Miltefosine in the Treatment of Cutaneous Leishmaniasis Caused by Leishmania braziliensis in Brazil: A Randomized and Controlled Trial

Cutaneous leishmaniasis (CL) is characterized by skin ulcerations and occurs in rural poor areas of developing countries. It is treated with daily injections of antimony for 20 days, which is associated with irregular use and increasingly lower cure rates. Miltefosine is an oral medication with activity against the agent of CL (Leishmania). We have studied the efficacy and safety of miltefosine compared with antimony in patients with CL caused by Leishmania braziliensis in Bahia, Brazil. A total of 90 patients participated; 60 received miltefosine and 30 were treated with antimony. Six months after treatment, 75% of patients treated with miltefosine were cured, compared with 53% of the patients in the antimony group, a difference considered significant (p = 0.04). We also found that miltefosine was more effective than antimony in adults than in children. The incidence of side effects was similar with both drugs (76.7% vs. 78.3%), but all patients were able to finish the treatments. Our study shows that miltefosine is more effective than antimony for the treatment of CL in Bahia, Brazil and can contribute to the control of this disease due to its activity and easier administration

Oil pollution in the North Sea: the impact of governance measures on oil pollution over several decades

Oil pollution entering the marine environment has been an issue of concern for many decades. It can come from riverine or land-based sources, accidental and intentional discharges from ships, or as a by-product of offshore oil extraction. Growing awareness of the impact of oil pollution on the marine environment has led, since the late 1960s, to the introduction of measures to reduce or eliminate pollution from shipping and the offshore oil industry. A framework for environmental protection of the North Sea has developed over many decades through international agreements, regional cooperation, and national measures, while education has also played an important role with modern-day sailors being given due training to understand that dumping waste at sea is illegal in many areas, and is harmful to the marine environment. This paper presents data on trends in pollution from ships and oil installations. While significant reductions in oil pollution have been identified over more than two decades, there remain some areas where action is needed to reduce inputs still further, especially from oil and gas platforms

Comment letters to the National Commission on Commission on Fraudulent Financial Reporting, 1987 (Treadway Commission) Vol. 1

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