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Abstract: Melanoma with lymphatic invasion has been associated with increased risk of metastasis, but the mechanisms and clinical implications are poorly understood. Although current reports have documented angiotropic spread of melanoma and suggest lymphatic spread of melanoma to increase the likelihood of metastasis, to our knowledge, lymphangitic metastatic melanoma resembling cutaneous carcinomatosis or presenting with facial hyperpigmentation has not been described. In this case report, we describe extensive cutaneous intralymphatic spread of melanoma, or lymphangitic melanomatosis, producing macular skin pigmentation in a 66-year-old man., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: None disclosed.

Competing Interests: None disclosed.

Introduction: cSCC is the second most common cutaneous malignancy worldwide behind basal cell carcinoma. Typically, SCC is diagnosed early before it infiltrates local subcutaneous tissue or metastasizes. However, unusual presentations are possible and can lead to delayed treatment and possibly worse outcomes., Materials and Methods: All patients were White of non-Hispanic or Latino decent. Three-quarters of the cases were male, and a quarter female. The age range was 45 to 78 years. The documented sizes of lesions ranged from 6 cm to 10 cm in diameter. Three of the cases were initially diagnosed as nonhealing wounds, and one was diagnosed as cellulitis., Results: The authors observed that SCC can present unusually by mimicking nonhealing infected ulcers or skin infections such as cellulitis. Over 18 months, the authors' practice recorded 4 cases of cSCC that were initially treated as persistent infections, which potentially lead to worse outcomes., Conclusion: These cases provide patterns and clues to potentially expedite the diagnosis and treatment of cSCC. Any skin lesion thought to be infectious but not responding to treatment should undergo tissue sampling.

Importance: Cases of photodistributed Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been infrequently reported since the first documented case in 1989. This emerging clinical entity and its underlying mechanism have yet to be fully characterized., Objective: To report a case of photodistributed SJS/TEN and highlight similarities to other cases reported in the literature., Design, Setting, and Participants: Case report and literature review of published cases of photodistributed SJS/TEN. The case report describes a 29-year-old woman with recent lamotrigine and trimethoprim-sulfamethoxazole exposure who developed TEN in a photodistributed pattern 1 day after prolonged sun exposure. A search of PubMed using the keywords toxic epidermal necrolysis, Stevens-Johnson syndrome, photo-distributed, photo-induced, and sun-exposed was performed to identify other cases reported in the literature., Results: Literature review revealed 8 previously reported cases of healthy individuals with known drug and UV radiation (UVR) exposures who subsequently developed SJS or TEN with photodistribution. Cases reviewed were skewed demographically to young women aged 19 to 48 years (8 of 9 patients) with all cases reporting UVR exposure 24 to 72 hours prior to the onset of symptoms., Conclusions and Relevance: Photodistributed TEN has been increasingly described in the literature and may represent a distinct variant of SJS/TEN. While the pathogenesis remains unclear, the role of UVR as a "second hit" is suggested by the data presented in the cases documented thus far.

Purpose of Review: Sarcoidosis is a complex granulomatous disease of unknown cause. Several drug categories are able to induce a systemic granulomatous indistinguishable from sarcoidosis, known as drug-induced sarcoidosis-like reaction (DISR). This granulomatous inflammation can resolve if the medication is discontinued. In this review, we discuss recent literature on medication associated with DISR, possible pathophysiology, clinical features, and treatment., Recent Findings: Recently, increasing reports on DISR have expanded the list of drugs associated with the systemic granulomatous eruption. Most reported drugs can be categorized as combination antiretroviral therapy, tumor necrosis factor-α antagonist, interferons, and immune checkpoint inhibitors, but reports on other drugs are also published. The proposed mechanism is enhancement of the aberrant immune response which results in systemic granuloma formation. It is currently not possible to know whether DISR represents a separate entity or is a triggered but 'true' sarcoidosis.As DISRs may cause minimal symptoms, treatment is not always necessary and the benefits of continuing the offending drug should be weighed against clinical symptoms and organ dysfunction. Treatment may involve immunosuppressive medication that is used for sarcoidosis treatment., Summary: In this article, we review recent insights in DISR: associated drug categories, clinical presentation, diagnosis, and treatment. Additionally, we discuss possible mechanisms of DISR which can add to our knowledge of sarcoidosis pathophysiology., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Maintaining military readiness requires integration and delivery of appropriate sex-specific health care services for active duty servicewomen (ADSW). Cervical cancer screening (CCS) provides early detection, intervention, and treatment, allowing for reductions in human papillomavirus (HPV) infections and cervical cancer cases. This scoping review examines existing cervical cancer evidence related to ADSW and identifies research gaps, leverage points, and policy recommendations within the context of the social ecological model for military women's health., Methods: We conducted a scoping literature search using both indexed databases and nonindexed sources. We managed retrieved records from 2000 to 2018 with Endnote reference and DistillerSR systematic review software., Results: Of 1,006 records from indexed databases and 208 records from nonindexed resources retrieved, 40 publications met the inclusion criteria. Cervical cancer research addressing ADSW is limited. Servicewomen have high rates of known cancer risk factors and face challenges related to deployments and change of duty station that affect continuity of health care and timely follow-up for abnormal CCS. Multimodal interventions with stakeholder support can encourage CCS adherence and increase HPV vaccination rates., Conclusion: Maintaining military readiness among ADSW requires robust evidence-based prevention efforts to address risk factors that are reportedly higher among servicewomen, as well as challenges to continuity in health care delivery that may increase the likelihood of cervical cancer incidence. Recognizing the role of HPV vaccination as cancer prevention, collaborations and partnerships, research, best practices, and creative solutions to close ADSW's sex-specific health gaps will help to ensure a fit and ready force., (Published by Elsevier Inc.)

