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What Happened to Education in Conflict-Affected Countries Immediately after the Outbreak of COVID-19?
Full text linkIn this paper we review prior research on educational responses to the initial phase of COVID-19 pandemic in conflict-affected countries. Furthermore, we reanalyze data from UNESCO, UNICEF, and the World Bank’s joint Survey on National Education Response to COVID-19 School Closure covering the period from the initial outbreak through the end of 2020. Our analyses suggest that extant educational disparities between non-conflict-affected countries and conflict-affected countries widened during the early stages of the pandemic, particularly in terms of insufficient infrastructure for distance (online) learning and a lack of support for students (especially disabled students), teachers, and parents. Had there been no comprehensive support from the international community, the negative impact of COVID-19 on education in conflict-affected countries would likely have persisted for an extended period.departmental bulletin pape
Surgical outcomes of emergency open appendectomy for acute appendicitis: an audit of 2268 patients in a single center
Full text linkAlthough conservative treatment and laparoscopic surgery are becoming increasingly popular for acute appendicitis, emergency open appendectomy is still performed in many situations. The purpose of this study was to examine the surgical outcomes of emergency open appendectomy for acute appendicitis. Between July 2008 and August 2022, 2,268 patients who underwent emergency open appendectomy for acute appendicitis were enrolled in this study. Of these patients, 417 (18.4%) had complicated appendicitis (CA), and 1,851 (81.6%) had uncomplicated appendicitis (UA). Clinical characteristics and both surgical and postoperative outcomes were compared between the groups. The percentage of CA patients increased after 2020, and by age, the proportion was greater for those aged 50 and older. In the CA group, patients were older (55.5 vs 30.0 years, p<0.001) and had more comorbidities (34% vs 12%, p<0.001). Additionally, in the CA group, the operation time was longer (86 vs 55 min, p<0.001), and the rate of postoperative complications was greater (16% vs 3.0%, p<0.001). There was one mortality in the CA group due to postoperative cerebral infarction. The postoperative hospital stay was significantly longer in the CA group (9 vs 5 days, p<0.001). In conclusion, in the CA group, the patients were older and had more comorbidities. Patients who underwent emergency open appendectomy for CA had longer operation times and more complications. This large single-center study provides insights into emergency open appendectomy for acute appendicitis and useful information in terms of comparisons with other treatment modalities, such as laparoscopic appendectomy and elective appendectomy.departmental bulletin pape
A case of severe immune-related adverse events, myocarditis with myositis, and myasthenia gravis overlap syndrome following adjuvant nivolumab administration for muscle-invasive bladder cancer
Full text linkHerein, we present a case of severe immune-related adverse events (irAEs), myocarditis with myositis, and myasthenia gravis overlap syndrome (IM3OS) in a patient receiving an immune checkpoint inhibitor (ICI), as adjuvant therapy after surgery for muscle-invasive bladder cancer. An 80-year-old woman who had undergone a total cystectomy for bladder cancer presented with ptosis, diplopia, and paralysis 18 days after receiving nivolumab, an anti-programmed cell death-1 (PD-1) monoclonal antibody, as adjuvant therapy for the first time. Initial testing revealed positive findings on the ice pack test; elevated troponin, creatine kinase, and aldolase levels; and an abnormal electrocardiogram, suggesting that the patient had developed ICI-related myocarditis, myositis, and myasthenia gravis. Despite treatment with intravenous immunoglobulin (IVIG) and high-dose corticosteroids, her condition worsened, leading to a complete atrioventricular block. After cardiac pacemaker insertion and intensive treatment with repeated high-dose corticosteroids, IVIG, plasma exchange, and tacrolimus, left ventricular function and myositis symptoms improved. However, the patient developed a respiratory infection and renal failure, leading to death on day 99. Although ICIs are considered relatively safe with few side effects, they can cause serious complications and lead to death. In particular, when severe irAEs occur in multiple organs, such as IM3OS, the prognosis is poor. Although IM3OS has no specific diagnostic biomarker, making early detection difficult, clinicians should always pay attention to patient symptoms when using ICI and evaluate other pathologies with IM3OS when conditions such as myositis or myocarditis are suspected. Further research is needed to elucidate the pathophysiology and risk factors of IM3OS.departmental bulletin pape
ある優生社会の街頭 : 三島由紀夫『美徳のよろめき』をめぐる病者の生
Full text linkThis paper discusses discrimination in Mishima Yukio’s “Bitoku no Yoromeki”. Previous research on this work has discussed sexism from a feminist perspective. However, the existence of a sick male person, who is discriminatorily portrayed in the work, has not been discussed. This paper focuses on this sick person and critically discusses the eugenic thought of the texts concerning illness and disability. The sick person is described as having a disfigured face. Based on the symptoms, the disease is first thought to be syphilis. However, it is also possible that Hansen’s disease could be the cause of similar symptoms. At the time of the publication of the text, the movement for the return of Hansen’s disease patients from sanatoriums was ongoing. The text metaphorizes the disease by not naming it explicitly. The metaphorical illness forms a discriminatory representation of the text. The protagonist, Setsuko, comes into contact with a sick person and fears that the disease may be transmitted to her pregnant child. This is an expression of the inner eugenicist. The sick person is erased from existence by eugenics. Setsuko, who conducts pregnancies and abortions, has eroticism and can be seen as a masochist. Mishima discussed eroticism in the 1950s, referring to masochists and sadists. Mishima argued that eroticism requires resistance, the function of which inevitably excludes the sick, who are represented as the uncanny. The eroticism of the text depends on the presence of the sick. The sick appears again in the text, but they are marked as a minority and discriminatorily erased. The novel of adultery thus divides the majority and the minority, and enlightens the former as citizen. The sick is erased in the narrative. In this way, all aspects of discrimination in eugenic society appear in the texts, and they must be discussed serially.departmental bulletin pape
