Victimhood as a driving force in the intractability of the Israeli-Palestinian conflict: reflections on collective memory, conflict ethos, and collective emotional orientations.

In intractable conflicts the feelings and claims of victimhood are as mature and well-entrenched as the conflict itself. The longer a conflict is waged, the more the geopolitical reasons for victimisation shift to the psychological. This gradually blurs the difference between facts and perceptions, rendering the conflict harder to resolve (e.g. Coleman 2003; Bar-Tal 2013). The general assumption in this study is that due to unique historical and political circumstances, the Israeli-Palestinian conflict draws heavily — perhaps more than other conflicts — from past and present victimisations to rationalise, justify, and perpetuate the status quo. The study seeks to examine the extent to which the narratives of victimhood add to intractability and therefore hinder settlement. It mainly but not exclusively draws on Bar-Tal’s socio-psychological framework of collective memory, conflict ethos, and collective emotional orientations to guide the discussion. First, the study proposes that Israel’s victimhood draws much of its validity from the Jewish collective memory, especially the Shoah. That among other things gave rise to ethos that established the Israeli-Palestinian conflict as part of the Jewish continuum of suffering, and not entirely as a political struggle with defined geopolitical causes. It is also proposed that collective memory and the current conflict have established certain emotional responses ranging from soft emotions like guilt and shame, which have subtle but significant reverberations, to strong emotions like fear. Building on Bar-Tal’s claims (2001) that fear dominates Israel’s emotional sate, it is suggested that fear also represents a main force behind Israel’s 'hyper security,’ which is seen as the most destructive manifestation of Israel’s victimhood narratives. Second, it is argued that even though Palestinian and Israeli-Jewish victimhood narratives are socio-psychologically similar, there are factors mainly determined by the conflict power hierarchy which make certain aspects of Palestinian victimhood different and more salient. Whilst Israel’s collective memory is premised on the fear of annihilation, Palestinian memory is mainly centred on the fear of being forgotten. And, whilst Israel’s dominant emotion is fear, Palestinian emotional orientation is largely steered by a sense of collective humiliation. The conflict ethos, as a result, seems to excessively focus on muqawama (resistance) as a reformative measure against humiliation. Even though the societal beliefs about victimhood in Israel or Palestine are not completely homogenous, they are prominent enough to have a detrimental effect on conflict resolution

Did salvage ICE chemotherapy improve the outcome in primary resistant/relapsing stage III/IV neuroblastoma?

AbstractBackground and purposeNeuroblastoma is the most common extracranial and deadly solid tumor in children. It accounts for 15% of the deaths from cancer in the pediatric age group. Approximately half of the newly diagnosed children are at “high risk” of treatment failure.The aim of this study is to evaluate the response rate of salvage chemotherapy by the ICE (Ifosfamide, Carboplatin, and Etoposide) regimen when administered to previously treated primary refractory or progressive high risk neuroblastoma patients.Patients and methodsSixty-six patients from the National Cancer Institute (NCI), Cairo University and the Children Cancer Hospital Egypt (CCHE) received salvage chemotherapy (ICE) either due to primary resistance in 51/66 (77.2%) or due to disease progression on primary chemotherapy in 15/66 (22.8%).ResultsThey were 40 males (60.6%) and 26 females (39.4%). Patients’ age ranged between 3months and 12.5years. The most common tumor site was suprarenal, followed by retroperitoneal mass. Two patients (3%) died from chemotherapy toxicity during ICE administration. Evaluation of tumor response in the remaining 64 patients showed the following: CR/PR in 24 patients (36.5%), SD in 11 patients (16.6%), and PD in 29 patients (43.9%).Fourteen patients (21.2%) were considered eligible for auto BMT, while 50/64 patients (78.8%) failed this second line (salvage) chemotherapy and had palliative lines of therapy.By the end of the study (May 2010), 47/66 (71.2%) of the patients were still alive, while 19/66 (28.8%) were dead. Two out of 14 patients (14.2%) who underwent HSCT died from post transplantation disease progression, while 12/14 (85.8%) were in CCR.ConclusionChemotherapy by ICE for primary resistant or progressive stage III/IV NB seems well tolerated. With a 36.6% response rate, 18% CCR, and 3% treatment mortality rate, it could be considered a good salvage therapy in the category of patients who are condemned for palliation

Opportunistic salpingectomy during hysterectomy for benign indications in women at low and high risk for ovarian cancer: a cross-sectional study

