A fuzzy decision support model for the evaluation and selection of healthcare projects in the framework of competition.

Our research aims to support decision-making regarding the financing of healthcare projects by structural funds with policies targeting reduction of the development gap among different regions and countries of the European Union as well as the achievement of economic and social cohesion. A fuzzy decision support model for the evaluation and selection of healthcare projects should rank the project applications for the selected region, accounting for the investor's wishes in the form of a regional coefficient in order to reduce the development gap between regions. On the one hand, our proposed model evaluates project applications based on selected criteria, which may be structured, weakly structured, or unstructured. On the other hand, it also incorporates information on the level of healthcare development in the region. The obtained ranking increases the degree of validity of the decision regarding the selection of projects for financing by investors, considering the level of development of the region where the project will be implemented. At the expense of European Union (EU) structural funds, a village, city, region, or state can receive funds for modernization and development of the healthcare sector and all related processes. To minimize risks, it is necessary to implement adequate support systems for decision-making in the assessment of project applications, as well as regional policy in the region where the project will be implemented. The primary goal of this study was to develop a complex fuzzy decision support model for the evaluation and selection of projects in the field of healthcare with the aim of reducing the development gap between regions. Based on the above description, we formed the following scientific hypothesis for this research: if the project selected for financing can successfully achieve its stated goals and increase the level of development of its region, it should be evaluated positively. This evaluation can be obtained using a complex fuzzy model constructed to account for the region's level of development in terms of the availability and quality of healthcare services in the region where the project will be implemented.

Case Report: Langerhans cell histiocytosis involving the cervical spine in an adult patient.

Langerhans Cell Histiocytosis (LCH) is a typically benign disorder that affects infants predominately, with adult occurrence being uncommon. We discuss the case of a 22-year-old guy who visited our clinic complaining of three months of acute nape pain and upper limb radiculopathy. Notably, the patient had no history of trauma, fall injuries, or tuberculosis. Radiological tests identified a single osteolytic lesion within the C3 vertebral body. The lesion was removed, an anterior C3 corpectomy and discectomy were performed, and the patient's spine was reconstructed with a titanium cage and plating. The patient's nape discomfort and radiculopathy vanished almost instantly after surgery. A definitive diagnosis of LCH was confirmed through histological examination. This case report illustrates the unusual and uncommon occurrence of LCH at the C3 vertebral body, for which fusion surgery was the only viable therapeutic option. The patient's recovery from radiating pain following the surgical procedure demonstrates the effectiveness of the intervention. LCH in the cervical spine is rather rare, but it is nevertheless important to be aware of the possibility of developing it.

GROSS TOTAL RESECTION IN A RARE CASE OF OPTIC NERVE ASTROCYTOMA: A CASE REPORT.

The authors present a 3-year-old female with increasing proptosis and absent vision in the right eye. Chemotherapy had done for 3months. But her ailments lingered. The right eye exhibited severe proptosis and poor vision, whereas the left eye was normal with 20/20 vision. Preoperative MRI revealed a dumbbell-shaped tumor in the intra-orbital and intra-cranial section of the right optic nerve. A lateral supra-orbital approach was used to dissect the dumbbell-shaped tumor and the right optic nerve. No remnant of the tumor was discovered during a follow-up examination. The case study demonstrates how to identify and treat ONA surgically. However, we need further research on optic nerve PA to gain a better understanding of their behavior. While gross total resection (GTR) is usually curative, tumors in deep locations may be unresectable and require alternative therapeutic procedures. Additionally, the case study emphasizes the importance of additional research on early detection and prevention.

Sphenoid wing meningiomas: peritumoral brain edema as a prognostic factor in surgical outcome.

Sphenoidal meningiomas constitute 18% of intracranial masses, and still present a difficult surgical challenge. PTBE has been associated with several complications and future recurrence. This study aims to evaluate the outcome of the operatively treated sphenoid wing meningiomas in relation to PTBE as a prognostic factor in a series of 65 patients. The clinical materials of 65 patients with SWM treated microsurgically between 2007 and 2020 were analyzed retrospectively. Follow-up ranged from 6 to 156 months (median, 86). Clinical outcomes include postoperative major neurological deficit, quality of life using KPS, recurrence, and mortality rates. The mean age of patients was 53.9 years (range 20-74), males 24.6% and females75.4%. An edema index (EI) of 1 (40%) was considered as absent edema, and EI > 1 (60%) indicated present edema. Total resection (Simpson I-II) was achieved in 64.6% and subtotal (Simpson IV) in 13.8%. Postoperative complications included vision impairment in 3 patients, motor weakness 6, third nerve palsy 6, intraoperative bleeding and edema 5, and MCA infarct 2, recurrence in 17% and 7.7% died. In univariate analysis, we found that the PTBE is one of the serious risk factors in the immediate surgical outcomes and complication, though more data is needed to support this claim, while having a negative effect on postoperative KPS at short-term follow up (χ2 = 6.44, p = 0.011). PTBE was associated with decline in KPS and quality of life in the early postoperative period (three months) while showing no significant effect at long-term outcomes.

