Present Time Research Articles

From Policy to Practice: Interpreting Polish Strategic Culture Amidst the Russian Full-Scale Invasion of Ukraine

This research analyses the key components of the Polish strategic culture, mainly the national historical memory of previous relations with Russia, the role of NATO in Poland’s security and defence, the country’s objective to become a leading power in the Central and Eastern European, and the concept of strategic culture can become an additional explanatory determinant of Poland’s response to the Russian full-scale aggression against Ukraine. The case study considered Poland’s immediate firm and sweeping support of Ukraine in the first year of the Russian full-scale aggression.
 This article aims to understand essential determinants in modern Polish foreign and security policy and how they played out during the Russian war against Ukraine. The paper applies the strategic culture as an example of the critical theoretical approach to explain how historically-based context and specific national identical features influence decision-making in present times. The study used a systemic review of related literature, media coverage of the latest Russian war against Ukraine developments, and deductive analysis methods.
 The central assumption is that the concept of strategic culture becomes a crucial explanatory factor in understanding policy- and decision-making processes in the field of foreign and security policy. The main conclusions of the paper are that Poland’s response and reaction to Russia’s invasion of Ukraine is a continuation of the long-lasting policy maintained by Poland regarding the elimination of military and hybrid threats posed by Russia, reduction of Russian influence in Europe, development of the Eastern European region and strengthening relations with its staunch ally – the US.

Control of PV power plants with quasi-Z-source cascaded H-bridge multilevel inverters under failure

At the present time, quasi-Z-source cascaded H-bridge multilevel inverters (qZS-CHBMLI) have gained attention in photovoltaic (PV) applications, due to their advantages over traditional multilevel inverters. They allow single-stage power conversion of a PV power plant by independently adjusting the DC voltage in each module; thus, each PV array operates at the maximum power. This advantage permits dispensing with a DC/DC boost converter and reduces the number of modules required. This paper develops a novel control strategy for a qZS-CHBMLI connected to a single-phase system that guarantees proper operation when a fault occurs in a quasi-impedance source inverter (qZSI). The control strategy is employed in a grid-connected qZS-CHBMLI with three modules, each one with a quasi-impedance network, a 4.8 kW PV array and a voltage source inverter (VSI), with H-bridge topology. The purpose of the control system is to deliver a suitable DC voltage at the input of the VSI and ensure the grid power requirements after a fault in a module. The proposed control system is evaluated through a 40 s simulation in MATLAB/Simulink® in two cases: A) analysis of the system behaviour when there is a variation in the operation limit equation; and B) evaluation of the control strategy under dissimilar operating conditions. In addition, an experimental setup based on an OPAL RT-4510 unit and a dSPACE MicroLabBox prototyping unit is employed to validate the results. The results confirmed the correct response of the applied strategy with the failure of a single module.

Валерий Варфоломеевич Мошев и его вклад в ракетостроение и пермскую науку

The article describes the life path of Valery Varfolomeevich Moshev, the Director of the Institute of Continuum Media Mechanics of the Ural Branch of the Russian Academy of Sciences (1986–1993), Professor, Doctor of Technical Sciences, his labor and scientific achievements. His contribution to the organization and development of Perm academic and applied science for the period starting from the 50s of the XX century and up to the present time is described in detail. Recollections of his colleagues, students and friends about V.V. Moshev are given.

