"Das dürfte in Europa eigentlich nicht passieren": Das Problem der Internationalen Beziehungen aus Sicht des Globalen Südens

Dieser Beitrag soll ein Plädoyer von Eliten des globalen Südens, insbesondere von führenden Politiker:innen und Meinungsmacher:innen in Afrika, aufgreifen, um der Debatte über den russischen Einmarsch in der Ukraine im Rahmen größerer Fragen zur internationalen Ordnung und den damit verbundenen Sicherheitssystemen eine andere Wendung zu geben. Dementsprechend geht der Artikel den zeitgenössischen Artikulationsformen der afrikanischen Blockfreiheit nach, die die Frage der Rechte der Ukraine, die Anliegen Russlands und die Ambitionen der NATO als drei separate Fragen betrachten, welche nicht miteinander vermengt oder als moralisch und rechtlich untrennbar zusammengeworfen werden dürfen. Obwohl solche Ansichten mit internationalen Normen und dem Grundsatz eines auf Regeln basierenden internationalen Systems im Einklang stehen, haben sie europäische Analytiker:innen verwirrt und amerikanische Politiker:innen verärgert, die davon ausgehen, die Führung Europas und des Westens sei von globalem normativem Nutzen, wenn nicht gar ein wünschenswertes universelles Gut. Dies hat zum falschen Vorwurf afrikanischer Gleichgültigkeit gegenüber der Ukraine geführt, der wenn auch nicht ausdrücklich, sondern unterschwellig den Gegensatz zwischen einem zivilisierten, liberal-demokratischen Europa und einem Afrika wiederholt, welches die Bedeutung von internationaler Moral, Recht und Sicherheit noch nicht verstanden habe. Gegen dieses falsche Urteil versucht der Beitrag, die konkurrierenden Erinnerungen und Lehren der afrikanischen Eliten aus der Geschichte zu beleuchten, die weder Teil des europäischen/westlichen noch des russischen Common Sense sind.This paper aims to revisit a plea by global south elites, particularly leaders and opinion-makers in Africa, to recast the debate around the Russian invasion into Ukraine along the axis of larger questions about the international order and attendant security systems. Accordingly, the article traces contemporary articulations of African non-alignment, which have held the question of Ukraine rights, Russian concerns, and NATO ambitions as three separate questions that are not to be confused or confl ated as morally and legally indivisible. Though consistent with international norms and the principle of a rule-based international system, such views have confused European analysts and angered US policymakers opera ting on the predicate that the guidance of Europe and the West is of global normative utility, if not a desirable universal good. This has led to a false charge of African indiff erence toward Ukraine, exemplified in the repeated, if insinuated, contrast between a civilized liberal democratic Europe and an Africa that has yet to understand the stakes of international morality, law, and security. Against this misinformed judgement, the paper seeks to illuminate the competing memories and lessons of histories that African elites hold, which are neither part of the European/Western nor Russian commonsense

The hidden Niemann-Pick type C patient:Clinical niches for a rare inherited metabolic disease

Background: Niemann-Pick disease type C (NP-C) is a rare, inherited neurodegenerative disease of impaired intracellular lipid trafficking. Clinical symptoms are highly heterogeneous, including neurological, visceral, or psychiatric manifestations. The incidence of NP-C is under-estimated due to under-recognition or misdiagnosis across a wide range of medical fields. New screening and diagnostic methods provide an opportunity to improve detection of unrecognized cases in clinical sub-populations associated with a higher risk of NP-C. Patients in these at-risk groups (clinical niches) have symptoms that are potentially related to NP-C, but go unrecognized due to other, more prevalent clinical features, and lack of awareness regarding underlying metabolic causes. Methods: Twelve potential clinical niches identified by clinical experts were evaluated based on a comprehensive, non-systematic review of literature published to date. Relevant publications were identified by targeted literature searches of EMBASE and PubMed using key search terms specific to each niche. Articles published in English or other European languages up to 2016 were included. Findings: Several niches were found to be relevant based on available data: movement disorders (early-onset ataxia and dystonia), organic psychosis, early-onset cholestasis/(hepato)splenomegaly, cases with relevant antenatal findings or fetal abnormalities, and patients affected by family history, consanguinity, and endogamy. Potentially relevant niches requiring further supportive data included: early-onset cognitive decline, frontotemporal dementia, parkinsonism, and chronic inflammatory CNS disease. There was relatively weak evidence to suggest amyotrophic lateral sclerosis or progressive supranuclear gaze palsy as potential niches. Conclusions: Several clinical niches have been identified that harbor patients at increased risk of NP-C

