Cutaneous leishmaniasis in refugees from Syria: complex cases in Berlin 2015–2020

Abstract Background The Syrian conflict has led to a dramatic increase of Old World cutaneous leishmaniasis (CL), triggered by continuous population displacements, disrupted control programmes, poor shelter and sanitation. Methods A retrospective patient record study was conducted at the Institute of Tropical Medicine and International Health in Berlin. Records of all refugees from Syria treated for CL between January 2015 and March 2020 were reviewed. Results Twenty refugees from Syria were treated. Seventeen refugees (85%) had complex lesions, mainly due to previous therapy failure or localization on the face. A long disease duration (50% > 1 year), pronounced facial scarring (20%), recurrences (20%), or worsening of existing lesions (20%) were observed. Nine patients (45%) had been pretreated in Syria. Complete remission was achieved in 10 of 16 patients (63%) treated with perilesional antimony. Eight patients (40%) required systemic treatment, thereof four (20%) repeated systemic treatment. Eight patients (40%) reported a delay of therapy ≥3 months in Germany, thereof one patient with a delay of 12 months and one patient with a delay of 32 months. Conclusion Between 2015 and 2020, Syrian refugees presented with severe morbidities of CL frequently requiring systemic and even consecutive systemic treatments. We assume a combination of socioeconomic and environmental factors associated with the ongoing Syrian conflict and migration to be responsible for the complex clinical presentations in this case series. More attention should be drawn to the situation of Syrian refugees with CL in countries where they are displaced to.

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Between Hospitality and Hostility: Public Attitudes and State Policies Toward Syrian Refugees in Turkey

NATO Science for Peace and Security Series – E: Human and Societal Dynamics - From Territorial Defeat to Global ISIS: Lessons Learned ◽

10.3233/nhsdp200084 ◽

2021 ◽

Author(s):

Sefa Secen ◽

Mustafa Gurbuz

Keyword(s):

Public Attitudes ◽

State Policies ◽

Early Years ◽

Syrian Refugees ◽

Active Engagement ◽

The European Union ◽

The Public ◽

Syrian Civil War ◽

The Face ◽

Syrian Conflict

This article provides an overview of the public attitudes and state policies toward Syrian refugees in Turkey between 2011 and 2020. Turkey’s policies toward refugees and the Syrian conflict have gradually changed over the course of the last nine years (2011–2020). Turkey’s legal approach to Syrian refugees has transformed from nonrecognition to recognition and from recognition to integration. Likewise, its military strategy has grown from one of limited engagement into one of active engagement in the face of ISIS attacks and YPG’s consolidation of power in northern Syria. Contrary to the generous policies adopted toward Syrian refugees during the early years of the Syrian civil war, a nativist turn and the weaponization of refugees against the European Union came to characterize the country’s approach in recent years as the country became more involved militarily in the Syrian conflict.

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Systemic Treatment in Advanced Phyllodes Tumor of the Breast: A Multi-institutional European Retrospective Case-series Analyses

10.21203/rs.3.rs-919256/v1 ◽

2021 ◽

Author(s):

Elena Palassini ◽

Olivier Mir ◽

Giovanni Grignani ◽

Bruno Vincenzi ◽

Hanneke Gelderblom ◽

...

Keyword(s):