Nonmelanoma skin cancers are common on the dorsal hands where reserve tissue is limited. We highlight the case of an elderly man who had 3 nonmelanoma skin cancers on the left hand that were treated on the same day and left similar wounds. The wounds were repaired by primary closure, secondary intention, and purse-string circumferential closure. All wounds healed with excellent and essentially equivalent cosmetic results. For small shallow wounds on the dorsal hands, dermatologic surgeons should have confidence that secondary intention healing likely will lead to acceptable cosmetic and functional results.

In a randomized clinical trial of 86 hospitalized COVID-19 patients comparing standard care to treatment with 300mL convalescent plasma containing high titers of neutralizing SARS-CoV-2 antibodies, no overall clinical benefit was observed. Using a comprehensive translational approach, we unravel the virological and immunological responses following treatment to disentangle which COVID-19 patients may benefit and should be the focus of future studies. Convalescent plasma is safe, does not improve survival, has no effect on the disease course, nor does plasma enhance viral clearance in the respiratory tract, influence SARS-CoV-2 antibody development or serum proinflammatory cytokines levels. Here, we show that the vast majority of patients already had potent neutralizing SARS-CoV-2 antibodies at hospital admission and with comparable titers to carefully selected plasma donors. This resulted in the decision to terminate the trial prematurely. Treatment with convalescent plasma should be studied early in the disease course or at least preceding autologous humoral response development.

Background: Lung histopathology demonstrates vasculopathy in a subset of deceased COVID19 patients, which resembles histopathology observed in antibody-mediated lung transplant rejection. Autoantibodies against angiotensin II type 1 receptor (AT1R) and Endothelin receptor Type A (ETAR) have been demonstrated in antibody-mediated rejection and may also be associated with severe COVID19 infection. Objective To assess AT1R and ETAR auto-antibodies in COVID19 patients and controls, and explore their association with disease course., Methods: 65 hospitalized patients with COVID19 infection were included. Clinical and laboratory findings were retrospectively assessed. Patients with unfavorable disease course, admitted at the intensive care unit and/or deceased during hospital admission (n=33) were compared to admitted COVID19 patients with favorable disease course (n=32). The presence of antinuclear antibodies (ANA) and auto-antibodies against AT1R or ETAR in peripheral blood were compared between COVID19 with unfavorable and favorable disease course and age matched controls (n=20)., Results: The presence of ANA was not significantly different between COVID19 patients with unfavorable (n=7/33; 21%) and favorable disease course (n=6/32; 19%) (p= 0.804) and controls (n=3/20; 15%). Auto-antibodies against AT1R were significantly increased in unfavorable disease course (median 14.59 U/mL, IQR 11.28 - 19.89) compared to favorable disease course (median 10.67 U/mL, IQR 8.55 - 13.0, p< 0.01). ETAR antibody titers were also significantly increased in unfavorable disease course (median 7.21, IQR 5.0 - 10.45) as compared to favorable disease course (median 4.0, IQR 3.0 - 6.0, p <0.05)., Conclusion: Auto-antibodies against AT1R and ETAR are significantly increased in COVID19 patients with an unfavorable disease course., Competing Interests: JM reports personal fees from Boehringer Ingelheim, Roche and Chiesi, all outside the submitted work. SS-B reports personal fees from Astra Zeneca, Chiesi, ALK, Novartis, GSK, all outside the submitted work. JA reports personal fees and non-financial support from MSD, personal fees from BMS, Boehringer Ingelheim, Amphera, Eli-Lilly, Takeda, Bayer, Roche, Astra Zeneca, all outside the submitted work. In addition, JA has a patent allogenic tumor cell lysate licensed to amphera, a patent combination immunotherapy in cancer pending, and a patent biomarker for immunotherapy pending (all outside submitted work) JV reports grants from ZonMW, during the conduct of the study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Miedema, Schreurs, van der Sar – van der Brugge, Paats, Baart, Bakker, Hoek, Dik, Endeman, Van Der Velden, van Gammeren, Ermens, Aerts and Thüsen.)

