Accessing breast cancer care in a protracted conflict: Qualitative exploration of the perspectives of women with breast cancer in northwest Syria.

BACKGROUND: Women with breast cancer in northwest Syria, an area of protracted armed conflict, face multiple intersecting challenges to accessing care which may relate to gender, social structures, and financial constraints. Our aim was to explore the perspectives of women with breast cancer in northwest Syria about the impact of their diagnosis and experiences of accessing care. METHODS: Women who accessed diagnosis or clinical care at the Syrian American Medical Society (SAMS) oncology centre in Idlib city during 2022 were identified from hospital records; they were invited to participate in semi-structured interviews conducted in Arabic by four local female-trained researchers. Participation was voluntary and informed consent was sought. Semi-structured interviews were conducted in August and September 2022 until thematic saturation was reached. Data were audio recorded and transcribed in Arabic before translation and thematic analysis using Nvivo to identify key emerging themes. RESULTS: 22 women with breast cancer were interviewed. Findings were categorised into three themes: 1. Challenges to accessing oncology care in northwest Syria 2. Interactions with healthcare workers 3. The role of community and society. All participants noted the financial strains which the breast cancer diagnosis placed on them and their families. Most also noted the additional strains of travelling long distances, either in northwest Syria or to Turkey, where referral would entail additional costs, bureaucracy or isolation from family or social support. Some participants described social impacts including the expectation that they would continue with household chores and childcare even while ill. Patients reported that strong faith, having children, compassion from healthcare staff and peer support as being important factors for coping with their diagnosis and treatment. CONCLUSION: Though there have been improvements to breast cancer care in northwest Syria, stock-outs and the lack of availability of radiotherapy may still force women to travel to Turkey for further investigations or treatment. Our findings suggest increased support for women with breast cancer as well as their families is required. This work is a starting point for future research on this topic both in northwest Syria and other areas in Syria

From tackles to trauma: investigating the influence of the FIFA World Cup 2022 on public maxillofacial department in Qatar - an observational study.

The Federation Internationale de Football Association (FIFA) World Cup (FIFA-WC) is considered the pinnacle of international sporting events, attracting a diverse array of attendees from across the globe1. Hosting such an event presents diverse challenges for the organizing country, which are further amplified by public health threats1. The 22nd FIFA-WC, held in Qatar from 20 November to 18 December 2022, distinguished itself in several unprecedented dimensions. It marked the first instance of a FIFA-WC being conducted amidst the throes of a global pandemic, specifically the COVID-19 crisis1,2. Moreover, Qatar’s demographic and geographic attributes further accentuated its unique position as the smallest nation, both in terms of population and territory, to host such a monumental event1,2. Notably, the event was devoid of the previously mandated COVID-19 restrictions, as they were lifted in September 2022, presenting an unparalleled scenario for the healthcare sector

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Causes of kidney failure among patients undergoing maintenance hemodialysis in Somalia: a multi-center study

Abstract Background Kidney failure is one of the leading causes of morbidity and mortality worldwide. The incidence of kidney failure in Somalia has been increasing in recent years. There is no data available on the causes of chronic kidney disease (CKD) leading to kidney failure in Somalia. Methods This is a multicentre, descriptive cross-sectional study designed to determine the aetiology of kidney failure among patients receiving haemodialysis in four major demographic areas of Somalia. The study was conducted over a one-year period, from June 2021 to June 2022. Participants were eligible for inclusion if they had been diagnosed with kidney failure, were on regular haemodialysis, and were over 18 years of age. Results A total of 127 patients were evaluated, 84 (66.1%) were males and 43 (33.9%) were female. The mean age of kidney failure patients was 49.3 ± 12.2 years. They originated from various regions, 5.6% from the south, 29.9% from the north-eastern, and 64.5% from the northwest. The mean duration of haemodialysis was 4.4 ± 2.2 years. The most common cause of kidney failure in our study was hypertension (33.1%), followed by diabetes mellitus (27.6%), uncertain aetiology (24.4%), glomerulonephritis (7.1%), obstructive uropathy (3.8%), renovascular hypertension (1.6%), neurogenic bladder, polycystic kidney disease, congenital and hereditary diseases (0.8%). Conclusions Our study showed the leading cause of kidney failure among maintenance haemodialysis patients was hypertension, followed by diabetes mellitus. To reduce the burden of kidney failure in Somalia, primary prevention of hypertension and diabetes and early detection and prompt management of chronic kidney disease (CKD) in high-risk populations should be a fundamental focus

Selection of Hyperspectral Vegetation Indices for Monitoring Yield and Physiological Response in Sweet Maize under Different Water and Nitrogen Availability

International audienceThis study used hyperspectral reflectance data to evaluate the crop physiological parameters of sweet maize. Principal component analysis (PCA) was applied to identify the wavelengths that primarily contributed to each selected PC. Correlation analysis and multiple linear regression, with a stepwise algorithm, were used to select the best-performing vegetation indices (VIs) for monitoring the yield and physiological response of sweet maize grown under different water and nitrogen availability. The spectral reflectance measurements of crops were taken during the mid-season stage, for two consecutive growing seasons. The multivariate regression results showed that red-edge group indices, such as CARI (Chlorophyll Absorption Reflectance Index), DD (Double Difference Index), REIP (Red-Edge Inflection Point), and Clred-edge (Chlorophyll Red-Edge) indices were good predictors of yield and physiological parameters, confirming the crucial role of the red-edge spectral region that also emerged through PCA. Moreover, DD, REIP, and Clred-edge VIs were able to discriminate transient temporary stress at the mid-season stage, as well as to separate water and N stress levels. Therefore, hyperspectral reflectance VIs can provide valid information to growers, helping them identify and discriminate between different stress conditions

“Actually, the psychological wounds are more difficult than physical injuries:” a qualitative analysis of the impacts of attacks on health on the personal and professional lives of health workers in the Syrian conflict

Abstract Introduction Attacks on healthcare in armed conflict have far-reaching impacts on the personal and professional lives of health workers, as well as the communities they serve. Despite this, even in protracted conflicts such as in Syria, health workers may choose to stay despite repeated attacks on health facilities, resulting in compounded traumas. This research explores the intermediate and long-term impacts of such attacks on healthcare on the local health professionals who have lived through them with the aim of strengthening the evidence base around such impacts and better supporting them. Methods We undertook purposive sampling of health workers in northwest and northeast Syria; we actively sought to interview non-physician and female health workers as these groups are often neglected in similar research. In-depth interviews (IDIs) were conducted in Arabic and transcribed into English for framework analysis. We used an a priori codebook to explore the short- and long-term impacts of attacks on the health workers and incorporated emergent themes as analysis progressed. Results A total of 40 health workers who had experienced attacks between 2013 and 2020 participated in IDIs. 13 were female (32.5%). Various health cadres including doctors, nurses, midwives, pharmacists, students in healthcare and technicians were represented. They were mainly based in Idlib (39.5%), and Aleppo (37.5%) governorates. Themes emerged related to personal and professional impacts as well as coping mechanisms. The key themes include firstly the psychological harms, second the impacts of the nature of the attacks e.g. anticipatory stress related to the ‘double tap’ nature of attacks as well as opportunities related to coping mechanisms among health workers. Conclusion Violence against healthcare in Syria has had profound and lasting impacts on the health workforce due to the relentless and intentional targeting of healthcare facilities. They not only face the challenges of providing care for a conflict-affected population but are also part of the community themselves. They also face ethical dilemmas in their work leading to moral distress and moral injury. Donors must support funding for psychosocial support for health workers in Syria and similar contexts; the focus must be on supporting and enhancing existing context-specific coping strategies

Quantifying the effects of attacks on health facilities on health service use in Northwest Syria: a case time series study from 2017 to 2019

