28th February Research Articles

In Memoriam: René Fiasse (1936-2024).

It is with great sadness that we learned of the death of Professor René Fiasse on the 26th of February 2024, at the age of 87. Born in Quiévrain in 1936 in the Borinage region, to two teachers, he was the eldest of four children. From an early age, he developed a quality that would mark him throughout his life: a committed humanism. Struck by the horrors of war, he became interested in international politics and then became actively involved in the pacifist movements and Amnesty International. Having received a pluralist education and thanks to his open-mindedness, he was always ahead of his time when it came to major ethical issues.

“Implementation of intensified COVID-19 vaccination optimization (ICVOPT) campaigns strategy in complex humanitarian emergency settings and hard-to-reach areas; a case of South Sudan”

IntroductionThe COVID-19 pandemic is still a public health concern in South Sudan having caused suffering since the first case of COVID-19 was introduced on 28th February 2020. COVAX vaccines have since been introduced using a number of strategies including fixed site, temporary mobile, hit and run in flooded and conflict affected areas. We aim to describe the 2 ICVOPT campaigns that were conducted to improve the uptake and document lessons learnt during the initial rollout of the COVID-19 vaccination programin South Sudan between February 2022 and June 2022 each lasting for 7-days.MethodologyWe conducted an operational cross-sectional descriptive epidemiological study of a series of the intensified COVID-19 vaccination Optimization (ICVOPT) campaigns from February 2022 to June 2022. Before the campaign, a bottom up micro-planning was conducted, validated by the County Health Departments (CHDs) and national MOH team. Each of the 2 campaigns lasted for 7 days targeting 30% of the eligible unvaccinated target population who were18 years and above. Each team consisted of 2 vaccinators, 2 recorders and 1 mobilizer. The teams employed both fixed site, temporary mobile, hit and run in flooded and conflict affected areas. The number of teams were calculated based on the daily workload per day (80 persons per team/day) for the duration of the campaigns.ResultsA total of 444,030 individuals were vaccinated with primary series COVID-19 vaccine (J&J) out of the targeted 635,030 persons. This represented 69.9% of target population in the selected 28 counties and 10 states of South Sudan in 7 days’ ICVOPT campaigns. More eligible persons were reached in 7 days campaigns than the 9 months of rollout of the COVID-19 vaccine prior to ICVOPT campaigns using the fixed site strategy at the health facility posts.ConclusionIntensified COVID-19 vaccination Optimization (ICVOPT) campaigns were vital and fast in scaling up vaccination coverages as compared to the fixed site vaccination strategies (2022 progress report on the Global Action Plan for Healthy Lives and Well-being for All Stronger collaboration for an equitable and resilient recovery towards the health-related Sustainable Development Goals, incentivizing collaboration, 2022) in complex humanitarian emergency settings and hard-to-reach areas of South Sudan.

Mortality predictors in earthquake victims admitted to intensive care unit in Kahramanmaraş earthquakes

BackgroundThe purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaraş, Türkiye, and to investigate parameters affecting mortality. MethodsThe demographic characteristics of patients followed-up in intensive care due to trauma following the earthquake, the treatments administered, developing complications, lengths of stay in the hospital and intensive care, and laboratory data were scanned retrospectively and recorded. These data were then compared between the surviving and non-surviving patients. ResultsTwenty-six patients, 13 (50 %) male, were followed-up in our intensive care, 24 (92 %) due to being buried under earthquake debris, and 2 (8 %) due to falling from heights. Increased Sequential Organ Failure Assessment (SOFA) (p = 0.027), higher initial serum potassium (p = 0.043), higher initial serum phosphorus (p = 0.035), higher initial and peak serum magnesium (p = 0.004 and p = 0.001), lower initial and peak bicarbonate (p = 0.021 and p = 0.012) and higher initial and peak serum base deficit values (p = 0.012 and p = 0.009) were associated with mortality. In the subgroup with crush injuries, higher initial and peak serum potassium (p = 0.001 and p = 0.025), higher initial and peak serum magnesium (p = 0.005 and p = 0.004), lower initial and peak bicarbonate (p = 0.019 and p = 0.021) and higher initial and peak serum base deficit values (p = 0.017 and p = 0.025) were associated with mortality. Multiorgan dysfunction failure developed in nine patients, sepsis in seven, dissemine intravascular coagulation in four, and acute respiratory distress syndrome in two. Fasciotomy was performed on 2 (8 %) patients and amputation on 8 (31 %). Extremity injuries were most frequently observed. 10 (38.5 %) of the 12 (46 %) patients developing acute kidney injury required renal replacement therapy. 7 (27 %) patients died during follow-up. In logistic regression analysis, higher SOFA scores, lower initial bicarbonate and BE levels, higher serum initial potassium and magnesium levels were a risk factor for mortality. Higher SOFA scores, lower initial bicarbonate and base deficit and higher initial phosphorus values affected mortality in patients with crush syndrome. ConclusionNot only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.