Objective Our study aims to evaluate the role of pathology evaluation of fallopian tubesduring hysterectomy for benign indications for the purpose ofearly detection of serous tubal intraepithelial carcinoma (STIC) in women at high and low risk for ovarian cancer. Material and methods This cross-sectional study was conducted at Minia Maternity University Hospital, Egypt, between June 2015 and December 2017. Our study included all women undergoing hysterectomy for benign conditions in the genital tract. Appropriate histories were taken, as well as physical exams, and laboratory and ultrasound evaluations were done prior to scheduling surgery. Abdominal hysterectomies including opportunistic salpingectomies were performed and the whole specimens including the tubal fimbria were sent to the pathology lab for histo-pathological examination. Results A total of 526 patients met inclusion criteria for this study. The mean age of the study participants was 49.75±8.95 years, the mean parity was 3.91±1.62 and the mean BMI was 24.21±2.38 Kg/m2. The most common surgical indications for hysterectomy were postmenopausal bleeding (34.6%), a clinically benign adnexal/pelvic mass (31.7%), and menorrhagia (24.7%). The fallopian tubes were found to have either no pathology or benign conditions in 500 out of the 526 patients. Among these patients, 56% had no pathologic abnormality. The most common benign conditions were paratubal cysts (25%), endometriosis (9%), torsion (2%) and hydrosalpinx (1%). STIC was identified in the fallopian tubes of 8 out of 526 patients. Conclusions Microscopic examination of the entire fimbriae from all patients regardless of the clinical context represents a novel method of early detection of sporadic tubal carcinoma, a putative precursor to advanced-stage pelvic cancer

Pediatric mature B-cell non Hodgkin lymphoma treatment with LMB-96 protocol. The Children Cancer Hospital Egypt experience

Purpose: Burkitt lymphoma (BL) is a highly aggressive mature B-cell non-Hodgkin lymphoma (NHL) and is the fastest growing human tumor. The outcome of childhood NHL has improved steadily over the past decades through the use of intensive sequential multi-agent chemotherapy regimens.Methods: A retrospective study having all patients 18 years old or younger diagnosed with mature B cell NHL and treated at Children Cancer Hospital Egypt (CCHE). All children were treated according to the modified (LMB 96) protocol during the period between July 2007 and December 2012. Patients were followed up till June 2013.Results: Three hundred and seventy-seven patients were diagnosed with mature B cell NHL and received the LMB96 treatment protocol. The majorities were males (76.4%) with a median age of 5.3 years, and ranged from 0.1-18.0 years. The median follow-up period was 28.2 months (range 0.9-72 months). Burkitt lymphoma was the most predominant pathologic subtype (79.6%, n = 300), and abdominal mass as a primary site was the most common presentation (71.3%). Twenty seven patients (7.2%) were treated as group A, 268 (71.0%) as group B, and 82 (21.8%) patients as high risk group C. Seventy-one (18.8%) patients suffered adverse events. Major adverse events were early deaths in 17 patients (4.5%), death during induction chemotherapy seen in 18 patients (4.7%), and during maintenance therapy in 7 patients (1.8%), tumor progression in 19 patients (5.0%), and relapse in 10 patients (3.7%). Sixty-three patients (16.7%) died during the study period. The main causes of death were tumor lysis syndrome (TLS) in 25.3%, and severe sepsis during chemotherapy in 41.3% of the patients. The 3 years OS and EFS were 83.3% and 80.4% respectively for the whole groups of patients. OS and EFS were 100% for group A, and 87.5%±3.9% and 85.9±4.3% for group B. For group C BM+/CNS- patients, OS was 55.62%±15.8%, and EFS of 53.8%±15.6%. For BM+/CNS+ patients, OS and EFS were 63.2%±21.76% and 57.9%±22.1% respectively. BM-/CNS+ patients had OS 72.4%±18.8% and EFS 67.6%±19.7% at 36 months. Conclusion: TLS and chemotherapy related toxicity remains a major challenge affecting the outcome of pediatric mature B cell NHL. We identified bone marrow involvement as a risk factor affecting treatment outcome. Aggressive supportive care measures are mandatory to avoid unacceptable high toxicity related mortality

The Role of Chronic Inflammation in Polycystic Ovarian Syndrome—A Systematic Review and Meta-Analysis

Although the current literature associates polycystic ovarian syndrome (PCOS) with chronic inflammation, the evidence for this link remains inconclusive and its causal nature remains unclear. The purpose of this systematic review was to assess the inflammatory status in PCOS women and to determine whether it is related to PCOS or to its associated adiposity. We searched electronic databases including PUBMED, EMBASE and MEDLINE, SCOPUS, DynaMed plus, TRIP, ScienceDirect and Cochrane Library, for studies investigating C-reactive protein (CRP) and other inflammatory makers in PCOS women versus healthy controls. Quality and risk of bias for selected studies were assessed using the modified Newcastle–Ottawa scale. CRP data were extracted and pooled using RevMan for calculation of the standardized mean difference (SMD) and 95% confidence interval (CI). Eighty-five eligible studies were included in the systematic review, of which 63 were included in the meta-analysis. Pooled analysis of the 63 studies revealed significantly higher circulating CRP in PCOS women (n = 4086) versus controls (n = 3120) (SMD 1.26, 95%CI, 0.99, 1.53). Sensitivity meta-analysis of 35 high quality studies including non-obese women showed significantly higher circulating CRP in PCOS women versus controls (SMD 1.80, 95%CI, 1.36, 2.25). In conclusion, circulating CRP is moderately elevated in PCOS women independent of obesity, which is indicative of low-grade chronic inflammation

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

CD44 in cervical cancer

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