Competing Interests: The authors declare no conflicts of interest.

Introduction: Systemic sclerosis (SSc) is a rare chronic autoimmune disease characterised by microvascular damage, immune dysregulation and fibrosis, affecting the skin, joints and internal organs. Interstitial lung disease (ILD) is frequently associated with systemic sclerosis (SSc-ILD), leading to a poor prognosis and a high mortality rate. The aim of the BUILDup study (BUrden of Interstitial Lung Disease Consensus Panel) was to investigate the overall disease management and to estimate the social and economic burden of SSc-ILD across 8 European countries., Methods: A modified Delphi method was used to obtain information on the management of SSc-ILD patients among 40 specialists (panellists) from 8 European countries. Average annual costs per patient and country were estimated by means of a direct cost-analysis study., Results: The panellists had managed 805 SSc-ILD patients in the last year, 39.1% with limited (L-SSc-ILD) and 60.9% with extensive (E-SSc-ILD) disease. Of these, 32.8% of the panellists started treatment at diagnosis, 42.3% after signs of deterioration/progression and 24.7% when the disease had become extensive. The average annual cost of SSc-ILD per patient ranged from €6191 in Greece to €25,354 in Sweden. Main cost drivers were follow-up procedures, accounting for 80% of the total annual costs. Hospitalisations were the most important cost driver of follow-up costs. Healthcare resource use was more important for E-SSc-ILD compared to L-SSc-ILD. Early retirement was taken by 40.4% of the patients with an average of 11.9 years before the statutory retirement age., Conclusions: SSc-ILD entails not only a clinical but also a social and economic burden, and is higher for E-SSc-ILD.

Background: An increased incidence in hygiene-related urogenital infections (bacterial vaginitis, vulvovaginal candidiasis, and urinary tract) has been reported in female warfighters serving in austere environments with decreased availability of water and sanitation resources, and when personal safety outweighs concerns for hygiene. Knowledge and access to an innovative kit designed for the female warfighter to self-test, self-identify, and self-treat common urogenital symptoms is critical to force health., Purpose: The purpose of this descriptive, cross-sectional, exploratory qualitative study was to explore female warfighters': 1) confidence in seeking sex-specific health care in field and deployment environments and 2) acceptance and willingness to self-test, self-identify, and self-treat urogenital symptoms and infections., Methodological Orientation: Qualitative data for this thematic analysis were collected during administration of the Military Women's Readiness Urogenital Health Questionnaire. Participants provided open-ended comments associated with three survey questions. Braun and Clarke's inductive thematic analysis method guided the narrative analysis., Sample: Our sample included a diverse group of US Army women (USAW; n = 152) from a large, military installation., Results: Narratives and themes demonstrate USAW's desire and need for the availability of a self-test and self-treatment kit. Access, time, mission, and prevention of self-harm by quicker resolve of symptoms are cited as key reasons in support of such a kit., Conclusions and Practice Implications: Nurse practitioners (NPs) are ideally positioned to provide sex-specific educational interventions and anticipatory guidance that supports physical health, to include urogenital conditions. As urogenital self-testing becomes available for female warfighters, NPs are the model healthcare provider for educating women on their use.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction characterized by a morbilliform cutaneous eruption, fever, lymphadenopathy, and multiorgan involvement. Alopecia universalis is a variant of alopecia areata characterized by complete loss of hair on the entire body. Herein, we report a case of alopecia universalis that presented after DRESS., (© 2020 Wiley Periodicals LLC.)