Typology and implications of verified attacks on health care in Ukraine in the first 18 months of war.

Attacks on health care are part of the spectrum of threats that health care endures during conflict. Protecting health care services against attacks depends on understanding the nature and types of attacks that occur during conflict. The World Health Organisation has implemented the Surveillance System for Attacks on Health Care (SSA) in Ukraine since 2020, and the system has continued to monitor and report on attacks on health care during the war in Ukraine. This study aims to analyse the data reported through the SSA for the first 18 months of the war. This paper involves a retrospective, descriptive study based on the analysis of publicly available SSA data of all incidents of attacks on health care in Ukraine reported through the SSA between February 24th 2022 and August 24th 2023. Out of the 1503 verified attacks, 37% occurred in the initial six weeks of the war. Attacks involving violence with heavy weapons were among the most common incidents reported (83%). The reported attacks were associated with a total of 113 deaths and 211 injuries among health care workers and patients: 32 (2%) attacks were associated with a death of a health care worker or patient, and 63 (4%) were associated with an injury. Health transports facing attacks had a higher probability of experiencing casualties than other health resources (p<0.0001, RR 3.1, 95%CI 1.9-4.9). In conclusion, the burden of attacks on health care in Ukraine was high and sustained over the course of the first 18 months of the war. Reported casualties were not homogenously distributed among attack incidents, but occurred in a set of high-casualty incidents. Health transports were found to be particularly vulnerable. In addition to continued calls for a cessation of hostilities, prevention, protection, mitigation, and reconstruction strategies are urgently required.

Earthquake “doublets” – case studies for Kresna-Kroupnik (Bulgaria-M7.8) and Gaziantep–Kahramanmaraş (Turkey-M7.8)

The devastating earthquakes (M7.8 and M7.5) on 6th February 2023 demonstrate the power of the nature and weakness and fragility of the human society. Affecting more than 20 million people in Turkey, the death poll reaches about 60 000 deaths and about three times more injured, 120 000 buildings destroyed and more than 60 billion economical losses in Turkey and Syria. This tremendous seismic event at the same time gave the possibility to study and extract the lessons learned and to prevent heavy consequences when next similar event occurred. Following the context of the specific behavior of the seismic process this event can be attributed to the terminology using the word “doubles” of such a combination of two very strong earthquakes occurred in close space and time window – near Gaziantep and Kahramanmaraş. The two strong earthquakes of 6th February demonstrated all peculiarities of the seismic process and its geophysical, seismological and social consequences. The similar effects have been observed also in 1904 in Bulgaria. On 4th of April, 1904 two very strong earthquakes (M7.2 and M7.8) occurred in a very close time and space domain. These seismic events can also be classified as a “doublet”. So the comparative analysis of such strong earthquakes can help to understand better the seismic process and the following risks for the population, infrastructure and the affected countries as a whole. This paper is targeted to the comparison of the case studies to the seismic doublets in Bulgaria and Turkey and their peculiarities with a focus on the seismic process, destructions, negative social consequences and the specifics if they exist and to extract knowledge which can be useful for the prevention of all possible negatives. The results obtained suggest that similar seismic events might have very different geophysical, seismological and social consequences due to the resilience and environmental peculiarities of the specifically affected sites.

Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review.

Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. Mixed studies systematic review. Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

Media Ombudsmen on the Scale in Africa: How Journalists Assess the Cameroon National Communication Council’s Sanction and Non-Suit Decisions of 2013-2015

This study is an assessment of the content of the Cameroon National Communication Council’s (NCC) sanction and non-suit decisions by journalists. The purpose is to determine the perceptions Cameroon journalists have of their National Communication Council and its decisions and to establish a correlation between the perceptions and the content of the decisions.” A survey of 108 journalists working in 40 media houses across four major regions in the country was conducted between the 11th of May and the 19th of June 2015. A textual analysis of 31 NCC sanction and non-suit decisions issued from the 5th of September 2013 to the 24th of February 2015 was also done. The results show that 59.3% of the respondents from the survey and 61.3% of data from the textual analysis indicate that NCC sanctions are protective of state officials and VIPs. Paradoxically, most of the respondents made positive assessments of the NCC decisions in relation to accusations that the decisions were biased, selective and politically motivated with 64.8% and 57.4 % in disagreement as compared to 35.2% and 42.6% in agreement, for the survey and textual analysis respectively. But the findings also reveal that there is a common opinion amongst sanctioned and unsanctioned journalists that the government has an influence on NCC decisions. The study, therefore, recommends that NCC should not focus only on sanctioning journalists and media houses but should also work to encourage journalists and press freedom through the organisation of capacity building workshops for journalists in order to build their capacity to respect professionalism. NCC should also communicate the justifications of their decisions to dispel the opinion that their decisions are influenced by the government.

Abstract PO3-04-06: A comparison of the efficacy of trastuzumab deruxtecan in advanced HER2-positive breast cancer: active brain metastasis versus progressive extracranial disease alone

Abstract Background Trastuzumab deruxtecan (T-DXd) has demonstrated efficacy in patients with brain metastasis (BM), a group historically with poor outcomes. The prevalence of BMs in patients commencing T-DXd is currently unknown. To date, no direct comparisons have been made of the activity of T-DXd in patients with active BM versus those with extracranial progression alone. This real-world study explored the prevalence of BMs at commencement of T-DXd, the efficacy of T-DXd in active BM versus extracranial progression alone and the safety of T-DXd. Methods Patients with HER2-positive advanced breast cancer treated with T-DXd between June 2021 and February 2023 at our specialist cancer hospital were identified and notes reviewed. Clinico-pathological information, prior treatment, the presence or absence of CNS disease, outcomes and treatment-emergent adverse events (TEAE) were recorded. Data cut-off was 28th February 2023. Results 29 female patients: 16 extracranial disease alone, 12 BM and 1 LMD were identified. Prevalence of BM at commencement of T-DXd was 41% (12 of 29). Median age was 52 (IQR 44-62), with a median 2 (range 2-6) prior lines of HER2 directed and chemotherapy:86% (25 of 29) had received prior trastuzumab and pertuzumab, 100% (29 of 29) T-DM1 and 3% (1 of 29) patient trastuzumab duocarmazine. At a median follow-up of 13.8 months, median progression free survival (PFS) for overall population was 13.9 months (95% CI: 12.4-NE), 16.1 months (95% CI: 15.1-NE) for active BMs, and 12.4 months (95% CI: 8.3-NE) for progressive extracranial disease alone (P=0.106). 12-month OS rate was 74% (95% CI: 59-95) in the overall population, 83% (95% CI: 58-100) and 66% (95% CI: 45-96) for active BMs, and extracranial only disease respectively (P=0.678). Objective response rates: overall population was 69% (95% CI: 52-86), active BMs was 60% (95% CI: 30-90), and progressive extracranial disease alone was 69% (95% CI: 46-91). 6% (1 of 16) with extracranial disease alone developed BM during treatment with T-DXd. Reasons for treatment discontinuation: 67% (10 of 15) disease progression or death; 33% (5 of 15) toxicity. 48% (14 of 29) remain on treatment. Most common TEAEs were fatigue (97%; 28 of 29), alopecia (76%; 22 of 29), and constipation (72%; 21 of 29). Pneumonitis occurred in 9 patients (31%, included 2 deaths). 1 pathologically confirmed case of radionecrosis was documented. An updated analysis with an additional 9 patients who commenced T-DXd since February 2023 will be presented. Conclusion In this real-world study a significant number of patients had BM at the commencement of T-DXd. We demonstrate that in advanced HER2 positive breast cancer that T-DXd is as effective, in terms of PFS and OS, in active BMs as it is in progressive extracranial disease alone. These data provide the first evidence that in contrast to the historical data that active BM may no longer be a detriment to survival as compared to progressive extracranial disease alone when treated with T-Dxd. These observations warrant further investigations in larger series. The high rate of pneumonitis warrants further consideration. Citation Format: James Pearson, Adeel Khan, Talvinder Bhogal, Helen Wong, Andrea Law, Samantha Mills, Nuria Santamaria, Joanne Cliff, Douglas Errington, Allison Hall, Clare Hart, Zafar Malik, Raj Sripadam, Helen Innes, Helen Flint, Gabriella Langton, Eliyaz Ahmed, Jill Bishop, Richard Jackson, Carlo Palmieri. A comparison of the efficacy of trastuzumab deruxtecan in advanced HER2-positive breast cancer: active brain metastasis versus progressive extracranial disease alone [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-04-06.