Kinase Inhibitors ◽

Systemic Treatment ◽

Case Series ◽

Phyllodes Tumor ◽

Median Number ◽

Advanced Breast ◽

High Rate ◽

High Dose ◽

Retrospective Case ◽

Systemic Treatments

Abstract Background: We aimed at investigating outcome of systemic treatments in advanced breast PT. Methods: All cases of advanced breast PT treated with systemic treatments from 1999 to 2019, in one of the referral sarcoma centres involved in the study, were retrospectively reviewed. Results: 56 female patients were identified. Median age was 52 (range 25-76) years. Patients re-ceived a median number of 2 systemic treatments (range 1-4). Best responses according to RECIST were: 1 (3.7%) CR, 11 (40.7%) PR, 6 (22.2%) SD, 9 (33.3%) PD with anthracyclines plus ifosfamide (AI); 2 (16.7%) PR, 4 (33.3%) SD, 6 (50.0%) PD with anthracycline alone; 3 (18.8%) PR, 4 (25.0%) SD, 9 (56.3%) PD with high-dose ifosfamide given as a continuous infusion (HD-IFX); 3 (20.0%) SD, 12 (80.0%) PD with a gemcitabine-based regimen (with 2 patients not evaluable); 1 (8.3%) PR, 2 (16.7%) SD, 9 (75.0%) PD with trabectedin (with 1 patient not evaluable); 1 (16.7%) PR, 1 (16.7%) SD, 4 (66.7%) PD with tyrosine-kinase inhibitors (TKI). The median PFS were: 5.7 (IQR, 2.5-9.1) months with AI; 3.2 (IQR, 2.2-5.0) months with anthracycline alone; 3.4 (IQR, 1.4-6.7) months with HD-IFX; 2.1 (IQR, 1.4-5.2) months with gemcitabine-based chemotherapy; 1.8 (IQR, 0.7-6.6) months with trabectedin; 3.4 (IQR, 3.1-3.8) months with TKI. With a median follow-up of 35.3 (IQR, 17.6-66.9) months, OS from the start of first-line systemic treatment was 15.2 (IQR, 7.6-39.6) months. Conclusion: In this series of advanced PT (to our knowledge, the largest reported so far), AI was associated with a high rate of responses, however with a median PFS of 5.7 months. Other systemic treatments were poorly active.

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Cutaneous Leishmaniasis – A Case Series from Dresden

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.028 ◽

2018 ◽

Vol 6 (1) ◽

pp. 89-92 ◽

Cited By ~ 3

Author(s):

Uwe Wollina ◽

André Koch ◽

Claudio Guarneri ◽

Georgi Tchernev ◽

Torello Lotti

Keyword(s):

Climate Change ◽

Cutaneous Leishmaniasis ◽

Hot Spots ◽

Mediterranean Region ◽

World Wide ◽

Case Series ◽

Northern Europe ◽

Syrian Refugees ◽

Single Centre ◽

Single Centre Experience

Leishmaniasis is world-wide one of the most common infectious disorders caused by protozoa. Due to the climate change, there is a risk of further spread of the disease to central and northern Europe. Another important issue is the high number of refugees from Syria since Syria is one of the hot spots of Old World leishmaniasis. We report on single-centre experience with leishmaniasis in the capital of Saxony, Dresden, during the years 2001 to 2017. We noted a substantial increase in the last five years. Once a very rare exotic disorder in Germany, cutaneous leishmaniasis has become a reality and physicians should be aware of it. A significant number of cases are from Syrian refugees; other cases had been acquired by tourists in the Mediterranean region!

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Prognosis of leptomeningeal metastases from melanoma: A case series of 28 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e13550 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e13550-e13550

Author(s):

Sarah Oinino ◽

Isabelle Rodrigues ◽

Thomas Boulanger ◽

Charles Andre ◽

Jacques Bonneterre ◽

...

Keyword(s):

