***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Cutaneous leishmaniasis ( CL ) treatment is based on pentavalant antimony ( sbv ) drugs which are accompanied by many side effects and are facing ever-increasing resistance . Topical treatment of CL is an attractive alternative avoiding toxicities of parenteral therapy while being administered through a simple painless route . The liposomal formulations of different drugs have recently been increasingly used in the treatment of several types of leishmaniasis . The efficacy of a topical liposomal azithromycin formulation was compared with intralesional meglumine antimoniate ( glucantime ) in the treatment of CL . Sixty-six patients with 97 lesions who met our inclusion criteria were r and omly divided into two groups . One group was administered with the topical liposomal form of azithromycin twice daily . The other group was treated by weekly intralesional injections of glucantime with a volume of 0.5 - 2 cm3 into each lesion till complete blanching of the lesion occurred . Clinical evaluations were performed weekly during the treatment course ( 8 weeks ) by a single dermatologist for both groups . Per- protocol analysis showed no statistically significant difference between the two groups ( p = 0.84 , 95 % confidence interval ( CI ) = 0.764 ( 0.714 - 0.821 ) . Serious drug side effects were not observed in either group . Topical liposomal azithromycin has the same efficacy as intralesional glucantime in the treatment of CL Background Cutaneous leishmaniasis ( CL ) is a disfiguring disease that confronts clinicians with a qu and ary : leave patients untreated or engage in a complex or toxic treatment . Topical treatment of CL offers a practical and safe option . Accordingly , the treatment of CL with WR279,396 , a formulation of paromomycin and gentamicin in a hydrophilic base , was investigated in a phase 2 clinical study in Tunisia and France . Methods A phase 2 , r and omized , double blind , vehicle-controlled study was conducted to assess the safety and efficacy of topical WR279,396 when applied twice a day for 20 days as treatment for parasitologically confirmed CL . The study protocol established the primary efficacy end point as complete clinical response ( CCR ) defined as 50 % or greater reduction in the ulceration size of an index lesion by day 50 ( D50 ) followed by complete re-epithelialization by D100 , and no relapse through D180 . Results Ninety-two subjects were r and omized . Leishmania major was identified in 66 of 68 isolates typed ( 97 % ) . In the intent-to-treat population , 47 of 50 WR279,396 treated participants ( 94 % ) met the definition of CCR , compared with 30 of 42 vehicle-placebo participants ( 71 % ) [ p = 0.0045 ] . Erythema occurred in 30 % and 24 % of participants receiving WR279,396 and placebo , respectively [ p = 0.64 ] . There was no clinical or laboratory evidence of systemic toxicity . Conclusion Application of WR279,396 for 20 days was found to be safe and effective in treating L. major CL , and offers great potential as a new , simple , easily applicable , and inexpensive topical therapy for this neglected disease . Trial Registration Clinical Trials.gov Background Leishmaniasis is an endemic disease in Iran . Although many treatments have been suggested for this disease , there has n't been an effective and safe treatment yet . Regarding the healing effect of honey  in the chronic ulcers and its reported therapeutic effect in cutaneous leishmaniasis , we performed a study to better evaluate the efficacy of honey in cutaneous leishmaniasis and its final scar . Methods In a prospect i ve clinical trial , 100 patients with confirmed cutaneous leishmaniasis were selected and r and omized into 2 groups . Group A were treated with topical honey twice daily along with intralesional injection of glucantime once weekly until complete healing of the ulcer or for maximum of 6 weeks . Group B were treated with intralesional injection of glucantime alone until complete healing of the ulcer or for a maximum of 6 weeks , too . The patients were followed for 4 months . The collected data were analyzed statistically using statistical tests including Chi-square , Mann Whitney and Kaplan – Mayer tests . Results In this study , 45 patients that had cutaneous leishmaniasis were treated with intralesional glucantime alone and 45 patients were treated with topical honey and glucantime .  