Post-diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading.

Based on the World Cancer Research Fund Global Cancer Update Programme, we performed systematic reviews and meta-analyses to investigate the association of post-diagnosis adiposity, physical activity, sedentary behaviour, and dietary factors with colorectal cancer prognosis. We searched PubMed and Embase until 28th February, 2022. An independent expert committee and expert panel graded the quality of evidence. A total of 167 unique publications were reviewed, and all but five were observational studies. The quality of the evidence was graded conservatively due to the high risk of several biases. There was evidence of non-linearity in the associations between body mass index and colorectal cancer prognosis. The associations appeared reverse J-shaped, and the quality of this evidence was graded as limited (likelihood of causality: limited-no conclusion). The evidence on recreational physical activity and lower risk of all-cause mortality (relative risk [RR] highest vs. lowest: 0.69, 95% confidence interval [CI]: 0.62-0.77) and recurrence/disease-free survival (RR: 0.80, 95% CI: 0.70-0.92) was graded as limited-suggestive. There was limited-suggestive evidence for the associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), intake of whole grains and coffee with lower risk of all-cause mortality, and between unhealthy dietary patterns and intake of sugary drinks with higher risk of all-cause mortality. The evidence for other exposures on colorectal cancer outcomes was sparse and graded as limited-no conclusion. Analyses were conducted excluding cancer patients with metastases without substantial changes in the findings. Well-designed intervention and cohort studies are needed to support the development of lifestyle recommendations for colorectal cancer patients.

Post-diagnosis dietary factors, supplement use and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis.

The role of diet in colorectal cancer prognosis is not well understood and specific lifestyle recommendations are lacking. We searched for randomised controlled trials (RCTs) and longitudinal observational studies on post-diagnosis dietary factors, supplement use and colorectal cancer survival outcomes in PubMed and Embase from inception until 28th February 2022. Random-effects dose-response meta-analyses were conducted when at least three studies had sufficient information. The evidence was interpreted and graded by the CUP Global independent Expert Committee on Cancer Survivorship and Expert Panel. Five RCTs and 35 observational studies were included (30,242 cases, over 8700 all-cause and 2100 colorectal cancer deaths, 3700 progression, recurrence, or disease-free events). Meta-analyses, including 3-10 observational studies each, were conducted for: whole grains, nuts/peanuts, red and processed meat, dairy products, sugary drinks, artificially sweetened beverages, coffee, alcohol, dietary glycaemic load/index, insulin load/index, marine omega-3 polyunsaturated fatty acids, supplemental calcium, circulating 25-hydroxyvitamin D (25[OH]D) and all-cause mortality; for alcohol, supplemental calcium, circulating 25(OH)D and colorectal cancer-specific mortality; and for circulating 25(OH)D and recurrence/disease-free survival. The overall evidence was graded as 'limited'. The inverse associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), whole grains, total, caffeinated, or decaffeinated coffee and all-cause mortality and the positive associations between unhealthy dietary patterns, sugary drinks and all-cause mortality provided 'limited-suggestive' evidence. All other exposure-outcome associations provided 'limited-no conclusion' evidence. Additional, well-conducted cohort studies and carefully designed RCTs are needed to develop specific lifestyle recommendations for colorectal cancer survivors.

