RESUMO
Gastric cancer (GC) represents a major global health burden and is responsible for a significant number of cancer-related fatalities. Its complex nature, characterized by heterogeneity and aggressive behaviour, poses considerable challenges for effective diagnosis and treatment. Single-cell RNA sequencing (scRNA-seq) has emerged as an important technique, offering unprecedented precision and depth in gene expression profiling at the cellular level. By facilitating the identification of distinct cell populations, rare cells and dynamic transcriptional changes within GC, scRNA-seq has yielded valuable insights into tumour progression and potential therapeutic targets. Moreover, this technology has significantly improved our comprehension of the tumour microenvironment (TME) and its intricate interplay with immune cells, thereby opening avenues for targeted therapeutic strategies. Nonetheless, certain obstacles, including tumour heterogeneity and technical limitations, persist in the field. Current endeavours are dedicated to refining protocols and computational tools to surmount these challenges. In this narrative review, we explore the significance of scRNA-seq in GC, emphasizing its advantages, challenges and potential applications in unravelling tumour heterogeneity and identifying promising therapeutic targets. Additionally, we discuss recent developments, ongoing efforts to overcome these challenges, and future prospects. Although further enhancements are required, scRNA-seq has already provided valuable insights into GC and holds promise for advancing biomedical research and clinical practice.
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Pesquisa Biomédica , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/genética , Perfilação da Expressão Gênica , Análise de Sequência de RNA , Microambiente Tumoral/genéticaRESUMO
Membrane trafficking is a physiological process encompassing different pathways involved in transporting cellular products across cell membranes to specific cell locations via encapsulated vesicles. This process is required for cells to mature and function properly, allowing them to adapt to their surroundings. The retromer complex is a complex composed of nexin proteins and peptides that play a vital role in the endosomal pathway of membrane trafficking. In humans, any interference in normal membrane trafficking or retromer complex can cause profound changes such as those seen in neurodegenerative disorders such as Alzheimer's and Parkinson's. Several studies have explored the potential causative mechanisms in developing both disease processes; however, the role of retromer trafficking in their pathogenesis is becoming increasingly significant with promising therapeutic applications. This manuscript describes the processes involved in membrane transport and the roles of the retromer in the onset and progression of Alzheimer's and Parkinson's. Moreover, we will also explore how these aberrant mechanisms may serve as possible avenues for treatment development in both diseases and the prospect of its future application.
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Doença de Alzheimer , Doença de Parkinson , Humanos , Membrana Celular , Transporte Biológico , Proteínas Associadas aos MicrotúbulosRESUMO
Parkinson's disease is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, including hallucinations. The use of antipsychotic medications is a common strategy to manage hallucinations associated with Parkinson's disease psychosis (PDP). However, careful consideration is necessary when selecting the most appropriate drug due to the potential risks associated with the available treatment options. Atypical antipsychotics (AAPs), such as Pimavanserin and Clozapine, have effectively controlled PDP symptoms. On the contrary, the support for utilizing quetiapine is not as substantial as other antipsychotics because research studies specifically investigating its application are still emerging and relatively recent. The broad mechanisms of action of AAPs, involving dopamine and serotonin receptors, provide improved outcomes and fewer side effects than typical antipsychotics. Conversely, other antipsychotics, including risperidone, olanzapine, aripiprazole, ziprasidone, and lurasidone, have been found to worsen motor symptoms and are generally not recommended for PDP. While AAPs offer favorable benefits, they are associated with specific adverse effects. Extrapyramidal symptoms, somnolence, hypotension, constipation, and cognitive impairment are commonly observed with AAP use. Clozapine, in particular, carries a risk of agranulocytosis, necessitating close monitoring of blood counts. Pimavanserin, a selective serotonin inverse agonist, avoids receptor-related side effects but has been linked to corrected QT (QTc) interval prolongation, while quetiapine has been reported to be associated with an increased risk of mortality. This review aims to analyze the benefits, risks, and mechanisms of action of antipsychotic medications to assist clinicians in making informed decisions and enhance patient care.
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Antipsicóticos , Clozapina , Alucinações , Doença de Parkinson , Piperidinas , Fumarato de Quetiapina , Humanos , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Antipsicóticos/farmacologia , Clozapina/efeitos adversos , Clozapina/administração & dosagem , Clozapina/farmacologia , Alucinações/tratamento farmacológico , Alucinações/etiologia , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/complicações , Piperidinas/efeitos adversos , Piperidinas/farmacologia , Piperidinas/administração & dosagem , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/farmacologia , Fumarato de Quetiapina/administração & dosagem , Ureia/análogos & derivados , Ureia/farmacologia , Ureia/efeitos adversosRESUMO
COVID-19 is an acute respiratory illness caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). The first case was reported in Africa on February 14, 2020 and has surged to 11 million as of July 2022, with 43% and 30% of cases in Southern and Northern Africa. Current epidemiological data demonstrate heterogeneity in transmission and patient outcomes in Africa. However, the burden of infectious diseases such as malaria creates a significant burden on public health resources that are dedicated to COVID-19 surveillance, testing, and vaccination access. Several control measures, such as the SHEF2 model, encompassed Africa's most effective preventive measure. With the help of international collaborations and partnerships, Africa's pandemic preparedness employs effective risk-management strategies to monitor patients at home and build the financial capacity and human resources needed to combat COVID-19 transmission. However, the lack of safe sanitation and inaccessible drinking water, coupled with the financial consequences of lockdowns, makes it challenging to prevent the transmission and contraction of COVID-19. The overwhelming burden on contact tracers due to an already strained healthcare system will hurt epidemiological tracing and swift counter-measures. With the rise in variants, African countries must adopt genomic surveillance and prioritize funding for biodiversity informatics.