The hidden Niemann-Pick type C patient : clinical niches for a rare inherited metabolic disease

BACKGROUND : Niemann-Pick disease type C (NP-C) is a rare, inherited neurodegenerative disease of impaired intracellular lipid trafficking. Clinical symptoms are highly heterogeneous, including neurological, visceral, or psychiatric manifestations. The incidence of NP-C is under-estimated due to under-recognition or misdiagnosis across a wide range of medical fields. New screening and diagnostic methods provide an opportunity to improve detection of unrecognized cases in clinical sub-populations associated with a higher risk of NP-C. Patients in these at-risk groups (“clinical niches”) have symptoms that are potentially related to NP-C, but go unrecognized due to other, more prevalent clinical features, and lack of awareness regarding underlying metabolic causes. METHODS : Twelve potential clinical niches identified by clinical experts were evaluated based on a comprehensive, non-systematic review of literature published to date. Relevant publications were identified by targeted literature searches of EMBASE and PubMed using key search terms specific to each niche. Articles published in English or other European languages up to 2016 were included. FINDINGS : Several niches were found to be relevant based on available data: movement disorders (early-onset ataxia and dystonia), organic psychosis, early-onset cholestasis/(hepato)splenomegaly, cases with relevant antenatal findings or fetal abnormalities, and patients affected by family history, consanguinity, and endogamy. Potentially relevant niches requiring further supportive data included: early-onset cognitive decline, frontotemporal dementia, parkinsonism, and chronic inflammatory CNS disease. There was relatively weak evidence to suggest amyotrophic lateral sclerosis or progressive supranuclear gaze palsy as potential niches. CONCLUSIONS : Several clinical niches have been identified that harbor patients at increased risk of NP-C.Actelion Pharmaceuticals Ltd., Allschwil, Switzerland. From Actelion Pharmaceuticals Ltd.: travel expenses AC, AD, AP, CD-V, CJH, CL, HHK, MT, MW, MP, MS, PB, OB, SD, SL; research funding AP, CL, CD-V, CJH, FT-B, J-CC, MW, OB, PB, RI, SD, TD, TdK; consultancy fees AP, CJH, CL, HHK, MT, MW, OB, PB, SL; speaker honoraria CD-V, MP, MS, PB, SD. MA has received speaker honoraria and travel expenses from Abbvie, TEVA, and UCB. J-CC has received speaker honoraria from Abbvie, travel grants from Abbvie, research funding from, Ipsen, and the Michael J Fox Foundation, and consultancy fees from BMS, Zambon, Pfizer, Amarantus, Clevexel, and Abbvie. CD-V has received research grants, investigator fees, speaker honoraria, and travel expenses from Sanofi Genzyme, Orphan Europe, and Nutricia. SD has received research funding from TEVA. CJH is Director of FYMCA Medical Ltd., has received consultancy fees and travel expenses from Alexion, Amicus, Biomarin, Inventiva, Sanofi Genzyme, and Shire, and has undertaken paid research on behalf of Amicus, Biomarin, Sanofi Genzyme and Shire. SL has received consultancy fees and travel expenses from TEVA, Boehringer, Gruenenthal, and UCB6e. AP has received research funding, consultancy fees and travel expenses from Eli-Lilly, GE Health, and Lundbeck. CT has received speaker honoraria and travel expenses from Abbvie, Zambon, TEVA, and UCB. CV and SK are employees of Actelion Pharmaceuticals Ltd.http://www.tandfonline.com/loi/icmo202018-03-02hj2018Paediatrics and Child Healt

Can we predict cognitive decline after initial diagnosis of multiple sclerosis? Results from the German National early MS cohort (KKNMS)