Comparative analysis of cholera serum vibriocidal antibodies from Convalescent and vaccinated adults in Zambia

Cholera is responsible for 1.3 to 4.0 million cholera cases globally and poses a significant threat, with Zambia reporting 17,169 cases as of 4th February 2024. Recognizing the crucial link between natural cholera infections and vaccine protection, this study aimed to assess immune responses post cholera infection and vaccination. This was a comparative study consisting of 50 participants enrolled during a cholera outbreak in Zambia’s Eastern Province and an additional 56 participants who received oral cholera vaccinations in Zambia’s Central Province. Vibriocidal antibodies were plotted as geometric mean titres in the naturally infected and vaccinated individuals. A significant difference (p < 0.047) emerged when comparing naturally infected to fully vaccinated individuals (2 doses) on day 28 against V. cholerae Ogawa. Those who received two doses of the oral cholera vaccine had higher antibody titres than those who were naturally infected. Notably, the lowest titres occurred between 0–9 days post onset, contrasting with peak responses at 10–19 days. This study addresses a critical knowledge gap in understanding cholera immunity dynamics, emphasizing the potential superiority of vaccination-induced immune responses. We recommend post infection vaccination after 40 days for sustained immunity and prolonged protection, especially in cholera hotspots.

Changing the Game: Interventional Radiology’s Growing Impact on Imaging

THIS YEAR’s European Congress of Radiology (ECR) took place in Vienna, Austria, from 28ᵗʰ February–3ʳᵈ March, and featured a gripping Innovation in Focus session that delved into the various ways interventional radiology (IR) is changing imaging today. Chaired by Jurgen Fütterer, University of Twente, Enschede, the Netherlands, the session featured talks discussing the evolution of interventional radiology from past to present, and where it will take us next.

Cancer Screening and Detection: Can AI Change The Game?

“We recognise that cancer detection is one of the main pillars of how to take care of the population today,” remarked Luis Marti-Bonmati, Le Fe Polytechnic and University Hospital, Valencia, Spain, who chaired a session at the European Congress of Radiology (ECR). In a timely conversation, the role of artificial intelligence (AI) in the screening, early detection, and depiction of tumours was explored at the annual ECR congress, which took place in Vienna, Austria, from the 28th February–3rd March 2024.

The Early Development History of the Relationship between Taiwanese Nationalism and Chinese Nationalism

This article aims to sort out the historical context of the first eighty years of the emergence and development of Taiwanese nationalism and explore the relationship between Taiwanese nationalism and Chinese nationalism. Taiwanese nationalism originated during the Japanese occupation. The unequal rule of the Japanese colonial government on the Taiwanese islanders united the Taiwanese people and formed an ideological community. At the same time, the Japanese government brought modern political concepts and environment to the island of Taiwan, providing fertile soil for the development of nationalism. During the Japanese occupation, Taiwan's nationalism was China's nationalism. The people of Taiwan identify with the cultural and ideological traditions of the Chinese nation and hope to return to the embrace of the motherland. However, the Kuomintang government's violent and corrupt rule over the Taiwanese people after liberation greatly disappointed the islanders. They gradually realized that the Kuomintang government was backward and that Taiwan could no longer become part of mainland China. After the February 28th Incident, Taiwanese nationalism further developed. Unlike Chinese nationalism, the Taiwanese formed a new nation of political and cultural self-determination.

The impact of natural disaster on mental health and how to deal with it?

AbstractNatural disasters are and will continue to represent a great challenge in addressing mental health issues globally. The most devastating recent (earthquakes on 6th February 2023 in Turkey and Syria) caused death of more than 55,000 people, injury of about 100,000 people and loss of property, overall affecting millions of people. Moreover, in the last several years in Europe, they came in a form of double disasters (for example coupled with the COVID-19 pandemic) and pointed out the unpreparedness of the health (including mental health) sectors for the emergency situations.However, in going through these experiences, we also learnt some of the practices that proved effective – including the fast creation of collaborative networks on a larger scale that also allowed fast spread of good practices and practical organisation of help. As a practical example of it - verbalized by the mental health professionals from Turkey through the Council of National Psychiatric Associations of the European Psychiatric Association, we organized a webinar delivered by experienced clincians, trauma experts and experts with lived experince in the earthquake zones. However, structural -implementation of mental health policies that focus on prevention and improving crisis response in care delivery are important to support populations affected by natural disasters to prevent the trauma sequel.Disclosure of InterestNone Declared