Targeted Therapy ◽

Metastatic Disease ◽

Systemic Treatment ◽

Case Series ◽

Braf Inhibitor ◽

Line Treatment ◽

First Line ◽

Melanoma Diagnosis ◽

Systemic Treatments ◽

First Line Treatment

e13550 Background: Leptomeningeal metastasis (LM) are reported in 5-25% of patients with melanoma. However, only very few large contemporary cohorts of melanoma patients with LM have been published. Methods: We report on a case series of 28 consecutive patients with LM from melanoma (BRAF mutated in 14 cases, of 19 tested) diagnosed between April 2007 and April 2016, and treated for LM using a combination of systemic treatment, intra-cerebrospinal fluid (CSF) therapy and radiotherapy according to prior treatments and the presentation of LM. Results: The median age at LM diagnosis was 49.5 years (range 27-73). Median ECOG-performance status was 2 (0-4). Concomitant brain metastases were present in all but 4 patients at LM diagnosis. LM was the first site of metastatic disease for only 2 patients. Median time from melanoma diagnosis to LM diagnosis was 0.33 years in patients with metastatic disease at melanoma diagnosis (4 patients) and 4.5 years in patients without metastatic disease at melanoma diagnosis (24 patients). First line treatment for LM was a combination of intra-CSF (liposomal cytarabine) and systemic treatments in 25 cases, and systemic treatment alone in 3 cases. Systemic treatments include chemotherapy (n = 18), targeted therapy (BRAF inhibitor n = 9; MEK inhibitor, n = 3) and immunotherapy (n = 4). No radiotherapy was performed. Ten patients received more than one line of treatment for LM. Median progression-free survival with first line treatment was 1.75 months. Responses or stabilization (for at least 2 months) were observed in only 7 patients. Median overall survival (OS) for the whole cohort was 3.08 months. Conclusions: The prognosis of patients with LM from melanoma remains poor. The role of new agents such as targeted therapies and immunotherapy for the treatment of LM is still not well defined. Adequate use of intrathecal chemotherapy, targeted therapy and immunotherapy could improve the survival of these patients.

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Systemic Treatment in Advanced Phyllodes Tumor of the Breast: A Multi-Institutional European Retrospective Case-Series Analyses

10.21203/rs.3.rs-919256/v2 ◽

2021 ◽

Author(s):

Elena Palassini ◽

Olivier Mir ◽

Giovanni Grignani ◽

Bruno Vincenzi ◽

Hans Gelderblom ◽

...

Keyword(s):

Kinase Inhibitors ◽

Systemic Treatment ◽

Case Series ◽

Phyllodes Tumor ◽

Median Number ◽

Advanced Breast ◽

High Rate ◽

High Dose ◽

Retrospective Case ◽

Systemic Treatments

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Miltefosine for Mucosal and Complicated Cutaneous Old World Leishmaniasis: A Case Series and Review of the Literature

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw008 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 15

Author(s):

Vincent Mosimann ◽

Claudia Blazek ◽

Heini Grob ◽

Matthew Chaney ◽

Andreas Neumayr ◽

...

Keyword(s):

Effective Treatment ◽

Cutaneous Leishmaniasis ◽

Clinical Studies ◽

Systemic Treatment ◽

Treatment Options ◽

Case Series ◽

Review Of The Literature ◽

Effective Treatment Option ◽

Old World ◽

Mucosal Leishmaniasis

Abstract Complicated Old World cutaneous leishmaniasis (OWCL) and Old World mucosal leishmaniasis (OWML) constitute an indication for systemic treatment. To date, there no controlled clinical studies that compare treatment options for these diseases. We compiled a case series of 24 cases successfully treated with miltefosine. We conclude that oral miltefosine is an effective treatment option for both OWCL and OWML.

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766. Everything Old is New Again-A Case Series of New World Leishmaniasis in African Children in Portland, Maine

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.956 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S428-S428

Author(s):

Jennifer Jubulis ◽

Amanda Goddard ◽

Elizabeth Seiverling ◽

Marc Kimball ◽

Carol A McCarthy

Keyword(s):