Maximal Mouth Opening in Infants: A Single-Group Prospective Cohort Study

BackgroundDetection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint. PurposeThe purpose of this study was to determine the normal ranges for maximal mouth opening (MMO) in healthy infants under 12 months of age. Study design, setting, sampleA single-group prospective cohort study of consecutive patients below 12 months of age was conducted in an outpatient setting at the Florida Craniofacial Institute in Tampa, Florida. Patients were excluded if they had trismus, presented with signs of obstructive sleep apnea, suffered a facial fracture, or were diagnosed with a craniofacial syndrome. Predictor/exposure/independent variableAge (in months) at the time of presentation, measured as a continuous variable. Main outcome variable(s)The main outcome variable was MMO. This was measured by placing a thumb and forefinger in the infant’s mouth and apply slight pressure to encourage maximal mouth opening. In older infants with erupted central incisors, MMO was measured from the gingival margins. CovariatesThe covariates were sex, race, and gestational age. AnalysesFindings were presented as means with 95% confidence intervals. A multivariate linear regression analysis was conducted to evaluate changes in MMO with increasing age. ResultsThe sample was composed of 151 infants with a mean age of 5.2 months (95% CI 4.8 to 5.6), and 33% were female. The mean MMO was 32.1 mm (95% CI 31.5 to 32.7). Results of the linear regression analysis showed MMO to significantly increase with increasing age, increasing at a mean rate of approximately 1 mm per month (coefficient 1.06, 95% CI 0.88 to 1.23, p<0.001). In neonates <1 month of age, the mean MMO was 22.0 mm (95% CI 20.4-23.6), compared to a mean of 36.7 mm (95% CI 34.8-38.6) in infants 11 months of age. Conclusions and RelevanceThe results of this study provide normative data of the association of age with MMO, which may be of value in assessing for infants with jaw mobility disorders.

Surveillance of resected metastatic colorectal cancer utilizing circulating DNA.

214 Background: There is limited data to guide surveillance in patients with metastatic colorectal cancer (CRC) who have had curative resection using circulating tumor DNA (ctDNA) in addition to labs and imaging studies. Minimal residual disease (MRD) assays utilize circulating tumor DNA (ctDNA) for the purposes of monitoring for early recurrence and predicting therapeutic response. In this study, we aim to investigate the utility of ctDNA monitoring in the setting of resected metastatic CRC. Methods: Patients were identified through retrospective search at a tertiary care and several satellite settings to identify patients with metastatic CRC who had undergone curative resection and later had ctDNA monitoring (using Signatera assay). IRB approval was obtained for the study. We recorded demographic information (sex, race, age at diagnosis), disease characteristics (stage at diagnosis, site of primary cancer, site of metastasis), treatment regimens, clinical outcomes (recurrence, survival) and follow-up data. Our primary outcome was to evaluate the rate of recurrence in patients with metastatic CRC who had curative resection in two different population, ctDNA positive or ctDNA negative, post-surgery. Results: We identified 35 patients with a median age of 55 years (range 31 – 82) at the time of metastatic diagnosis. In this study cohort, 20 (57%) were female; 23 (66%) were white, and 10 (29%) were African American. 22 (63%) patients had left-sided primary tumors and the remaining (47%) had right-sided primary tumors. At the time of presentation, 23 (66%) patients had synchronous metastases and 12 (34%) developed metachronous metastases. ctDNA positivity was reported in 21 (60%) pts post-curative therapy. Median time from curative therapy to ctDNA positivity was 62 days. 22 (63%) pts experienced recurrence of disease post-curative resection. Median time to recurrence after ctDNA test was first positive was 6.6 months. Among 21 patients in ctDNA positive group, 19 (86%) developed recurrences and among 14 ctDNA negative patients, only 3 (21%) developed recurrences (p-value &lt;0.01). Recurrence free survival was significantly shorter in patients who were ctDNA positive post surgery (Median RFS: 7.17 months, 95% CI: 4.4-18.0 months) compared to those who were ctDNA negative (Median RFS: 30.8 months; 95% CI: 12.6-NR) (p-value=0.005). Conclusions: In patients with metastatic CRC who underwent curative resection ctDNA may have utility in predicting disease recurrence at both academic and community sites. Larger studies are needed for validation of ctDNA as an adjunct test for surveillance in broader population.

Outcomes of Conservative Management of Postoperative Adhesive Small Bowel Obstruction among Yemeni Patients