Intra-tumoral immunomodulatory therapy for advanced abdominal cancers using lipopolysaccharide: The Regional Immuno-Oncology Trial-1 (RIOT-1) protocol (NCT05751837)

BackgroundIntra-tumoral immunotherapy has shown potential in treating advanced cancers. Delivery challenges have limited exploration of these modalities in intra-abdominal tumors. In this study, we explore the safety of injecting intra-abdominal tumors with lipopolysaccharide (LPS) from Escherichia coli 0113. This agonist of toll-like receptor 4 (TLR4) holds promise as an agent to enhance the anti-tumor immune response within the tumor microenvironment. MethodsThis Phase I study will recruit adult patients with peritoneal metastases from gastrointestinal primary malignancies who have at least two suitable intra-abdominal soft tissue tumors for injection. LPS will be administered as a single 1 μg dose during diagnostic laparoscopy in patients in whom a subsequent interval laparotomy is planned. A control injection of saline will be injected into a second lesion. Primary outcome is safety, with secondary outcomes being biomarkers of the tumor immune microenvironment in pre- and post-treatment biopsies. ResultsThe primary endpoint is to determine the safety (frequency and nature of adverse events) following intra-tumoral LPS injection. Adverse events will be classified using Common Terminology Criteria for Adverse Events. Secondary endpoints include cellular and molecular biomarkers of immune response. The study will proceed until twelve patients have completed the protocol. DiscussionPatients undergoing standard-of-care laparoscopy in preparation for interval cytoreductive surgery may be ideal candidates for intra-tumoral immunotherapy. This study seeks to establish the safety of using E. coli LPS for injection into intra-abdominal tumors and to establish precedent for interval tumor immune microenvironment assessment as a window-of-opportunity concept in the context of abdominal metastatic disease. Trial RegistrationThe trial is registered at Clinical Trials.gov; NCT05751837 (registered February 28th, 2023).

APPROACHES OF RUSSIA AND TURKEY IN STRENGTHENING REGIONAL SECURITY IN THE MIDDLE EAST AND CENTRAL ASIA IN THE SECOND HALF OF THE 20TH AND THE FIRST QUARTER OF THE 21ST CENTURIES

The article considers the problem of regional security which is on the agenda of the international community. Russia and Turkey as two politically and economically interconnected countries have a rich history of relations. The Middle East and Central Asia where their national interests overlap are priority directions at the present stage. However, disagreements in conflict resolution do not allow reaching a compromise and entering a new level of interaction. At the beginning of the 21st century Russia and Turkey showed an interest in strengthening regional security and achieving peace and stability. Although the incident in November of 2015 slowed down the development of cooperation and caused the refusal to maintain friendly contacts Moscow and Ankara realized the need to overcome differences and follow the provisions of concluded treaties and agreements. The beginning of a special military operation in Ukraine on the 24th of February of 2022 showed their complex and ambiguous interaction in the Middle East and Central Asia. The aim of the article is to identify the approaches of Russia and Turkey in strengthening regional security.

Changes in public attitude toward epilepsy in Hungary since 1994. A multicriteria weighting analysis.