Latin America ◽

Cutaneous Leishmaniasis ◽

New World ◽

Pediatric Patients ◽

Data Extraction ◽

Clinical Manifestations ◽

Case Series ◽

Surgical Excision ◽

Skin Lesions ◽

Travel History

Abstract Background Leishmaniasis has many clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis is found primarily in Africa and Asia, and is associated with visceral disease, while new world disease, seen primarily in Latin America, is more commonly mucocutaneous. We present a case series of pediatric African patients with New World cutaneous leishmaniasis (NWCL). Methods Data extraction was performed via chart review, analyzing travel history, clinical presentation, diagnosis, and management in children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal CDC for identification by PCR and culture. Results Five cases of NWCL were diagnosed in pediatric patients in Maine from November 2018 through February 2020. Median age of patients was 10 years (range 1.5-15 years). Four cases (80%) occurred in children from Angola or Democratic Republic of Congo, arriving in Maine via Central/South America, with one case in a child from Rwanda who arrived in Maine via Texas. Three patients had multiple skin lesions and two had isolated facial lesions. Leishmaniasis was not initially suspected resulting in median time to diagnosis of 5 months (range 1-7 months). Four patients were initially treated with antibacterials for cellulitis and one was treated with griseofulvin. After no improvement, patients underwent biopsy with 2 patients diagnosed with L panamensis, 1 with L braziliensis, 1 with mixed infection (L panamensis and L mexicana), and 1 with Leishmania species only. One patient was managed with surgical excision, 3 with ketoconazole, and 1 was observed off therapy. Four patients were referred to otolaryngology. All continue to be followed in infectious disease clinic. Conclusion We present five cases of new world cutaneous leishmaniasis in African pediatric patients arriving to Maine through Latin America or Texas. Patients were diagnosed with cellulitis, tinea corporis or atopic dermatitis initially, underscoring importance of high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with illness not congruent with country of origin. Optimal therapy remains unclear. Disclosures All Authors: No reported disclosures

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Farm to School of Park County: A Journey from Program to Nonprofit (B)

Kellogg School of Management Cases ◽

10.1108/case.kellogg.2021.000084 ◽

2019 ◽

pp. 1-6

Author(s):

Karen L. Cates ◽

Liz Livingston Howard

Keyword(s):

Local Community ◽

Annual Report ◽

Case Series ◽

School Organization ◽

Board Members ◽

Farm To School ◽

The Us ◽

Need To Evaluate ◽

The Face ◽

Independent Organization

This case series describes the startup of Farm to School of Park County, an emerging nonprofit organization in the US state of Montana. Case (A) describes the community, the need, and the origins of Farm to School in Livingston, Montana. The leaders of Farm to School face a budget crisis and need to evaluate four options to decide whether, when, and how it should become an independent organization. As Case (B) begins, Farm to School has decided to enter into a fiscal sponsorship agreement with the local community foundation. The next task for the organization's leaders is recruiting founding board members. They need to decide whom to ask and how to do it. In Case (C), the board develops a strategic plan and establishes committees. However, the board members and leaders start to feel fatigue in the face of the demands of a startup organization, leading to questions about what is truly strategic and how work will get done. The Farm to School organization in Case (D) has just issued its first annual report, filled with meaningful accomplishments. The leaders of the organization begin to plan to build an organization that will outlast them and the founding board members.

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Mitigation/Adaptation and Health: Health Policymaking in the Global Response to Climate Change and Implications for other Upstream Determinants

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2010.00516.x ◽

2010 ◽

Vol 38 (3) ◽

pp. 629-639 ◽

Cited By ~ 12

Author(s):

Lindsay F. Wiley

Keyword(s):

Climate Change ◽

International Health ◽

Environmental Research ◽

World Health ◽

Environmental Concerns ◽

The Face ◽

Development Goals ◽

United Nations System ◽

Health Organization ◽

Development Objectives

In coming decades, enhanced global health governance will be crucial to achieving international health and development objectives in the face of a number of challenges; this article focuses on one of them. Climate change, which is now widely recognized as the defining challenge of the 21st century, will make the work of ensuring the conditions in which people can be healthy more difficult in a myriad of ways. Scientists from both the health and climate communities have been highlighting the significant interaction between climate and health for decades and have made significant strides in integrating health and environmental research. Those of us in the law and policy community have been a bit slow to catch up, and have only just begun to call for better integration of our responses to health and environmental concerns. Environmental health specialists at the World Health Organization have recently pointed to a mandate for better integration of health and environmental concerns within the United Nations system. The Millennium Development Goals interweave health, environmental, and development concerns.

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