Melanoma is the leading cause of death among cutaneous neoplasms. Best outcome relies on early detection and accurate pathologic diagnosis. For the great majority of melanocytic tumors, histopathologic examination can reliably distinguish nevi from melanomas. However, there is a subset of melanocytic tumors that cannot be definitively classified as benign or malignant using histopathological criteria alone. These tumors are usually diagnosed using terms that imply various degrees of uncertainty in regards to their malignant potential and create the possibility for over or undertreatment. For such tumors, additional ancillary tests would be beneficial in adjudicating a more definitive diagnosis. In recent years, DNA-based molecular ancillary tests, specifically comparative genomic hybridization and fluorescence in situ hybridization, have been developed to help guide the diagnosis of ambiguous melanocytic proliferations. This study will present an updated overview of these two major ancillary tests, which are currently being used in clinical practice to assist in the diagnosis of challenging melanocytic neoplasms.

Introduction: The term progressive fibrosing interstitial lung disease (ILD) describes patients with fibrotic ILDs who, irrespective of the aetiology of the disease, show a progressive course of their disease despite current available (and non-licensed) treatment. Besides in idiopathic pulmonary fibrosis, little is known about management and the burden of patients with fibrotic ILD, particularly those with a progressive behaviour., Methods: Using the Delphi method, 40 European experts in ILD management delivered information on management of (progressive) fibrosing ILD and on the impact of the disease on patients' quality of life (QoL) and healthcare resource utilisation (HCRU). Annual costs were calculated for progressive and non-/slow-progressive fibrosing ILD for diagnosis, follow-up management, exacerbation management, and end-of-life care based on the survey data., Results: Physicians reported that progression in fibrosing ILD worsens QoL in both patients and their caregivers. Progression of fibrosing ILD was associated with a greater use of HCRU for follow-up visits and maintenance treatment compared with the non-/slow progression. The number of patients who suffered at least one acute exacerbation was reported to be more than three times higher in progressive fibrosing ILD patients than in patients with non-/slow-progressive fibrosing ILD. On average, annual estimated costs of progressive fibrosing ILD per patient were 1.8 times higher than those of the non-/slow-progressive form of the disease., Conclusions: Progression in fibrosing ILD causes a significant impact on QoL and HCRU and costs. These survey data underline the need for safe and effective therapies to slow the disease progression.

Thin-slices multi-detector computed tomography (MDCT) plays a key role in the differential diagnosis of interstitial lung disease (ILD). However, thin-slices MDCT has a limited ability to detect active inflammation, which is an important target of newly developed ILD drug therapy. Magnetic resonance imaging (MRI), thanks to its multi-parameter capability, provides better tissue characterisation than thin-slices MDCT.Our aim was to summarise the current status of MRI applications in ILD and to propose an ILD-MRI protocol. A systematic literature search was conducted for relevant studies on chest MRI in patients with ILD.We retrieved 1246 papers of which 55 original papers were selected for the review. We identified 24 studies comparing image quality of thin-slices MDCT and MRI using several MRI sequences. These studies described new MRI sequences to assess ILD parenchymal abnormalities, such as honeycombing, reticulation and ground-glass opacity. Thin-slices MDCT remains superior to MRI for morphological imaging. However, recent studies with ultra-short echo-time MRI showed image quality comparable to thin-slices MDCT. Several studies demonstrated the added value of chest MRI by using functional imaging, especially to detect and quantify inflammatory changes.We concluded that chest MRI could play a role in ILD patients to differentiate inflammatory and fibrotic changes and to assess efficacy of new ILD drugs., Competing Interests: Conflict of interest: C. Romei has nothing to disclose. Conflict of interest: L. Turturici has nothing to disclose. Conflict of interest: L. Tavanti has nothing to disclose. Conflict of interest: J. Miedema has nothing to disclose. Conflict of interest: S. Fiorini has nothing to disclose. Conflict of interest: M. Marletta has nothing to disclose. Conflict of interest: P. Wielopolski has nothing to disclose. Conflict of interest: H. Tiddens reports industry funding from Roche, lecture and advisory board fees from Novartis, and grants from CFF, Vertex, Gilead and Chiesi, outside the submitted work. In addition, H. Tiddens has a patent licensed with Vectura, and a patent PRAGMA-CF scoring system issued. Conflict of interest: F. Falaschi has nothing to disclose. Conflict of interest: P. Ciet reports personal fees from Vertex Pharmaceutical, outside the submitted work., (Copyright ©ERS 2018.)