Background: Adhesive small bowel obstruction (ASBO) is a surgical emergency and represents the leading cause of small bowel obstruction, accounting for 60–75% of cases. Conservative management is the main approach for treating ASBO in the absence of complications. Therefore, the present study aimed to assess the success rate, outcomes and complications of conservative management for ASBO in Yemen.&#x0D; Methods: A prospective, case-series study of 102 patients with ASBO was conducted at two tertiary care hospitals in Sana’a city, Yemen; namely, Al-Thawra Modern General Hospital and Kuwait University Hospital, in the period from January 2021 to January 2023. A structured data collection sheet was used to collect pre- and postoperative data, including demographic characteristics, history of previous surgery, type of surgery, time of presentation from initial symptoms, presenting symptoms, details of non-surgical management, success or failure of conservative treatment, intraoperative findings, complications during hospital stay, and condition at discharge. Data were then analyzed and presented using descriptive statistics.&#x0D; Results: Of 102 patients with ASBO, 69 patients (67.6%) responded well to conservative management and did not require surgical management, while conservative management failed and surgical intervention was indicated for 33 patients (32.4%). The condition of most patients undergoing conservative management (88.4%) improved within 1–2 days, while five patients (7.3%) improved within one day and three patients (4.3%) improved after three days. For patients who required surgical intervention, continuous abdominal compromise was observed in 31 patients (93.9%), fever in 23 patients (69.7%), tachycardia in 28 patients (84.8%), tenderness in 31 patients (93.9%), and leukocytosis in 13 patients (39.4%). However, one patient was diagnosed with peritonitis, and one patient did not show any improvement within three days. During the surgical intervention for the 33 patients who failed conservative management, fibrous bands were identified in 51.5% of patients, while diffuse adhesions were observed in 45.4% of patients. On the other hand, 3.1% of patients showed gangrenous bowels. Out of patients undergoing surgical intervention, two patients (6%) experienced venous thromboembolism, three patients (9%) developed wound infections, two patients (6%) developed fistulas, one patient (3%) experienced a pulmonary complication, and one patient (3%) died.&#x0D; Conclusion: Conservative management of Yemeni patients with ASBO is safe and preferred over surgical intervention. This approach can be attempted for 72 hours unless signs or symptoms of bowel compromise or peritonitis develop. By opting for conservative management, the risk of surgical intervention can be reduced, and the length of hospital stay can be shortened. Therefore, conservative management should be considered the primary treatment option for ASBO. However, it is crucial to carefully evaluate and monitor patients to exclude any signs of bowel compromise or peritonitis that would require discontinuation of conservative management and prompt initiation of surgical intervention.

Clinical Applications of "In-Hospital" 3D Printing in Hip Surgery: A Systematic Narrative Review.

Introduction: Interest in 3D printing for orthopedic surgery has been increasing since its progressive adoption in most of the hospitals around the world. The aim of the study is to describe all the current applications of 3D printing in patients undergoing hip surgery of any type at the present time. Materials and Methods: We conducted a systematic narrative review of publications indexed in MedLine through the search engine PubMed, with the following parameters: 3D printing AND (orthopedics OR traumatology) NOT tissue engineering NOT scaffold NOT in vitro and deadline 31 July 2023. After reading the abstracts of the articles, papers were selected according to the following criteria: full text in English or Spanish and content related to hip surgery. Those publications involving experimental studies (in vitro or with anatomical specimens) or 3D printing outside of hospital facilities as well as 3D-printed commercial implants were excluded. Results are presented as a reference guide classified by disease, including the used software and the steps required for the development of the idea. Results: We found a total of 27 indications for in-house 3D printing for hip surgery, which are described in the article. Conclusions: There are many surgical applications of 3D printing in hip surgery, most of them based on CT images. Most of the publications lack evidence, and further randomized studies should be encouraged to assess the advantages of these indications.

Gender Sensitization and Gender Inclusivity with Respect to Role in Education

Gender sensitization is a way of creating awareness among the masses about issues related to gender equality. The nature of this process is revolutionary and unconventional as it strives to change the previous concepts related to gender stereotypes, so it modifies an individual's behavior, his outlook, and thought process to behold the society with a newer perspective treating male and female both as being avoiding any discrimination. with the changing world gender, gender-sensitive issues have gained the attention of the world due to discrimination and exploitation against girls and women and various movements and protests have taken place from time to time fighting for equality. after home, which is regarded as the first school of a child he enters the formal education setup where he has to gain awareness of gender sensitization. education in present times is following the Gender Sensitive Education models to focus on teaching techniques and methods that promote gender equality through course curriculum and teaching content by propagating gender-positive material. Learning activities involve innovative strategies to develop respect for other gender roles and strive to contribute in this direction. the concept of Gender inclusivity includes the idea of gaining education in equal measure, working together, and inculcating collaborative skills with other gender biases through law and cultural changes. the paper intends to focus on all these issues with special reference to the field of education which plays a crucial role in shaping a society educated in gender-sensitive issues.

