Treatment of mucocutaneous leishmaniasis - A systematic review.

Mucocutaneous leishmaniasis is a severe infectious disease, predominantly endemic in Central and South America and is characterized by granulomatous, destructive mucosal lesions in the oral, nasal, and pharyngeal cavities. It is caused by protozoa of the genus Leishmania spp. transmitted to humans by sandflies. Mucocutaneous leishmaniasis occurs after untreated or inadequately treated cutaneous leishmaniasis and is more common in immunocompromised patients. The aim of this systematic review is to summarize all reported treatment options for mucocutaneous leishmaniasis. This review is based on all English, German, French, Spanish and Portuguese articles published in the databases "PubMed" and "Lilacs" from 1995 to 2020. Most of the medical literature is limited to case reports, small case series, retrospective studies, and a few randomized controlled trials. Various treatment options include pentavalent antimonates such as meglumine antimonate or sodium stibogluconate, amphotericin B (liposomal, deoxycholate, lipid complex, colloidal dispersion), miltefosine, and pentamidine. Other therapeutic options include itraconazole, fluconazole, ketoconazole, aminosidine sulfate, and azithromycin. The choice of drug depends primarily on its availability in the endemic area and the patient's comorbidities.

Introducing a novel educational training programme in dental implantology for pregraduate dental students.

INTRODUCTION: This study aimed to determine whether implant surgery procedures can be implemented in the dental curriculum by designing novel courses for students. Additionally, this study assesses the perception of these courses and how they can be established in the future. MATERIALS AND METHODS: Students from the third to fifth years participated in a programme consisting of 4 modules according to their academic year. The modules taught theoretical and practical content as well as clinical references. After participating, the students completed two questionnaires with research questions (RQ1 = evaluation of the relevance and effects; RQ2 = impact of modules 3 and 4) to evaluate the programme. The questionnaires consisted of 52 statements, each rated on a 6-point scale (1 'totally disagree' to 6 'totally agree'). Cronbach's alpha analysis was used, and median values, interquartile ranges and Pearson correlations (p-value) were statistically calculated. RESULTS: In total, 94 students completed the questionnaires. Cronbach's alpha exceeded 0.7 for all constructs except for one (skills training). The highest evaluated median was 6, and the lowest was 4.75. Pearson correlations were significant (<0.05) for perceived importance/lectures, perceived importance/tutor performance, lectures/skills training, skills training/tutor performance and tutor performance/lectures. Seventeen analysed free comments expressed strong interest in implantology courses for the curriculum. 88% of the students wished for more practical exercises in dental implantology during the curriculum or suggested expanding the programme in the future. CONCLUSION: The programme was highly accepted among dental students. The students wished for more practice in the future to perform supervised procedures on patients.

Impact of Professional Background on Inter-Annotator Variability and Accuracy During Annotation of Clinical Notes.

BACKGROUND: The aging population's need for treatment of chronic diseases is exhibiting a marked increase in urgency, with heart failure being one of the most severe diseases in this regard. To improve outpatient care of these patients and reduce hospitalization rates, the telemedical disease management program HerzMobil was developed in the past. OBJECTIVE: This work aims to analyze the inter-annotator variability among two professional groups (healthcare and engineering) involved in this program's annotation process of free-text clinical notes using categories. METHODS: A dataset of 1,300 text snippets was annotated by 13 annotators with different backgrounds. Inter-annotator variability and accuracy were evaluated using the F1-score and analyzed for differences between categories, annotators, and their professional backgrounds. RESULTS: The results show a significant difference between note categories concerning inter-annotator variability (p<0.0001) and accuracy (p<0.0001). However, there was no statistically significant difference between the two annotator groups, neither concerning inter-annotator variability (p=0.15) nor accuracy (p=0.84). CONCLUSION: Professional background had no significant impact on the annotation of free-text HerzMobil notes.

Kinetic Gait Parameters in Unilateral Lower Limb Amputations and Normal Gait in Able-Bodied: Reference Values for Clinical Application.

Unilateral lower limb amputations usually present with asymmetric interlimb gait patterns, in the long term leading to secondary physical conditions and carrying the risk of low physical activity and impairment of general health. To assess prosthetic fittings and rehabilitation measures, reference values for asymmetries as well as the most significant gait parameters are required. Kinetic gait data of 865 patients with unilateral lower limb amputations (hip and knee disarticulations, transfemoral, transtibial and foot amputations) and 216 able-bodied participants were quantitatively assessed by instrumented gait analyses. Characteristic spatiotemporal (stance time, walking speed, step length and width) and ground reaction force parameters (weight-acceptance and push-off peak) were contrasted to normal gait. All spatiotemporal and ground reaction force parameters differed significantly from normal gait with the largest differences in transfemoral amputations. These also differed between amputation levels and showed age-dependencies. The stance time and push-off peak difference were identified as the most discriminative parameters with the highest diagnostic specificity and sensitivity. The present results mark the first step to establishing universal reference values for gait parameters by means of which the quality and suitability of a prosthetic fitting and the rehabilitation progress can be assessed, and are generalizable for all adults with unilateral lower limb amputations in terms of level walking.

Presence of contractile impairment appears crucial for structural remodeling in idiopathic left bundle-branch block.

BACKGROUND: To differentiate effects of ventricular asynchrony from an underlying hypocontractile cardiomyopathy this study aimed to enhance the understanding of functional impairment and structural remodeling in idiopathic left bundle-branch block (LBBB). We hypothesize, that functional asynchrony with septal flash volume effects alone might not entirely explain the degree of functional impairment. Hence, we suggest the presence of a superimposed contractile cardiomyopathy. METHODS: In this retrospective study, 53 patients with idiopathic LBBB were identified and matched to controls with and without cardiovascular risk factors. Cardiovascular magnetic resonance (CMR) was used to evaluate cardiac function, volumes and myocardial fibrosis using native T1 mapping and late gadolinium enhancement (LGE). Septal flash volume was assessed by CMR volumetric measurements and allowed to stratify patients with systolic dysfunction solely due to isolated ventricular asynchrony or superimposed contractile impairment. RESULTS: Reduced systolic LV-function, increased LV-volumes and septal myocardial fibrosis were found in patients with idiopathic LBBB compared to healthy controls. LV-volumes increased and systolic LV-function declined with prolonged QRS duration. Fibrosis was typically located at the right ventricular insertion points. Subgroups with superimposed contractile impairment appeared with pronounced LV dilation and increased fibrotic remodeling compared to individuals with isolated ventricular asynchrony. CONCLUSIONS: The presence of superimposed contractile impairment in idiopathic LBBB is crucial to identify patients with enhanced structural remodeling. This finding suggests an underlying cardiomyopathy. Future studies are needed to assess a possible prognostic impact of this entity and the development of heart failure. TRIAL REGISTRATION: This study was retrospectively registered.

Helical Multi-Coordination Anion-Binding Catalysts for the Highly Enantioselective Dearomatization of Pyrylium Derivatives.

A general and highly enantioselective synthesis of oxygen heterocycles from readily available in situ generated pyrylium derivatives has been realized by embracing a multi-coordination approach with helical anion-binding tetrakistriazole catalysts. The high activity of the tetrakistriazole (TetraTri) catalysts, with distinct confined anion-binding pockets, allows for remarkably low catalyst loadings (down to 0.05 mol %), while providing a simple access to chiral chromanones and dihydropyrones in high enantioselectivities (up to 98:2 e.r.). Moreover, experimental and theoretical studies provide new insights into the hydrogen-donor ability and key binding interactions of the TetraTri catalysts and its host:guest complexes, suggesting the formation of a 1:3 species.

Triazole-Based Anion-Binding Catalysis for the Enantioselective Dearomatization of N-Heteroarenes with Phosphorus Nucleophiles.

The first enantioselective synthesis of chiral heterocyclic α-amino phosphonates by nucleophilic dearomatization of quinolines and pyridines using an anion-binding organocatalysis approach is described. Chiral tetrakistriazoles were employed as efficient hydrogen-bond donor catalysts by forming a chiral close ion-pair with the in situ formed N-acyl salts and 2,2,2-trichlorethoxycarbonyl chloride (TrocCl). The ion-pair was subsequently treated with various phosphorus nucleophiles, such as silyl-protected dialkyl- and trialkylphosphites. Thus, the corresponding products were obtained in complete or high regioselectivities and up to 97:3 e.r. for quinolines or up to 89:11 e.r. for the more challenging pyridine substrates. This method allows for rapid access to substituted chiral cyclic α-amino phosphonates, which can be easily transformed into phosphonic acid derivatives.

Asymmetric nucleophilic dearomatization of diazarenes by anion-binding catalysis.

The first anion-binding organocatalyzed enantioselective Reissert-type dearomatization of diazarenes has been developed. This reaction represents a synthetic challenge since diazarenes have various reactive sites. The use of a chiral tetrakistriazole as a C-H-based hydrogen-donor catalyst allowed the straightforward highly regio- and enantioselective synthesis of a variety of chiral diazaheterocycles.

Highly Enantioselective Nucleophilic Dearomatization of Pyridines by Anion-Binding Catalysis.

The asymmetric dearomatization of N-heterocycles is an important synthetic method to gain bioactive and synthetically valuable chiral heterocycles. However, the catalytic enantio- and regioselective dearomatization of the simplest six-membered-ring N-heteroarenes, the pyridines, is still very challenging. The first anion-binding-catalyzed, highly enantioselective nucleophilic dearomatization of pyridines with triazole-based H-bond donor catalysts is presented. Contrary to other more common NH-based H-bond donors, this type of organocatalyst shows a prominent higher C2-regioselectivity and is able to promote high enantioinductions via formation of a close chiral anion-pair complex with a preformed N-acyl pyridinium ionic intermediate. This method offers a straightforward and useful synthetic approach to chiral N-heterocycles from abundant and readily available pyridines.