Background and Purpose: Critical research topics were identified after nurse practitioner (NP) organization stakeholders participated in the Fellows of the American Association of Nurse Practitioner, 2015 Nurse Practitioner Research Agenda Roundtable. Strategies and recommendations were identified to support further work examining NP outcomes-based research priorities in four areas: 1) policy and regulation; 2) workforce; 3) education; and 4) practice. For the purpose of this article, we focus on NP education. Important contrasts became evident after critiquing, analyzing, and synthesizing the literature. Meaningful differences were discovered in the understanding of the complexity of the construct, NP Education Models. Our results are presented as an integrative review. This is the third article in a four-part series investigating FAANP research priorities., Methods: A systematic literature review summarizing the literature for NP Education Models was conducted. PRISMA evidence-based methods were used to identify relevant studies. Of the 3,374 studies identified, 133 duplicate studies were eliminated, yielding a total of 3,241 articles. A team of three reviewers conducted screening and reviewing processes using defined eligibility criteria., Conclusions: A lack of clarity regarding use of the construct, NP Education Models, was discovered. The construct was broadly defined and represented different meanings. There is a paucity of theoretical development in current NP education that should be core to practice-focused NP educational programs., Implications for Practice: Theoretical and conceptual NP education models and frameworks would bridge the gap between practice- and research-focused graduate programs. Overarching theoretical and conceptual models and frameworks promote critical thinking and decision-making across settings and populations.

Case Presentation: A 79-year-old woman presented to the ED with complaints of gradually worsening exertional dyspnea, dizziness, and chest discomfort. For several weeks she had not been able to perform light household work. The patient's medical history mentioned pulmonary embolism following immobilization (2012), several fractures after trauma, an ischemic cerebral vascular accident (2014), and curative treatment for breast cancer (1995). Her current medication included esomeprazole, clopidogrel, simvastatin, calcium/vitamin D, amitriptyline, and acetaminophen., (Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Objective: Tubular microdiscectomy has become a staple technique among spine surgeons. Yet the associated learning curve, especially its later stages, has not been extensively studied. With studies reporting a higher rate of recurrent herniation using tubular microdiscectomy, surgeons' level of experience becomes of primary importance for the interpretation of such findings. We aimed to analyze possible improvements in the later stages of the learning curve and to identify factors independently associated with recurrent herniation., Methods: A retrospective study was conducted using prospectively collected data from a consecutive cohort of all 1241 patients operated for single-level lumbar disc herniation with tubular microdiscectomy by a single surgeon who already had extensive experience with this technique. We collected demographic and perioperative data and consequently tracked all complications, recurrent herniations, and other reoperations. In addition, 495 patients (40%) provided complete outcome scores on a numeric rating scale for back and leg pain and the Oswestry Disability Index at baseline, 6 weeks, and 12 months postoperatively., Results: A decrease in surgical time (P < 0.001) and recurrent herniations was observed (P = 0.012) over time. Increased leg pain at 6 weeks was independently associated with recurrent herniation (P = 0.01). Fifty-six patients (4.5%) experienced ipsilateral recurrent herniation., Conclusions: Relevant improvements in clinical results were seen even after the surgeon had already accumulated extensive experience. Any future studies should unambiguously report the level of experience of the participating surgeons, possibly including the number of cases previously treated using a particular technique., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Pulmonary fibrosis greatly impacts patients and their partners. Unmet needs of patients are increasingly acknowledged; the needs of partners often remain unnoticed. Little is known about the best way to educate patients and partners. We investigated pulmonary fibrosis patients' and partners' perspectives and preferences in care, and the differences in these between the Netherlands and Germany. Additionally, we evaluated whether interactive interviewing could be a novel education method in this population. Patients and partners were interviewed during pulmonary fibrosis patient information meetings. In the Netherlands, voting boxes were used and results were projected directly. In Germany, questionnaires were used. In the Netherlands, 278 patients and partners participated; in Germany, 51. Many participants experienced anxiety. Almost all experienced misunderstanding, because people do not know what pulmonary fibrosis is. All expressed a need for information, psychological support and care for partners. Use of the interactive voting system was found to be pleasant (70%) and informative (94%). This study improves the knowledge of care needs of patients with pulmonary fibrosis and their partners. There were no major differences between the Netherlands and Germany. Interactive interviewing could be an attractive method to acquire insights into the needs and preferences of patients and partners, while providing them with information at the same time., Competing Interests: Conflict of interest: Disclosures can be found alongside this article at openres.ersjournals.com

The authors--with expertise in dermatology and pathology--provide pointers that can help you improve your approach to skin biopsy.