Problems of Judicial Practice on Consideration of Appeals of Bankruptcy Creditors Against Decisions of Courts of General Jurisdiction

Within the framework of this article, the authors attempt to identify and highlight the conflict in the current legal regulation and judicial practice that arises when appeals courts consider complaints filed by bankruptcy creditors against decisions of courts of general jurisdiction, including the problem of abuse of the procedural right to appeal a judicial act in order to exclude bankruptcy creditors, including bona fide creditors, from the register of creditors’ claims and removing their claims from the register. The authors purposefully made a selection of relatively recent judicial practice in order to emphasize that the conflict covered has taken place up to the present time. The authors draw attention to the current lack of a unified approach not only among the court of appeal, but also among the courts of cassation instance, to the consideration of appeals of bankruptcy creditors against decisions of courts of general jurisdiction, on the basis of which the claims of “competing” creditors are included in the register of creditors’ claims. Based on the results of the analysis, the authors conclude that there is an urgent need explanations from the Supreme Court of the Russian Federation regarding the procedure for considering appeals from persons participating in the debtor’s bankruptcy case (with the exception of arbitration managers).

Trends of Poisoning Cases Coming to a Tertiary Care Center in Lucknow: A Retrospective Observational Study

Introduction: The term “suspected poisoning” describes the potential exposure of a human or animal to a poisonous chemical, which might result in a variety of symptoms ranging from minor symptoms to severe consequences. The kind and quantity of the poison implicated may affect the symptoms. If poisoning is suspected, it’s crucial to get help right away so that the correct toxin can be identified and the proper management can be given.Aim: To monitor the epidemiological traits and clinical trends of poisoning cases at the emergency department of Dr. RMLIMS Lucknow.Methods: All 295 instances of acute poisoning were reported to the emergency department between April 2022 to March 2023. It is retrospective observational research of 12 months duration carried out in a tertiary care hospital. Data on the patient’s age, gender, kind of poisoning, length of hospital stay, and result were gathered from hospital medical records and examined.Result: The majority of victims have married housewives with poor socioeconomic and educational standingwho were between the ages of 31 and 40. Agriculture poisons and domestic poisons were the two most often used toxins. Most of the time, the general health at the time of presentation was unstable.Conclusion: Suspected poisoning is a serious medical emergency that might have life-altering effects on thevictims. Knowledge of the probable causes and symptoms of poisoning is crucial to ensure prompt diagnosis and treatment. Those who have been exposed to harmful chemicals can recover and prevent long-term harm with the proper measures.

Cinematic rendering of non-traumatic thoracic aorta emergencies: a new look at an old problem.

Non-traumatic thoracic aorta emergencies are acute conditions associated with substantial morbidity and mortality. In the emergency setting, timely detection of aortic injury through radiological imaging is crucial for prompt treatment planning and favorable patient outcomes. 3D cinematic rendering (CR), a novel rendering algorithm for computed tomography (CT) image processing, allows for life-like visualization of spatial details and contours of highly complex anatomic structures such as the thoracic aorta and its vessels, generating a photorealistic view that not just adds to diagnostic confidence, but is especially useful for non-radiologists, including surgeons and emergency medicine physicians. In this pictorial review, we demonstrate the utility of CR in the setting of non-traumatic thoracic aorta emergencies through 10 cases that were processed at a standalone 3D CR station at the time of presentation, including its role in diagnosis and management.

A comprehensive profile of SARS-CoV-2 variants spreading during the COVID-19 pandemic: a genomic characterization study from Chhattisgarh State, India.