BACKGROUND: Throughout the Syrian conflict, the Syrian government has intentionally attacked health facilities, violating International Humanitarian Law. Previous studies have qualitatively described health system disruptions following attacks on healthcare or established associations between armed conflict and health service utilisation, but there are no quantitative studies exploring the effects of health facility attacks. Our unprecedented study addresses this gap by quantifying the effects of health facility attacks on health service use during the Syrian conflict. METHODS: This retrospective observational study uses 18 537 reports capturing 2 826 627 consultations from 18 health facilities in northwest Syria and 69 attacks on these facilities. The novel study applies case time series design with a generalised non-linear model and stratification by facility type, attack mechanism and corroboration status. RESULTS: The study found significant, negative associations between health facility attacks and outpatient, trauma and facility births. On average, a health facility attack was associated with 51% and 38% reductions in outpatient, RR 0.49 (95% CI 0.43 to 0.57) and trauma consultations, RR 0.62 (95% CI 0.53 to 0.72), the day after an attack, with significant reductions continuing for 37 and 20 days, respectively. Health facility attacks were associated with an average 23% reduction in facility births, the second day after an attack, RR 0.77 (95% CI 0.66 to 0.89), with significant reductions continuing for 42 days. CONCLUSIONS: Attacks on health facilities in northwest Syria are strongly associated with significant reductions in outpatient, trauma and facility births. These attacks exacerbate the adverse effects of armed conflict and impede the fundamental right to health. The findings provide evidence that attacks on health facilities, violations of international humanitarian law by themselves, also negatively affect human rights by limiting access to health services, underscoring the need to strengthen health system resilience in conflict settings, expand systematic reporting of attacks on healthcare and hold perpetrators accountable

Deprotometalation-Iodolysis and Direct Iodination of 1-Arylated 7-Azaindoles: Reactivity Studies and Molecule Properties

International audienceFive protocols were first compared for the copper-catalyzed C-N bond formation between 7-azaindole and aryl/heteroaryl iodides/bromides. The 1-arylated 7-azaindoles thus obtained were subjected to deprotometalation-iodolysis sequences using lithium 2,2,6,6-tetramethylpiperidide as the base and the corresponding zinc diamide as an in situ trap. The reactivity of the substrate was discussed in light of the calculated atomic charges and the pK(a) values. The behavior of the 1-arylated 7-azaindoles in direct iodination was then studied, and the results explained by considering the HOMO orbital coefficients and the atomic charges. Finally, some of the iodides generated, generally original, were involved in the N-arylation of indole. While crystallographic data were collected for fifteen of the synthesized compounds, biological properties (antimicrobial, antifungal and antioxidant activity) were evaluated for others

A fluorine scan of a tubulin polymerization inhibitor isocombretastatin A-4: Design, synthesis, molecular modelling, and biological evaluation

A novel series of tubulin polymerization inhibitors, based on fluorinated derivatives of isocombretastatin A-4 was synthesized with the goal of evaluating the effect of these compounds on the proliferative activity. The introduction of fluorine atom was performed on the phenyl ring or at the linker between the two aromatic rings. The modification of isoCA-4 by introduction of difluoromethoxy group at the para-position (3i) and substitution of the two protons of the linker by two fluorine atoms (3m), produced the most active compounds in the series, with IC50 values of 0.15–2.2 nM (3i) and 0.1–2 nM (3m) respectively, against a panel of six cancer cell lines. Compounds 3i and 3m had greater antiproliferative activity in comparison with references CA-4 or isoCA-4, the presence of fluorine group leads to a significant enhancement of the antiproliferative activity. Molecular docking studies indicated that compounds 3i and 3m occupy the colchicine binding site of tubulin. Evaluation of cytotoxicity in Human noncancer cells indicated that the compounds 3i and 3m were practically ineffective in quiescent peripheral blood lymphocytes, and may have a selective antiproliferative activity against cancer cells. Analyses of cell cycle distribution, and morphological microtubules organization showed that compound 3m induced G2/M phase arrest and, dramatically disrupted the microtubule network