Representatives of Subclass Elasmobranchii are cartilaginous fish whose members include sharks, skates, and rays. Because of their unique phylogenetic position of being the most primitive group of vertebrates to possess all the components necessary for an adaptive immune system, the immune regulatory compounds they possess may represent the earliest evolutionary forms of novel compounds with the potential for innovative therapeutic applications. Conditioned medium, generated from short term culture of cells from the epigonal organ of bonnethead sharks (Sphyrna tiburo), has been shown to have potent reproducible cytotoxic activity against a variety of human tumor cell lines in vitro. Existing data suggest that epigonal conditioned medium (ECM) exerts this cytotoxic activity through induction of apoptosis in target cells. This manuscript describes apoptosis induction in a representative tumor cell line, Jurkat E6-1, in response to treatment with ECM at concentrations of 1 and 2 mg/mL. Data indicate that ECM exposure initiates the mitochondrial pathway of apoptosis through activation of caspase enzymes. Future purification of ECM components may result in the isolation of an immune-regulatory compound with potential therapeutic benefit for treatment of human cancer.

Aims: We applied digital image analysis techniques to study selected types of melanocytic lesions., Methods and Results: We used advanced digital image analysis to compare melanocytic lesions as follows: (i) melanoma to nevi, (ii) melanoma subtypes to nevi, (iii) severely dysplastic nevi to other nevi and (iv) melanoma to severely dysplastic nevi. We were successful in differentiating melanoma from nevi [receiver operating characteristic area (ROC) 0.95] using image-derived features, among which those related to nuclear size and shape and distance between nuclei were most important. Dividing melanoma into subtypes, even greater separation was obtained (ROC area 0.98 for superficial spreading melanoma; 0.95 for lentigo maligna melanoma; and 0.99 for unclassified). Severely dysplastic nevi were best differentiated from conventional and mildly dysplastic nevi by differences in cellular staining qualities (ROC area 0.84). We found that melanomas were separated from severely dysplastic nevi by features related to shape and staining qualities (ROC area 0.95). All comparisons were statistically significant (P < 0.0001)., Conclusions: We offer a unique perspective into the evaluation of melanocytic lesions and demonstrate a technological application with increasing prevalence, and with potential use as an adjunct to traditional diagnosis in the future., (© 2012 Blackwell Publishing Ltd.)

Objective: To describe the patient population in Dekkerswald, Nijmegen, one of two tuberculosis (TB) centres in The Netherlands., Design: Descriptive, retrospective study., Method: Examination of medical records for all TB patients hospitalised between 2000 and 2005, including demographic, social, clinical and follow-up data., Results: Data from 166 patients were analysed. Tertiary referrals accounted for 98% of all hospitalisations. Most patients (68%) were referred for clinical reasons, and 32% were referred for social reasons. Drug resistance was encountered in 23% of patients; 9% had multidrug-resistant TB. Ten percent of patients were seropositive for HIV. Toxicity and side-effects of treatment often led to changes in treatment (40%). Patients had pulmonary TB (59%), extrapulmonary TB (23%) or both (17%). Overall, 141 patients (85%) completed treatment. The TB-related mortality rate was 5%., Conclusion: In Dekkerswald, there is a selected patient population that is characterised by drug-resistance, comorbidity, side-effects, extrapulmonary disease and social issues. Due to the low prevalence of TB in The Netherlands, knowledge and experience regarding complex types of TB are limited. Centralisation of patient care is important to preserve and optimise this expertise.

This article focuses on the question of why fairness matters to people. On the basis of fairness heuristic theory, the authors argue that people especially need fairness when they are uncertain about things that are important to them. Following terror management theory, the authors focus on a basic kind of human uncertainty: fear of death. Integrating these two theoretical frameworks, it is proposed that thinking about their mortality should make fairness a more important issue to people. The findings of three experiments support the authors' line of reasoning: Asking participants to think about their mortality led to stronger fair process effects (positive effects of perceived procedural fairness on subsequent reactions) than not asking them to think about mortality. It is argued that these findings suggest that fairness especially matters to people when they are uncertain about fundamental aspects of human life such as human mortality.