SARS-CoV-2 has expressively changed its sequences during the COVID-19 pandemic situation by encompassing persistent evolutionary mutational changes resulting in the emergence of many clades and lineages. Evolution of these SARS-CoV-2 variants have significantly imparted fitness advantage to the virus, enhanced its transmissibility and severity of the disease. These new variants are a potential threat to the vaccine efficacy as well. It is therefore pertinent to monitor the evolution of these variants and their epidemiological and clinical impact, in a geographic setting. This study has thus looked into the geographic distribution and genetic diversity of SARS-CoV-2 variants and the evolutionary circulation of different clades in Chhattisgarh (CG) state from March 2020 to July 2023. A total of 3018 sequences were retrieved from the GISAID database, in which 558 were submitted by us. The demographic data revealed male preponderance of 56.45% versus 43.54% females, with the overall mean age of 36.5years. SARS-CoV-2 sequences represented many variants viz., Delta (55%), Omicron (22%) and others (15%) with a small proportion of recombinant (5%), Kappa (2%), and Alpha (1%). The viral clades G was found predominant for a year from initial days of pandemic in March, 2020 to January, 2021 which then subsequently evoluted to subclade GK (Delta B.1.617.2) and remained in circulation in CG till November, 2021. From December 2021, the GRA (Omicron B.1.1.529) variant had replaced GK to become the dominant strain and continues to predominate in present time. GRA clade is however continuously encompassing new recombinant strains, having various non-synonymous mutations especially in spike protein. The non-synonymous mutation P314L in ORF1b, S84L in ORF8 and D614G in spike protein were found as the pan mutation carried over from clade G to GRA. The continuous evolution in SARS-CoV2 warrants periodical geographic genomic surveillance monitoring to timely detect any new variants having the potential of causing future outbreak.

Overview of Clinical Trials With Efgartigimod in Autoimmune Blistering Diseases: Pemphigus Vulgaris and Pemphigus Foliaceus (ADDRESS and ADDRESS+) and Bullous Pemphigoid (BALLAD and BALLAD+)

Introduction &amp; Objectives: Efgartigimod is an engineered Fc fragment that inhibits the activity of the neonatal Fc receptor (FcRn), thereby reducing levels of circulating IgG including pathogenic IgG autoantibodies. Pemphigus vulgaris (PV), pemphigus foliaceus (PF), and bullous pemphigoid (BP) are autoimmune blistering diseases. Pemphigus is mediated by IgG autoantibodies targeting desmoglein (Dsg)-3 in PV, and Dsg-1 in mucocutaneous PV (in addition to Dsg-3), while PF is attributed to IgG autoantibodies against Dsg-1 only. Dsg-3 and Dsg-1 are desmosomal proteins mediating keratinocyte cell-cell adhesion. BP is mediated by IgG autoantibodies against BP180 (type XVII collagen) and BP230 structural proteins of the dermal-epidermal junction. Materials &amp; Methods: ADDRESS is a multicenter, randomized, double-blind, placebo-controlled trial evaluating efficacy and safety of efgartigimod in patients with PV or PF (NCT04598451). Participants are undergoing randomization (2:1) to receive subcutaneous efgartigimod co-formulated with PH20 or placebo/PH20 on top of oral prednisone (or equivalent). Primary endpoint is the proportion of patients with PV or PF who achieve complete remission on minimal therapy (CRmin) within 30 weeks. BALLAD is a global, multicenter, phase 2/3, randomized, double-blind, placebo-controlled trial evaluating efficacy and safety of subcutaneously administered efgartigimod in patients with BP (NCT05267600). Part A will be a proof-of-concept study and recruit 40 participants, while the Part B confirmatory study will recruit 120 participants. Parts A and B will be identical in schedule, structure, assessments, and conduct. Primary endpoint is the proportion of participants in complete remission off oral corticosteroid therapy for ≥8 weeks at week 36. Results &amp; Conclusions: As of February 28, 2023, 222 participants have been enrolled into ADDRESS and enrolment of BALLAD has started. It is anticipated that the recruitment of the ADDRESS full study and BALLAD part A will be completed, and a further update will be given at the time of presentation.

Real-World Evidence Demonstrating Tralokinumab Onset of Action and Efficacy in Two Skin of Color Patients with Moderate-to-Severe Atopic Dermatitis

