – IL‐22 and IL‐20 – could prove to be the foundation for such therapies. Whereas IL‐22 is mainly produced by activated T‐cell sub‐populations (Th22, Th1, Th17), monocytes, dendritic cells and keratinocytes produce IL‐20. Blood and lesional skin samples from psoriasis patients demonstrate high levels of IL‐22 and IL‐20. Interestingly, both cytokines act principally on keratinocytes and do not impact the immune system. Similar to the changes in the psoriasis epidermis these cytokines inhibit the terminal differentiation of keratinocytes although they simultaneously increase their innate defense, mobility, and the production of some chemokines. Some IL‐22 effects are amplified by TNF‐α, IL‐17, and IFN‐α. IL‐22/IL‐20 lends the reconstructed epidermis a psoriasis‐like appearance with acanthosis, hypogranularity, and hyperkeratosis. In addition, mice that constitutively express high levels of IL‐22 or IL‐20 demonstrate a psoriasis‐like appearance. A therapy counteracting IL‐22 and IL‐20 would be an innovative treatment with the potential for few side effects that would act on the final phase of psoriasis pathogenesis.
Performance of Children with Cochlear Implants, Tactile Aids, and Hearing Aids

This investigation c o m p a r ed the speech perception skills of children with prelingual profound deafness who used the multichannel Tactaid 7 (TA7) (n = 9) to those of a matched group of children who used the Nucleus 22-channel cochlear implant (CI) (n = 10) at a predevice inter val, and after an average of 1.8 years of mul tichannel device use. Performance was assessed with closed-set m e a s u r es of phoneme and word recognition, and on an open-set test of phrase recognition. Several measures evaluated perception with cues from the device a l o n e; o ne m e a s u re assessed device-plus-lipreading perfor mance. The results demonstrated that the CI group's performance improved signifi cantly between the pre-and postdevice intervals on all measures. The scores of the TA7 users showed little c h a n ge with increased device use, except on the mea sure of closed-set word recognition and the m e a s u re of s e n t e n ce p e r c e p t i on with lipreading, on which small improvements were observed. As a result, the scores of the CI group were significantly higher than those of the TA7 group on all measures at the postdevice interval. The speech percep tion abilities of the CI and the TA7 groups at the postdevice interval were next com pared to that of matched children with prelingual deafness who used conventional hearing aids (HA). Hearing aid subjects were grouped by unaided thresholds: Gold subjects (PTA = 94 dB HL) and Silver sub jects (PTA = 103 dB HL). The performance of the Tactaid 7 group was significantly poorer than that of the Gold HA subjects on all measures, and poorer than that of the Silver HA subjects on open-set sentence recognition in the auditory-only modality. In contrast, there were no significant differ ences between the performance of the CI group and the two HA groups. The current results suggest that c h i l d r en with CIs learned to recognize words and understand speech without lipreading, and that their speech perception abilities approach that of children with profound hearing impair ment who obtain some benefit from con ventional amplification. However, children with the TA7 demonstrated only limited speech understanding, even when auditory cues were combined with speechreading.
Effects of Human GH on Lipid Metabolism in Hypophysectomized Mature Rats (II)

Replacement therapy with GH in GH deficiency (GHD) has proved to be effective in stimulating growth in childhood. And GHD has not been treated either in GHD children once they have reached adulthood or in patients with adult-onset hypopituitarism, but it has been found by various research groups that many symptoms such as abnormalities in body composition and lipid metabolic derangements are associated with GHD in adults (1). Furthermore, there is evidence that untreated adult GHD patients have increased risk of premature death from cardiovascular diseases (2). Many studies performed in GHD adults suggest that these patients benefit from GH replacement therapy (1, 3). Most, if not all, of the abnormalities can be corrected by GH substitution, showing that GH plays an essential role throughout life. Recently, in order to acquire supporting data that confirm the efficacy of GH replacement therapy in adult GHD patients, we demonstrated that efficacy of replacement therapy with recombinant human growth hormone (rhGH) alone in hypophysectomized (HPX) mature rats (4), but some adult GHD patients lack not only GH but
Activin A immunoexpression as predictor of occult lymph node metastasis and overall survival in oral tongue squamous cell carcinoma

The presence of regional lymph node metastasis has an important impact on clinical management and prognostication of patients with oral tongue squamous cell carcinoma (SCC). Approximately 30% to 50% of patients with oral tongue SCC have regional metastasis at diagnosis, but the limited sensibility of the current diagnostic methods used for neck staging does not allow detection of all cases, leaving a significant number of undiagnosed metastasis (occult lymph node metastasis). In this study, we evaluated whether clinicopathologic features and immunohistochemical detection of carcinoma‐associated fibroblasts (CAFs) and activin A could be predictive markers for occult lymph node metastasis in oral tongue SCC.
Educating Young People about Mental Health and Mental Illness: Evaluating a School - Based Programme

Reducing the stigma of mental illness, increasing knowledge about mental health and improving help-seeking for mental health problems are essential areas of change targeted by mental health promotion interventions. A school-based programme aimed specifically at these areas is the Mental Illness Education programme, where people who have experience of mental illness give an interactive presentation to high school class groups. This article reports an evaluation of the Mental Illness Education programme (MIE) as implemented in the Australian Capital Territory (ACT). Using a case control design, 457 high school students were tested by self-report questionnaire before and after participation in the MIE-ACT programme. The results showed that the programme had a strong impact on increasing knowledge and a moderate impact on reducing stigma, but a weak impact on changing help-seeking intentions. Overall, the evaluation of the programme was positive, although areas of continuing challenge are identified.
HIV protease inhibitors: Present and future

Antiretroviral therapy offers many options, largely based on the next-generation protease inhibitors (PIs). Early PI-based treatments involve high pill burdens and dosing schedules, and concerns of long-term toxicities are well established. In patients who have already achieved viral suppression, novel agents and strategies should be used to simplify the dosing treatment, reduce adverse events or preserve drug options. In experienced patients, drug escalation between PIs and different associations between classes allow virological suppression to be reached in the majority of patients. Therefore, there is a persistent clinical need for the discovery and development of new protease inhibitors. Several firms are trying to develop new types of PIs that will not be cross-resistant with existing drugs and will not require ritonavir boosting. This article aims to offer an overview on present drug options recommended for treatment in naive and experienced patients, new strategies currently undergoing clinical eva.
Experience With Hemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome at a Single Institution

Background Hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS) is a serious and potentially life threatening histiocytic disorder in children and adults. The most commonly used protocol-based therapy includes corticosteroids, cyclosporine-A, and etoposide. However, patients are often started on corticosteroid alone with or without the addition of intravenous γ-globulin. The role of the various therapies in HLH/MAS remains undefined. Objective To identify patient-related factors that led to the use of full protocol therapy (HLH 1994/2004) and to determine treatment-related factors that were associated with adverse outcome including relapse and death. Design/Methods Patients who were diagnosed with HLH/MAS between January 1998 and December 2005 were included in this study. Results Thirty-eight patients had a median age of 9.1 years at diagnosis. Underlying diagnoses were: viral/other 42%; rheumatologic 37%; and malignancy 21%. Initial treatment included corticosteroids 29%; intravenous immunoglobulin (IVIG) 18%; steroids+IVIG 8%; cyclosporine 5%; etoposide 5%; HLH protocol 32%. Etoposide was eventually used in 21% (3/14) of rheumatology and 75% (18/25) viral/other patients. In all, 5/14 (36%) rheumatology and 12/16 (75%) viral/other patients required intensive care unit admission, and 1/14 (7.1%) rheumatology, and 6/16 (38%) viral/other patients died. Three children received a bone marrow transplant. Eleven of 38 (29%) patients died, despite 8 having received etoposide therapy. Three deaths were secondary to underlying malignancy and one from transplant-related complication for malignancy. Conclusions Patients with HLH are at high risk for death early in their disease course. However, corticosteroids and/or IVIG may be sufficient as first-line therapy for patients with underlying rheumatologic disease who present with HLH/MAS. Further prospective studies are required to more precisely define early risk factors for poor outcomes in this often fatal disease.
Perceptions of the Role of Cancer Patients' Companions During Medical Appointments

ABSTRACT To determine the perceptions of the role of cancer patients' companions in medical encounters with oncologists, semi-structured telephone interviews were conducted with 18 patients and 17 companions. Companions (most often a spouse) attended a medical encounter to provide support and companionship, increase patients* understanding, ask questions, and furnish transportation. Companions viewed themselves as more active than the patients perceived them to be. Patients perceived that the presence of a companion during an appointment resulted in little change in the content of the meeting. The authors concluded that the companion's presence during a medical encounter was important and satisfying to both patients and their companions.
Differentiated Normalization and Drug Transitions among Rural Youth in Ireland.

Prevalence surveys in Ireland indicate an increased trend of youth drug use with rural areas reporting comparable drug availability and prevalence of use in urban settings (Currie, C., Nic Gabhainn, S., Godeau, E., Roberts, C., Smith, R., & Currie, D. (Eds.). (2008). Inequalities in young people's health: HBSC international report from the 2005/2006 survey. Copenhagen: WHO Regional Office for Europe). Few studies have explored the contexts and meaning of drug use on rural youth transitions in terms of increased drug prevalence, recent influx of rural drug activity, normative tolerance of recreational drug consumption and fragmentation of traditional rural communities. Qualitative interviews were conducted with 220 young people (15–17 years), and 78 service providers in a rural area of Ireland, in order to yield contextualized narratives of their experiences of drug use and achieve a wider exploration of processes, drug transitions and realities of rural youth. The thematic analysis of the research described varied pathways, attitudes and typologies of rural youth drug use, ranging from abstinent, recreational and moderated to maturing out. The research suggests support for a ‘differentiated’ normalization theory (Shildrick, T. (2002). Young people, illicit drug use and the question of normalisation theory. Journal of Youth Studies, 5, 35–48) in terms of consumerist and normative rural youth drug use transitions in their negotiation of risk within integrating rural and urban dichotomies. In conclusion, it is recommended that drug education programmes need to situate localized rural drug taking behaviours within a wider understanding of rural community life.