Scientists without borders: lessons from Ukraine.

Conflicts and natural disasters affect entire populations of the countries involved and, in addition to the thousands of lives destroyed, have a substantial negative impact on the scientific advances these countries provide. The unprovoked invasion of Ukraine by Russia, the devastating earthquake in Turkey and Syria, and the ongoing conflicts in the Middle East are just a few examples. Millions of people have been killed or displaced, their futures uncertain. These events have resulted in extensive infrastructure collapse, with loss of electricity, transportation, and access to services. Schools, universities, and research centers have been destroyed along with decades' worth of data, samples, and findings. Scholars in disaster areas face short- and long-term problems in terms of what they can accomplish now for obtaining grants and for employment in the long run. In our interconnected world, conflicts and disasters are no longer a local problem but have wide-ranging impacts on the entire world, both now and in the future. Here, we focus on the current and ongoing impact of war on the scientific community within Ukraine and from this draw lessons that can be applied to all affected countries where scientists at risk are facing hardship. We present and classify examples of effective and feasible mechanisms used to support researchers in countries facing hardship and discuss how these can be implemented with help from the international scientific community and what more is desperately needed. Reaching out, providing accessible training opportunities, and developing collaborations should increase inclusion and connectivity, support scientific advancements within affected communities, and expedite postwar and disaster recovery.

EXTENSIVE PERITUMORAL BRAIN EDEMA IN A SMALL CLINOIDAL MENINGIOMA: CLINICAL CASE.

Peritumoral brain edema (PTBE) is seen in 40-78% of all cases of intracranial meningiomas. It may vary in shape and size, occasionally being two to three times larger than the tumor. We present a case of a 62-year-old female patient, suffering from seizure and progressive headache. She was diagnosed with left medial sphenoid wing meningioma and referred for treatment to Uzhhorod Regional Center of Neurosurgery and Neurology. The patient had no major focal neurological deficit and Karnofsky Performance Scale (KPS) of 70 on admission. The preoperative magnetic resonance imaging (MRI) with and without contrast showed a 2.1×2.2×2.5 cm solid mass at the inner third of the left sphenoid wing, with homogenous enhancement and encasement of middle cerebral artery (MCA). In addition, there was a disproportionately extensive PTBE in the left cerebral hemisphere that caused midline shift and mass effect. The patient underwent left pterional craniotomy and gross total resection of the mass. The postoperative course was without complications or new neurological deficit, MRI within 48 hours revealed gross total tumour resection with residual brain edema and the patient was discharged with a KPS of 80 on day 7. Based on several studies, significant correlation between PTBE and tumor volume was observed: larger tumors cause larger PTBE. This particular case had a very large hemispheric PTBE, which was disproportionate to the small size of the meningioma. Most likely, the PTBE in this patient was caused by venous congestion, but this had no influence on surgical outcome. Therefore, the presence of a large PTBE does not necessarily indicate a poor prognosis and isn't always the reason of surgical complications.

Genome diversity in Ukraine.

BACKGROUND: The main goal of this collaborative effort is to provide genome-wide data for the previously underrepresented population in Eastern Europe, and to provide cross-validation of the data from genome sequences and genotypes of the same individuals acquired by different technologies. We collected 97 genome-grade DNA samples from consented individuals representing major regions of Ukraine that were consented for public data release. BGISEQ-500 sequence data and genotypes by an Illumina GWAS chip were cross-validated on multiple samples and additionally referenced to 1 sample that has been resequenced by Illumina NovaSeq6000 S4 at high coverage. RESULTS: The genome data have been searched for genomic variation represented in this population, and a number of variants have been reported: large structural variants, indels, copy number variations, single-nucletide polymorphisms, and microsatellites. To our knowledge, this study provides the largest to-date survey of genetic variation in Ukraine, creating a public reference resource aiming to provide data for medical research in a large understudied population. CONCLUSIONS: Our results indicate that the genetic diversity of the Ukrainian population is uniquely shaped by evolutionary and demographic forces and cannot be ignored in future genetic and biomedical studies. These data will contribute a wealth of new information bringing forth a wealth of novel, endemic and medically related alleles.