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory skin disease that has higher prevalence, persistence, and severity, as well as different response to treatment, in skin of color (SOC) patients. This underscores the importance of clinical trial diversity and real-world case reports to help reduce health inequity, improve clinical understanding, and enhance treatment access for all patient populations. Tralokinumab specifically targets interleukin-13, and the onset, efficacy, and safety outcomes from the initial clinical trials revealed striking therapeutic potential. &#x0D; Objective: To provide examples of rapid tralokinumab onset of action in SOC patients, including improvement of the difficult-to-treat head and neck subtype and of hyperpigmentation on the hands.&#x0D; Methods: The authors describe the clinical outcomes of two SOC patients: an 18-year-old Asian male [patient 1] and a 37-year-old African-American male [patient 2]. Data related to tralokinumab treatment were collected during routine clinical practice.&#x0D; Results: Both patients were diagnosed with AD in infancy and continued to suffer from AD. At baseline, each had clearly perceptible erythema, induration, and lichenification and were assigned IGA scores of 3. Patient 1 had a BSA of 22%, managed with clobetasol 0.05% ointment for the body and ruxolitonib 1.5% cream for the face. He had never received systemic treatment. Patient 2 had previous medical history of mild asthma and BSA of 29%. His AD was managed with clobetasol 0.05% ointment. Over the prior two decades, he had been managed with myriad topical corticosteroids, prednisone tapers, as well as methotrexate. Due to insurance barriers, there were challenges obtaining tralokinumab immediately for both patients. The lapse in time was less than 6 weeks in each case. Not surprisingly, IGA 3 was assigned at both time of initial presentation and at time of tralokinumab initiation. Both patients were prescribed an initial dose of 600 mg (four 150 mg subcutaneous injections) followed by 300 mg (two 150 mg subcutaneous injections) administered every other week. After 10 weeks, patient 1 experienced a decrease in IGA from 3 to 1; his BSA decreased from 22% to 7%. After only 6 weeks, patient 2 also exhibited a decrease in IGA from 3 to 1; his BSA decreased from 29% to 6%. The improvement was sustained throughout a 6-month follow-up period in both patients. The authors observed significant improvement in the quality of life for both patients, subjectively and objectively. To date, no patient-reported or investigator-recognized adverse outcomes have occurred.&#x0D; Conclusions: Treatment with tralokinumab 300 mg, every other week, showed a rapid onset of action, with superior efficacy to the original clinical trials in two SOC patients with moderate-to-severe AD, one of which had involvement of the difficult-to-treat area of the head and neck. With no patient- or physician- adverse events reported to date, this observational study underscores the importance of future real-world reports to potentially corroborate our findings.

Parkinson’s disease motor progression in relation to the timing of REM sleep behavior disorder presentation: an exploratory retrospective study

REM sleep behavior disorder (RBD) is a frequent non-motor symptom of Parkinson’s disease (PD), and the timing of its presentation might have a role in the underlying neurodegenerative process. Here, we aimed to define the potential impact of probable RBD (pRBD) on PD motor progression.We conducted a longitudinal retrospective study on 66 PD patients followed up at the University Hospital of Rome Tor Vergata. Patients were divided into three groups: with post-motor pRBD (pRBDpost, n = 25), without pRBD (pRBDwo, n = 20), and with pre-motor pRBD (pRBDpre, n = 21). Hoehn and Yahr (H&Y) scores, Unified PD Rating Scale (UPDRS) motor scores, and levodopa equivalent daily dose were collected at two follow-up visits conducted in a 5-year interval (T0 and T1). pRBDpost patients had a greater rate of motor progression in terms of the H&Y scale compared to pRBDpre and pRBDwo patients, without the influence of anti-parkinsonian treatment.These preliminary findings suggest that the post-motor occurrence of pRBD can be associated with an acceleration in PD motor progression.

The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaraş earthquakes: Injuries and challenges.

This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center. Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded. The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department. This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.

The Impact of Fluctuating Oil Revenues on Economic Growth: New Evidence from Saudi Arabia

The fluctuations that occur in oil revenues are among the main reasons that lead to disruptions in economies that depend on them. Hence, this study aims to find out the impact of fluctuation in oil revenues on the economic growth for the Kingdom of Saudi Arabia during the period from 2000 to 2020. The study showed that the relationship between the fluctuations of oil revenues and economic growth may be either a positive relationship, and this relationship is confirmed in oil-exporting countries, which is the most common relationship, or a negative relationship, and this relationship is confirmed in oil-importing countries, which is the exceptional case. In order to find out the direction of this relationship in the Kingdom, the study used the application of the Autoregressive Distributed Lag Model (ARDL) model. The study concluded that the fluctuations of oil revenues has significant positive effects on the economic growth of the Kingdom of Saudi Arabia in the short and long terms. Therefore, the study recommends the need for the Kingdom to exploit these revenues in areas that achieve a return for it at the present time and in the future, in a manner that guarantees the diversification of the economy and its non-disruption when any disturbances occur in these revenues, as well as keeping part of these revenues in its sovereign fund to guarantee the rights of future generations.

