Search

Background: American Cutaneous Leishmaniasis (ACL) shows variable response to therapy, but data on species-specific treatment efficacy is scarce. We describe the clinical characteristics and outcome of patients with ACL imported to a tertiary centre in Germany and determine whether species-specific therapy according to the 2014 "LeishMan" group recommendations is associated with cure. Methods: A retrospective chart review was conducted at the Charité Institute of International Health in Berlin. We analysed data on PCR-confirmed ACL cases collected between 2000 and 2023. Systemic therapy included liposomal amphotericin B, miltefosine, pentavalent antimony, ketoconazole or itraconazole. Localized therapy included perilesional pentavalent antimony or paromomycin ointment. Cure was defined as re-epithelialization of ulcers or disappearance of papular-nodular lesions after 3 months of treatment. Logistic regression models were used to quantify the effect of species-specific systemic therapy on the outcome. Results: 75 cases were analysed. Most patients were male (62%), median age was 35 years, no patient had a history of immunosuppression. The most common reason for travel was tourism (60%), the most common destination was Costa Rica (28%), the median duration of illness was 8 weeks, and most patients presented with ulcers (87%). Lesions were complex in 43%. The most common Leishmania (L.) species was L. braziliensis (28%), followed by L. panamensis (21%). 51/73 (70%) patients were cured after initial therapy and 17/21 (81%) after secondary therapy. Cure after systemic therapy was more frequent when species-specific treatment recommendations were followed (33/45; 73%), compared to when not followed, (6/17; 35%, P = 0.008). This association was independent of age, sex, previous therapy, complex lesions, and Leishmania species (adjusted OR, 5.06; 95% CI, 1.22–24.16). Conclusions: ACL is a rare, imported disease in Germany. Complex lesions were common, challenging successful therapy. This study highlights the importance of identifying the parasite species and suggests that a species-specific approach to treatment leads to better outcomes. Author summary: American cutaneous leishmaniasis is a skin disease caused by parasites that are transmitted through the bite of sandflies. It is considered as a neglected tropical disease. In non-endemic countries like Germany, this disease is rarely seen and is imported by migrants or travellers who have been infected in tropical or subtropical areas of the Americas. Experts suggest that the treatment should be given depending on the specific parasite species found in the affected skin, but there is still a scarcity of information on the optimal management strategy. We analysed 75 American cutaneous leishmaniasis cases seen between 2000 and 2023 at our German medical centre. Most patients were men, around 35 years of age, who most commonly travelled to the Americas for tourism. We found that when using systemic medications (i.e., given by mouth, injection or drip into a vein), that were recommended for the specific parasite type, patients were more likely to be cured, with a 73% success rate, compared to a mere 35% success rate when those recommendations were not followed. This highlights the importance of identifying the species that is causing the disease, and suggests that tailoring treatment to the specific parasite species increases the chances of cure. [ABSTRACT FROM AUTHOR]

Provides an outline of the general educational practice in German elementary school classrooms and its institutional frame factors. Gives the teachers' use of worksheets as an example. Presents results derived from a larger study seeking insights into the effectiveness of state regulations and restrictions concerning instructional media and processes. (DK)

Background Cutaneous leishmaniasis (CL), a parasitic disease which represents a public health problem, particularly in Central and South America, has become a leading condition in travelers who return from tropical countries with skin disorders. Cutaneous leishmaniasis caused by Leishmania ( Viannia) braziliensis, the most common causative agent, requires systemic treatment because it is potentially able to disseminate and to cause mucosal or mucocutaneous disease. Although several drugs are available for the systemic treatment of leishmaniases, a definitive treatment regimen for infection caused by species of the Viannia subgenus has yet to be established in many countries, including Germany. Methods We analyzed treatment outcomes in 23 returnees from Central and South America who were diagnosed with L. ( V.) braziliensis CL by polymerase chain reaction. Results Complete cure within one month following treatment was observed in 18 patients (78%). Cure was achieved with liposomal amphotericin B in 11 of 13 patients, miltefosine in five of eight patients, and meglumine antimoniate in two (of two) patients. Of the five patients (22%) who failed to respond to initial therapy, four were cured with meglumine antimoniate and one with liposomal amphotericin B. Conclusions In this outcome evaluation of treatment of imported L. ( V.) braziliensis infections, liposomal amphotericin B, miltefosine, and meglumine antimoniate proved to be effective. Conventional meglumine antimoniate showed high efficacy as a first-line treatment and cured lesions that failed to respond to the other two drugs. A multi-country study using standardized treatment protocols is needed to establish a definitive regimen. [ABSTRACT FROM AUTHOR]

Purpose - Because of the increasing importance of immigration for Germany due to the ageing population and the lack of highly skilled in some industries, the purpose of this paper is to analyse the return-migration of German immigrants. Design/methodology/approach - The paper uses the German Socio-economic Panel to conduct an event-history analysis of return-migration. Findings - The analysis reveals that return migration is heavily influenced by country of origin. Individuals from countries with free labour movement agreements with Germany show a considerably higher likelihood of leaving Germany relative to the other countries. The main finding is, with respect to the self-selection process, that highly skilled are more likely to remigrate than those who are less skilled. In addition, the results give substantial information considering the design of German immigration policy. Originality/value - This paper conducts the first remigration analysis using the Cox proportional hazard model with years of residence as waiting time. Using the latest data, with respect to qualification, a positive self-selection of remigrants was found. [ABSTRACT FROM AUTHOR]

This article provides an estimate of the trade equations for manufactured exports from Germany using cointegration and error-correction estimation techniques. It describes the structural change and the catch up process of the manufacturing industries and exports of the Central East European Countries (CEECs) closing the technology gap. The article concludes with a specification of the determinants of the export demand and supply in an imperfect substitute trade model.

The article discusses the waste and failure at the German bureau of Labor, made public in an August 2002 report, and a subsequent, successful effort to reform the agency. A new leadership structure was put in place which created a Hartz Commission to investigate modern services in the labor market and propose legislation to reform both the bureau and national labor policy.

Presents information on the occurrence of leishmaniasis in Germany. Overview of the protozoal disease; Characteristics of patients with cutaneous and mucosal leishmaniansis in the country.

Focuses on terrorism and conflict management in Germany. Social implications of terrorism; Factors that need to be considered in the analysis of terrorism; Mechanisms involved in terrorism; Changes in public discussions about the causes of terrorism; Discussion on the motivation crisis of youth.

It was only after the Second World War that the sociology of education in Germany developed into an independent sociological discipline. Certainly, educational questions had been examined from a sociological viewpoint before that time, but it was only in the 1950's that sociologists began to undertake more thorough empirical research into the social conditions under which upbringing and education take place and into the social functions, which the corresponding institutions fill. This empirical work was inspired as a rule by political problems: the urgent need for reform in German universities after the war, the authoritarian structure of the German family, the integration into West German society of refugees and German-speaking inhabitants expelled from the Eastern parts of Europe. Lastly, the whole educational system, as in other countries, was at that time in need of fundamental restructuring. The recognition that relationships which at first had been understood simplistically were much more complex and not at all easy to investigate and explain led inevitably to an increase in political abstinence. Educational research and the politics of education began to grow wider apart.