The effect of the presence of epileptic attacks on the clinical duration of supratentorial brain meningiomas.

OBJECTIVE: The aim: To study the effect of epileptic seizures in patients with supratentorial brain meningiomas on the clinical course of meningiomas in the early and late postoperative period. PATIENTS AND METHODS: Materials and methods: A retrospective analysis of the course of the disease was performed in 242 patients with total removed supratentorial meningioma of the brain (general group). Long-term outcome of the disease was estimated in 176 people (a catamnesis group). RESULTS: Results: The occurrence of a new neurological deficit was observed in 18 (18.0±3.8 %) patients out of 100 among patients with epileptic seizures before surgery and in 19 (13.4±2.9 %) out of 142 among those who had no seizures. The mortality rate was 1 (1.0±1.0 %) in the group of patients with seizures and 3 (2.8±1.4 %) in the group of patients without seizures before surgery. The prevalence of new neurological deficits in the catamnesis group is 14 (19.2±4.6 %) of 73 patients with epileptic seizures before surgery and 17 (16.5±3.7 %) of 103 patients without seizures. Mortality was 3 cases (4.1±2.3 %) in patients with seizures and 9 cases (8.7±2.8 %) among patients without seizures. CONCLUSION: Conclusions: No data have been obtained that the presence of epileptic seizures affects the incidence of new neurological deficits, complications and mortality after surgical treatment of meningiomas in the early and late postoperative period.

Epilepsy after ishemic stroke: is it worth administering anticonvulsants after the first attack?

OBJECTIVE: Introduction: Epileptic attacks frequency in patients after stroke ranges widely from 3 % up to 60 %. Today many aspects of this problem in post-stroke epilepsy haven't been completely studied, regarding the problem of the time for administering antiepileptic drugs (AEDs). The aim of this study was to define the prognosis of symptomatic epilepsy development after stroke depending on the patients taking AEDs after the first epileptic attack. PATIENTS AND METHODS: Materials and methods: We perform a complex examination of 1012 patients (562 males and 450 females) aged from 49 up to 90 who had suffered from ischemic stroke during 2011-2014. Neurologic examinations were carried out according to the conventional methods scaling score NIHSS (National Institute of Health Scale of Stroke Severity, USA). RESULTS: Results: It was revealed that within 6 months after the ischemic stroke at least one epileptic attack was observed in 151 patients. According to the type of attacks focal attacks (80.9%, p<0.001) prevailed, and only in 11.1% initially generalized epileptic attacks were diagnosed. In the first patients group who took anticonvulsants during one year repeated epileptic attacks were revealed in 27.1% of patients while in the other group where there was no treatment with anticonvulsants during a year repeated attacks were observed in 53.75% patients. CONCLUSION: Conclusions: Obtained results are the basis for further investigations and possible recommended administration of AEDs just after the first epileptic attack in the patients after stroke.

Prestroke alcohol consumption and smoking are not associated with stroke severity, disability at discharge, and case fatality.

BACKGROUND: Heavy alcohol consumption and smoking are known risk factors for stroke, but their influence on stroke severity and outcome may also be important. We tested if alcohol consumption and smoking relate to initial stroke severity, disability at discharge from hospital, and outcome at 30 days and at 1 year in 1049 patients of the Mures-Uzhgorod-Debrecen database. METHODS: Initial stroke severity was scored by the National Institutes of Health Stroke Scale. Case fatality and the modified outcome scale of the First International Stroke Trial were used to assess outcome. We used multiple regression analysis. RESULTS: Before their stroke, 24.5% were smokers and 24.7% admitted regular alcohol consumption. Neither smoking nor alcohol consumption status was associated with initial stroke severity. Case fatalities at discharge, at 30 days, and at 1 year were 12.2%, 16.9%, and 28.3%, respectively. Initial stroke severity, hemorrhagic subtype, and age in men over 60 years were strong predictors of outcome. We did not find significant difference among alcohol consumers and nonconsumers in 30-day and in 1-year case fatality in all stroke patients and in ischemic stroke patients. In hemorrhagic stroke, there was a nonsignificant tendency for higher case fatality among alcohol consumers (39.5% versus 26.4%, P > .2, at 30 days and 48.8% versus 35.8%, P > .2, at 1 year). Smoking did not influence significantly the outcome at 30 days and at 1 year. CONCLUSION: Despite being risk factors, prestroke smoking and alcohol consumption do not have a significant influence on stroke severity and on short- and long-term outcome.