BackgroundCognitive impairment (CI) affects approximately one-third of the patients with early multiple sclerosis (MS) and clinically isolated syndrome (CIS). Little is known about factors predicting CI and progression after initial diagnosis.MethodsNeuropsychological screening data from baseline and 1-year follow-up of a prospective multicenter cohort study (NationMS) involving 1123 patients with newly diagnosed MS or CIS were analyzed. Employing linear multilevel models, we investigated whether demographic, clinical and conventional MRI markers at baseline were predictive for CI and longitudinal cognitive changes.ResultsAt baseline, 22% of patients had CI (impairment in 2 cognitive domains) with highest frequencies and severity in processing speed and executive functions. Demographics (fewer years of academic education, higher age, male sex), clinical (EDSS, depressive symptoms) but no conventional MRI characteristics were linked to baseline CI. At follow-up, only 14% of patients showed CI suggesting effects of retesting. Neither baseline characteristics nor initiation of treatment between baseline and follow-up was able to predict cognitive changes within the follow-up period of 1 year.ConclusionsIdentification of risk factors for short-term cognitive change in newly diagnosed MS or CIS is insufficient using only demographic, clinical and conventional MRI data. Change-sensitive, re-test reliable cognitive tests and more sophisticated predictors need to be employed in future clinical trials and cohort studies of early-stage MS to improve prediction

Ofatumumab versus Teriflunomide in Multiple Sclerosis

BACKGROUND: Ofatumumab, a subcutaneous anti-CD20 monoclonal antibody, selectively depletes B cells. Teriflunomide, an oral inhibitor of pyrimidine synthesis, reduces T-cell and B-cell activation. The relative effects of these two drugs in patients with multiple sclerosis are not known. METHODS: In two double-blind, double-dummy, phase 3 trials, we randomly assigned patients with relapsing multiple sclerosis to receive subcutaneous ofatumumab (20 mg every 4 weeks after 20-mg loading doses at days 1, 7, and 14) or oral teriflunomide (14 mg daily) for up to 30 months. The primary end point was the annualized relapse rate. Secondary end points included disability worsening confirmed at 3 months or 6 months, disability improvement confirmed at 6 months, the number of gadolinium-enhancing lesions per T1-weighted magnetic resonance imaging (MRI) scan, the annualized rate of new or enlarging lesions on T2-weighted MRI, serum neurofilament light chain levels at month 3, and change in brain volume. RESULTS: Overall, 946 patients were assigned to receive ofatumumab and 936 to receive teriflunomide; the median follow-up was 1.6 years. The annualized relapse rates in the ofatumumab and teriflunomide groups were 0.11 and 0.22, respectively, in trial 1 (difference, -0.11; 95% confidence interval [CI], -0.16 to -0.06; P<0.001) and 0.10 and 0.25 in trial 2 (difference, -0.15; 95% CI, -0.20 to -0.09; P<0.001). In the pooled trials, the percentage of patients with disability worsening confirmed at 3 months was 10.9% with ofatumumab and 15.0% with teriflunomide (hazard ratio, 0.66; P = 0.002); the percentage with disability worsening confirmed at 6 months was 8.1% and 12.0%, respectively (hazard ratio, 0.68; P = 0.01); and the percentage with disability improvement confirmed at 6 months was 11.0% and 8.1% (hazard ratio, 1.35; P = 0.09). The number of gadolinium-enhancing lesions per T1-weighted MRI scan, the annualized rate of lesions on T2-weighted MRI, and serum neurofilament light chain levels, but not the change in brain volume, were in the same direction as the primary end point. Injection-related reactions occurred in 20.2% in the ofatumumab group and in 15.0% in the teriflunomide group (placebo injections). Serious infections occurred in 2.5% and 1.8% of the patients in the respective groups. CONCLUSIONS: Among patients with multiple sclerosis, ofatumumab was associated with lower annualized relapse rates than teriflunomide. (Funded by Novartis; ASCLEPIOS I and II ClinicalTrials.gov numbers, NCT02792218 and NCT02792231.)