Ten patients left out the study . In the glucantime alone treated group , 32 patients ( 71.1 % ) had complete cure whereas in the group treated with both glucantime & topical honey , 23 patients ( 51.1 % ) achieved complete cure . This difference was significant statistically ( p = 0.04 ) . Conclusion Further studies to better clarify the efficacy of honey in cutaneous leishmaniasis is needed . We suggest that in another study , the efficacy of honey with st and ardized level of antibacterial activity is evaluated against cutaneous leishmaniasis Cutaneous leishmaniasis ( CL ) is endemic in the Bikaner region situated in the Thar Desert of Rajasthan , India . This study describes clinicoepidemiological data of pediatric CL in pre-school children ( 0 - 5 years of age ) from this region during 2001 - 2012 . In total , 151 patients with 217 lesions were reported during the study period . The mean age of the study group was 3.29 ± 1.43 years ( 0.25 - 5 years ) , with many ( 41.7 % ) cases being in the age group of 2 - 4 years . Face was the most common site involved , and morphologically , the lesions were either plaque type or papulonodular . Smear for parasitologic examination was positive in 84 ( 70 % ) of 120 cases , and histopathologic examination confirmed CL in 10 ( 55.55 % ) of 18 cases . Parasite species identification conducted for 13 r and omly selected patients by polymerase chain reaction identified Leishmania tropica as the causative species . Intralesional sodium stibogluconate was the most commonly used treatment and found to be well-tolerated . Other therapies that were effective included oral rifampicin , oral dapsone , radiofrequency heat therapy ( RFHT ) , and combinations of the three therapies This is an open study to compare the cure rate of cutaneous leishmaniasis caused by L. major and treated with either paromomycin sulfate or intralesional injection of meglumine antimoniate .  Sixty parasitologically proven cases with 1 - 3 lesions were included and divided r and omly into two equal groups ; one group received 1 ml of meglumine antimonate intradermally every other day for 20 days , the other group received the ointment containing 15 % parmomycin sulfate in urea twice daily for 20 days . The patients were clinical ly evaluated at 1 and 6 weeks after treatment was completed . The results of clinical evaluation at 1 week after treatment completed showed a cure rate of 18 out of 27 ( 66 % ) in the meglumine antimonate injected group and 20 out of 29 ( 68 % ) in the paromomycin sulfate treated group . The chi square test was used to compare the cure rate between the two groups and showed no significant difference ( p = 0.85 ) BACKGROUND Intralesional 7 % hypertonic saline ( HS ) has been shown to be effective and safe against Leishmania donovani and Leishmania major cutaneous leishmaniasis ( CL ) , with cure rates of 92 % and 96 % , respectively . This study was design ed to assess the efficacy and safety of 10 % and 15 % HS in CL . METHODS A total of 444 patients ( 643 lesions ) were r and omly allocated to sodium stibogluconate ( SSG ) , 10 % HS and 15 % HS at a ratio of 2 : 2 : 1 , taking into consideration any unwanted side effects that might arise with 15 % HS . The follow-up period was 18 months . Survival analysis using Cox proportional hazard regression was performed to assess the effectiveness of the three treatment modalities . The clinical trial was registered at the Sri Lanka Clinical Trial Registry ( SLCTR/2013/024 ) . RESULTS Treatment with SSG result ed in a cure rate of 96.3 % within one to seven injections ( mean : 3.6 injections ) ; the mean ( median ) duration of treatment was six weeks ( 6 weeks ) per lesion . Treatment with 10 % HS showed a cure rate of 93.0 % within one to 10 injections ( mean : 5.28 injections ) ; the mean ( median ) duration of treatment was 9.3 weeks ( 9 weeks ) per lesion . Treatment with 15 % HS showed a cure rate of 93.6 % within two to 10 injections ( mean : 5.3 injections ) ; the mean ( median ) duration of treatment was 11.3 weeks ( 10.0 weeks ) per lesion . Treatment with 10 % HS and 15 % HS caused cutaneous necrosis in 3.1 % and 30.6 % of lesions , respectively . Despite continuous data collection for 14 months , we were unable to recruit a sample of sufficient size . Seventeen ( 3.8 % ) patients were lost to follow-up , and 24 ( 5.4 % ) were partial or non-responders . CONCLUSIONS This study found 10 % HS to be an effective and safe alternative to SSG . Treatment with HS at concentrations of 15 % or above was not safe as a result of cutaneous necrosis . Safety was not studied for concentrations of 11 - 14 % , and these concentrations should be avoided pending further evidence . Hypertonic saline is very cheap ( < US$ 1 per 100 ml , whereas SSG is priced at US$ 160 per 100 ml ) , is prepared locally and has no systemic side effects and minimal local side effects Background A previously published proof of principle phase IIa trial with 113 patients from Kabul showed that bipolar high-frequency ( HF ) electro-cauterization ( EC ) of cutaneous leishmaniasis ( CL ) ulcers and subsequent moist wound treatment ( MWT ) closed 85 % of all Leishmania ( L. ) tropica lesions within 60 days . Methods A three-armed phase IIb , r and omized and controlled clinical trial was performed in Mazar-e-Sharif . L. tropica- or L. major-infected CL patients  received intradermal sodium stibogluconate ( SSG ) ( Group I ) ; HF-EC followed by MWT with 0.045 % DAC N-055 ( Group II ) ; or MWT with 0.045 % DAC N-055 in basic crème alone ( Group III ) . The primary outcome was complete epithelialisation before day 75 after treatment start . Results 87 patients enrolled in the trial were r and omized into group I ( n = 24 ) , II ( n = 32 ) and III ( n = 31 ) . The per- protocol analysis of 69 ( 79 % ) patients revealed complete epithelialisation before day 75 in 15 ( of 23 ; 65 % ) patients of Group I , in 23 ( of 23 ; 100 % ) patients of Group II , and in 20 ( of 23 ; 87 % ) patients of Group III ( p = 0.004 , Fisher ’s Exact Test ) . In the per- protocol analysis , wound closure times were significantly different between all regimens in a pair-wise comparison ( p = 0.000039 , Log-Rank ( Mantel-Cox ) test ) . In the intention-to-treat analysis wound survival times in Group II were significantly different from those in Group I ( p = 0.000040 , Log-Rank ( Mantel-Cox ) test ) . Re-ulcerations occurred in four ( 17 % ) , three ( 13 % ) and seven ( 30 % ) patients of Group I , II or III , respectively ( p = 0.312 , Pearson Chi-Square Test ) . Conclusions Treatment of CL ulcers with bipolar HF-EC followed by MWT with 0.045 % DAC N-055 or with DAC N-055 alone showed shorter wound closure times than with the st and ard SSG therapy . The results merit further exploration in larger trials in the light of our current knowledge of in vitro and in vivo activities of chlorite . Clinical trials.gov ID : NCT00996463 . Registered : 15th October 2009 Background . Cutaneous leishmaniasis is an endemic disease in Iran .  Pentavalent antimonial drugs have been the first line of therapy in cutaneous leishmaniasis for many years . However , the cure rate of these agents is still not favorable . This study was carried out to compare the efficacies of intralesional glucantime with topical trichloroacetic acid 50 % ( TCA 50 % ) + glucantime and fractional carbon dioxide laser + glucantime in the treatment of cutaneous leishmaniasis . Methods . A total of 90 patients were r and omly divided into three groups of 30 to be treated with intralesional injection of glucantime , a combination of topical TCA 50 % and glucantime , or a combination of fractional laser and glucantime . The overall clinical improvement and changes in sizes of lesions and scars were assessed and compared 
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CONCLUSIONS Despite the high heterogeneity and low method ological quality of studies , an indirect comparison shows that the antimony infiltration efficacy rate is similar to that reported for antimony systemic use .
The evidence gathered thus far is insufficient to identify the ideal IL therapeutic regime or estimate the rates of adverse events and mucosal late complications