A time-average ocean: Thermal wind and flow spirals

Using a 26-year average of a dynamically consistent ECCO state-estimate, an effort is made to find a few simple descriptive, but quantitative, patterns of properties of the ocean circulation that are near-globally applicable outside the Arctic regions. The conceptual assumption is made that such an average is physically meaningful. Even with a 26-year average, complex spatial variations in the flow field remain, particularly below about 2000 m where the intricate structure of the underlying topography becomes manifest. Nonetheless, certain constructs do describe the great bulk of the ocean. These constructs consist of thermal wind balance (quasi-geostrophy), spiral-like flow behavior in the near-surface boundary layers with orientation analogous to that of an Ekman layer—abruptly changing sign across the equator. In contrast, evidence for beta-spirals is very thin, consistent with the spatially complex meridional and vertical velocities. As expected, integration so as to remove spatial dependence in one coordinate (e.g. zonal) does produce much simplified structures, albeit in the process suppressing diverse dynamical regimes. Predominantly zonal structures persist in the zonal velocity at depth, and are presumed sensitive to the (parameterized) mean eddy fluxes. An unanswered question, and one perhaps unanswerable at the present time, is whether a much longer averaging interval would significantly further simplify the upper-ocean circulation. The abyssal circulation almost everywhere appears dominated by the topography and slopes and whose structure likely would persist in averages of arbitrary duration.

Warthin-like variant of papillary thyroid carcinoma with lymph node metastases: a case report and review of the literature

BackgroundWe present a rare case of thyroid lesion marked as the Warthin-like variant of papillary thyroid carcinoma (WLV-PTC) with lymph node metastases. A proper preoperative identification is difficult because of unspecific cytology features and common ultrasound characteristics of this malignant tumor. The long-term prognosis cannot be thoroughly described due to the scarcity of data. The purpose of the presentation is to show common characteristics and long-term survival rates of an uncommon variant of differentiated thyroid cancer (DTC). Therefore, the data represented in this article can make a significant contribution to future investigations.Case presentationA 40-year-old Ukrainian woman had a lesion in the thyroid gland, which was accidentally diagnosed during medical checkup. Ultrasound (US) features were similar to the common suspicious nodule. It had typical signs of suspicion for malignancy (TI-RADS-4) on the background of thyroiditis. A thorough investigation of the neck showed lymph nodes with nonspecific US features on both lateral compartments. Lymph nodes were hypoechoic, oval-shaped and 10 mm wide, with regular contours, low central vascularity, with preserving hilar fat, without cystic formation. The patient did not have any complaints or changes in the hormone status. No hereditary findings linked with cancer were discovered. The woman had been living for a long time in the country with a high level of insolation, which was atypical for the ordinary environment of the patient. Fine-needle aspiration (FNA) of the lesion was done and the Bethesda system 6 result was obtained. Total thyroidectomy with central lymph node dissection was accomplished. The histological conclusion was WLV-PTC on the background of lymphocytic infiltration of the gland with metastasis to the lymph nodes. The inpatient radioactive iodine (RAI) ablation (100 mCi) was subsequently performed. Hormone withdrawal was used followed by RAI. In one year after the surgery the level of thyroglobulin (Tg) was 0.2 ng/ml. Up to the present time the five-year follow-up has not demonstrated any signs of recurrence relying on a level of Tg (< 0.04 ng/ml), Tg antibodies (< 14 IU/ml), neck US without any structural disease.ConclusionWLV-PTC resembles salivary gland tumors with similar histological features. This variant is not well known, but often associated with a stroma lymphocytic infiltration and a low risk of lymph node metastases. It is regarded that this rare subtype has similar long-term survival rates as classic papillary thyroid cancer (PTC).

Reducing greenhouse gas emissions in a bariatric surgical unit is a complex but feasible project

Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021–March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities.