Leishmania infantum leishmaniasis in corticosteroid – treated patients

BACKGROUND: The number of leishmaniasis cases associated with immunosuppression has increased regularly over the past 20 years. Immunosuppression related to HIV infection, immunosuppressive treatment, organ transplantation, and neoplastic diseases increases the risk for Leishmania-infected people to develop visceral illness. CASE PRESENTATION: Three cases of Leishmania infantum leishmaniasis in corticosteroid (CS)-treated patients are reported: an isolated lingual leishmaniasis in a farmer treated with CS for asthma, a severe visceral leishmaniasis associated with cutaneous lesions in a woman with myasthenia gravis, and a visceral involvement after cutaneous leishmaniasis in a man receiving CS. CONCLUSION: Physicians should recognise CS-treated patients as a population likely to be immunesuppressed. In immunodeficiency conditions, unusual forms of leishmaniasis can develop and foster the risk of a diagnostic delay and of poor response to therapy

Introduction and acknowledgements

This timely book assesses national and supranational bilateral approaches to dealing with the rising tide of migration into the European Union via the Mediterranean Sea. International law and EU migration law specialists critically assess the legal tools adopted to engage with the \u2018refugee crisis\u2019. While the EU works to develop a unified approach to Mediterranean transit and origin countries, the authors argue that a crucial role should be accorded to individual states in finding a solution to this complex and sensitive situation

Social-multi criteria evaluation of alternative geothermal power scenarios: the case of Mt. Amiata in Italy

Italy was the first country in the world to exploit geothermal resources for the production of electricity. In Europe it is still the first country in terms of installed capacity. Currently, the only region in Italy with geothermal power plants is Tuscany. This study focuses on Mt. Amiata, one of the two geothermal areas in Tuscany, where there is strong opposition to the exploitation of geothermal resources. The context is characterized by contested scientific results regarding crucial issues such as the impact of geothermal exploitation, the conservation of water resources and human health. A social multi-criteria evaluation is proposed to explore the different legitimate perspectives of the actors involved. Scenarios are distinguished in terms of their installed capacity, technology and plant site. A Condorcet consistent aggregation algorithm is applied and results are analyzed using a sensitivity analysis. The alternative scenarios are evaluated in a multi-dimensional way by attaching different weights to the criteria reflecting divergent points of view

Social-Multi Criteria Evaluation of Alternative Geothermal Power Scenarios: The case of Mt. Amiata in Italy

Italy was the first country in the world to exploit geothermal resources for the production of electricity. In Europe it is still the first country in terms of installed capacity. Currently, the only region in Italy with geothermal power plants is Tuscany. This study focuses on Mt. Amiata, one of the two geothermal areas in Tuscany, where there is strong opposition to the exploitation of geothermal resources. The context is characterized by contested scientific results regarding crucial issues such as the impact of geothermal exploitation, the conservation of water resources and human health. A social multi-criteria evaluation is proposed to explore the different legitimate perspectives of the actors involved. Scenarios are distinguished in terms of their installed capacity, technology and plant site. A Condorcet consistent aggregation algorithm is applied and results are analyzed using a sensitivity analysis. The alternative scenarios are evaluated in a multi-dimensional way by attaching different weights to the criteria reflecting divergent points of view

Migration and Mobility in the EU’s Eastern Neighbourhood: Mapping out the Legal and Political Framework

Migration and mobility is an increasingly important topic within the European Neighbourhood Policy (ENP). The very first ENP Strategy Papers already acknowledged that perspectives for lawful migration and common efforts to combat illegal migration, as well as the establishment of efficient mechanisms for return, are crucial determinants for successful cooperation with neighbouring countries. With the first revision of the ENP the issue of migration and mobility was encapsulated in the two regional dimensions of the ENP covering respectively the Eastern Partnership (EaP) and the Southern Mediterranean. The focus of this chapter is on the EU’s Eastern neighbourhood and EU-related instruments, systematized in three main groups: (1) legally binding instruments; (2) non-legally binding instruments; and (3) operational and cooperation instruments. In addition, this chapter evaluates the effectiveness of the EU’s efforts in light of the EaP’s policy objective to ensure enhanced mobility of citizens in a secure and well-managed environment

Valve-related complications in elderly patients with biological and mechanical aortic valves

BACKGROUND: Controversy still exists about the choice of aortic prosthesis in elderly patients. This study investigates valve- and anticoagulant-related morbidity and mortality in elderly patients after aortic valve replacement (AVR) with a biologic (BP) or mechanical prosthesis (MP). METHODS: Between 1981 and 1995, 355 consecutive patients aged 70 years or older (mean, 74+/-4 years; range, 70 to 87 years) underwent isolated AVR. There were 222 (63%) replacements with an MP and 133 (37%) with a BP. Mean follow-up was 3.7+/-2.8 years (range, 3 months to 15 years), with a total follow-up of 1,214 patient-years. RESULTS: Hospital mortality was 7.6% (27 of 355), decreasing to 4.6% in the last 3 years. There were 55 late deaths, 33 in patients with MP and 22 in those with BP. At 10 years there was no significant difference between MP and BP recipients in the actuarial estimates of survival (51%+/-8% versus 33%+/-13%), freedom from valve-related death (82%+/-7% versus 72%+/-12%), and freedom from thromboembolism (84%+/-7% versus 94%+/-3%). In contrast, 10-year freedom from anticoagulant-related hemorrhages was 74%+/-8% for MP and 99%+/-1% for BP (p = 0.02). Only 1 structural deterioration occurred, in a patient with BP. CONCLUSIONS: Satisfactory early results can be obtained in elderly patients after AVR with both MP and BP. The comparable low late survival in the two groups was predominantly influenced by non-valve-related deaths. A higher incidence of anticoagulant-related hemorrhages limits the use of MP in elderly patients. Thus, in this population, BP should be preferred not just on the basis of their expected longer durability, but mainly to avoid the risk of anticoagulant-related hemorrhages

Valve-related complications in elderly patients with biological and mechanical aortic valves

BACKGROUND: Controversy still exists about the choice of aortic prosthesis in elderly patients. This study investigates valve- and anticoagulant-related morbidity and mortality in elderly patients after aortic valve replacement (AVR) with a biologic (BP) or mechanical prosthesis (MP). METHODS: Between 1981 and 1995, 355 consecutive patients aged 70 years or older (mean, 74+/-4 years; range, 70 to 87 years) underwent isolated AVR. There were 222 (63%) replacements with an MP and 133 (37%) with a BP. Mean follow-up was 3.7+/-2.8 years (range, 3 months to 15 years), with a total follow-up of 1,214 patient-years. RESULTS: Hospital mortality was 7.6% (27 of 355), decreasing to 4.6% in the last 3 years. There were 55 late deaths, 33 in patients with MP and 22 in those with BP. At 10 years there was no significant difference between MP and BP recipients in the actuarial estimates of survival (51%+/-8% versus 33%+/-13%), freedom from valve-related death (82%+/-7% versus 72%+/-12%), and freedom from thromboembolism (84%+/-7% versus 94%+/-3%). In contrast, 10-year freedom from anticoagulant-related hemorrhages was 74%+/-8% for MP and 99%+/-1% for BP (p = 0.02). Only 1 structural deterioration occurred, in a patient with BP. CONCLUSIONS: Satisfactory early results can be obtained in elderly patients after AVR with both MP and BP. The comparable low late survival in the two groups was predominantly influenced by non-valve-related deaths. A higher incidence of anticoagulant-related hemorrhages limits the use of MP in elderly patients. Thus, in this population, BP should be preferred not just on the basis of their expected longer durability, but mainly to avoid the risk of anticoagulant-related hemorrhages

Bilateral Relations in the Mediterranean - Prospects for Migration Issues

This timely book assesses national and supranational bilateral approaches to dealing with the rising tide of migration into the European Union via the Mediterranean Sea. International law and EU migration law specialists critically assess the legal tools adopted to engage with the \u2018refugee crisis\u2019. While the EU works to develop a unified approach to Mediterranean transit and origin countries, the authors argue that a crucial role should be accorded to individual states in finding a solution to this complex and sensitive situation