To assess the adult Hungarian population's knowledge about and attitude toward epilepsy and compare the present findings with previous ones in 1994 and 2000. We performed a cross-sectional survey of the Hungarian adult population from 28th February to 8th March 2023. A non-probability quota sampling with a random walk method was used. We applied the computer-assisted personal interviewing (CAPI) method and used a multicriteria weighting procedure to correct for bias along the main sociodemographic variables. To detect changes over time, we used chi-squared tests, and to analyze the effect of sociodemographic characteristics, we applied multivariate logistic regression. One thousand participants (53.1% women, mean age 48.1 ± 16.75 years) representing Hungary's population were interviewed yielding a response rate of 80.3%. 26.3% knew someone with epilepsy (55.9% in 1994 and 51.9% in 2000), and 30.8% saw an epileptic seizure (58% in 1994 and 55.3% in 2000). Compared to the young, fewer adults and elderly people knew someone with epilepsy or had seen a seizure. Like in 1994 and 2000, 16.6% reported objection to their children's interaction with people with epilepsy; however, in the present study, significantly fewer people opposed their children marrying or working together with epileptic people, indicating a change in attitude (p < 0.0001). Rural residents had less objection to their children's interaction with people with epilepsy (p < 0.05). People with secondary education objected significantly more often than those with primary education to their children's interaction (p = 0.037), marriage to people with epilepsy (p = 0.043), or their having equal employment (p = 0.008). Higher education people were as "permissive" as those with primary education. Certain parameters of familiarity and attitude markers of the Hungarian population toward epilepsy have improved. These tendencies are promising, but work is still needed; our results will hopefully evoke educational programs and campaigns against negative attitudes. The knowledge of the Hungarian population about epilepsy and their attitude toward people with epilepsy has been improved since 1994. People from rural areas have shown more acceptance for people with epilepsy. Those people who completed secondary education were significantly more prone to stigmatization than those with primary education.

Field Reconnaissance and Earthquake Vulnerability of the RC Buildings in Adıyaman during 2023 Türkiye Earthquakes

The 6th February 2023 Pazarcık and Elbistan earthquakes (Mw = 7.7 and Mw = 7.6) caused great destruction in many cities and were the disaster of the century for Türkiye. The greatest destruction was caused in the provinces of Hatay, Kahramanmaraş, and Adıyaman during these earthquakes, which were independent of each other and occurred on the same day. Information about earthquakes and strong ground motion records is given within the scope of this study. Reinforced concrete (RC) structures which constitute a large part of the urban building stock in the earthquake region were exposed to structural damage at different levels. The structural damage in the RC structures in the city center, Gölbaşı, and Kahta districts of the province of Adıyaman was evaluated within the scope of earthquake and civil engineering after field investigations. Insufficient RC, low-strength concrete reinforcement problems, RC frame failure, heavy overhang, short columns, soft story, and pounding effect are the main causes of the earthquake damage. The presence of these factors that reduce the earthquake resistance of RC structures increased the damage level. In addition, the fact that the earthquakes occurred nine hours apart and the continuation of aftershocks during that period negatively affected the damage levels. It has been observed that structures that receive the necessary engineering services during the construction and project phases ensure the safety of life and property, even if the structure is slightly damaged. In this study, we also tried to reveal whether the target displacements were satisfactorily represented by numerical analysis for a sample RC structure.

Pharmacological interventions for early-stage frozen shoulder: a systematic review and network meta-analysis.

To evaluate the efficacy of pharmacological interventions for treating early-stage, pain predominant, adhesive capsulitis, also known as frozen shoulder. We performed a systematic review in accordance with PRSIMA guidelines. Searches were conducted on PUBMED, EMBASE and Cochrane Central Register of Controlled Trials on the 24th of February 2022. Outcomes were shoulder pain, shoulder function and range of movement. Synthesis involved both qualitative analysis for all studies and pairwise meta-analyses followed by a network meta-analysis for randomised controlled trials (RCTs). A total of 3,252 articles were found, of which 31 met inclusion criteria, and 22 of these were RCTs. Intraarticular (IA) injection of corticosteroids (8 RCTS, 340 participants) and IA injection of platelet-rich plasma (PRP) (3 RCTs, 177 participants) showed benefit at 12 weeks compared with physical therapy in terms of shoulder pain and function, while oral non-steroidal anti-inflammatories (NSAIDs) (2 RCTs, 44 participants) and IA injection of hyaluronate (2 RCTs, 42 participants) did not show a benefit. Only IA PRP showed benefit over physical therapy for shoulder range of movement. These results shows that IA corticosteroids IA PRP injections are beneficial for early-stage frozen shoulder. These findings should be appraised with care considering the risk of bias, heterogeneity, and inconsistency of the included studies. We believe that research focused on early interventions for frozen shoulder could improve patient outcomes and lead to cost-savings derived from avoiding long-term disability. Further well-designed studies comparing with standardised physical therapy or placebo are required to improve evidence to guide management.