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COVID-19 , Humanos , COVID-19/epidemiologia , SARS-CoV-2/genética , Controle de Doenças Transmissíveis , África/epidemiologia , GenômicaRESUMO
The Ebola virus, a member of the filoviridae family of viruses, is responsible for causing Ebola Virus Disease (EVD) with a case fatality rate as high as 50%. The largest EVD outbreak was recorded in West Africa from March 2013 to June 2016, leading to over 28 000 cases and 11 000 deaths. It affected several countries, including Nigeria, Senegal, Guinea, Liberia, and Sierra Leone. Until then, EVD was predominantly reported in remote villages in central and west Africa close to tropical rainforests. Human mobility, behavioral and cultural norms, the use of bushmeat, burial customs, preference for traditional remedies and treatments, and resistance to health interventions are just a few of the social factors that considerably aid and amplify the risk of transmission. The scale and persistence of recent ebola outbreaks, as well as the risk of widespread global transmission and its ability for bioterrorism, have led to a rethinking of public health strategies to curb the disease, such as the expedition of Ebola vaccine production. However, as vaccine production lags in the subcontinent, among other challenges, the risk of another ebola outbreak is likely and feared by public health authorities in the region. This review describes the inequality of vaccine production in Africa and the resurgence of EVD, emphasizing the significance of health equality.
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Vacinas contra Ebola , Ebolavirus , Doença pelo Vírus Ebola , Humanos , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , África Ocidental/epidemiologia , Surtos de Doenças/prevenção & controle , NigériaRESUMO
BACKGROUND: The Russia-Ukraine war has undeniably impacted global science and healthcare in Ukraine. Many Ukrainian researchers have had their projects disrupted by this war, either due to loss of life, displacement, or destruction of resources. Despite these challenges, these researchers have sought to make their voices heard. This scoping review highlights the trend of healthcare-related publications on the current Russia-Ukraine war and characterizes the contribution of Ukrainian authors to these publications. METHOD: A comprehensive literature search was performed using two databases (Scopus and Pubmed) for publications related to the ongoing Russia-Ukraine war. We included articles only related to healthcare. We then extracted and analyzed bibliometric data. RESULT: One hundred and eighty-three articles were identified, including 12 (6.6%) original articles, 26 (14.2%) cross-sectional studies, 19 (10.4%) letters to the editor, 10 (5.5%) commentaries, 5 (2.7%) perspectives, 35 (19.1%) editorials, 2 (1.1%) randomized controlled trials, 11(6.0%) correspondences, 13 (7.1%) opinions, 8 (4.4%) reviews and 42 (23.0%) are identified as others. 180 (98.4%) studies were in English, and 3 (1.7%) were in German. 54 (29.5%) papers on the war had at least one author affiliated with a Ukrainian institution, and 29 (15.9%) studies had authors with Ukrainian affiliation as first authors. CONCLUSION: our study shows that there has been a significant number of publications on the Russia-Ukraine war and only a small portion of first authors, co-authors, and last authors of these publications are affiliated to an institution in Ukraine. Therefore, despite the relatively high number of publications, most publications do not arise from the perspective of Ukrainian authors.
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Autoria , Humanos , Estudos Transversais , Ucrânia , Bases de Dados Factuais , Federação RussaRESUMO
Intracranial aneurysms (IAs) pose complex and potentially life-threatening challenges in Africa, where limited resources, restricted access to specialised healthcare facilities, and disparities in healthcare provision amplify the difficulties of management. Timely diagnosis and treatment are pivotal in preventing complications, including subarachnoid haemorrhage. Treatment options encompass observation, surgical clipping, endovascular coiling, and flow diversion. Positive outcomes observed in IA management in Africa include high survival rates, favourable functional outcomes, successful treatment techniques, and the absence of complications in some cases. However, negative outcomes such as postoperative complications, reduced quality of life, perioperative mortality, and the risk of recurrence persist. Challenges in IA management encompass limited access to diagnostic tools, a scarcity of specialised healthcare professionals, and an unequal distribution of services. Addressing these challenges requires interventions focused on improving access to diagnostic tools, expanding the number of trained professionals, and establishing specialised IA treatment centres. Collaboration, research, and capacity-building efforts hold significant importance in improving patient outcomes and reducing disparities in IA management across Africa.
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Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Qualidade de Vida , Resultado do Tratamento , Hemorragia Subaracnóidea/complicações , Complicações Pós-Operatórias/etiologia , Procedimentos Endovasculares/métodos , Embolização Terapêutica/métodosRESUMO
The need for improved palliative care in developing countries is great. Of 58 million people who die every year, 45 million die in developing countries. An estimated 60% (27 million) of these people in poor nations would benefit from palliative care, and this number is growing as chronic diseases such as cancer rise rapidly. Yet a combination of highly restrictive policies on opioid prescription and a lack of awareness within the medical profession conspire to deprive patients of palliative care. Human rights advocates argue that this neglect is a breach of human rights that is tantamount to torture. This editorial explores the neuropalliative approach and addresses the current state of neuropalliative care in developing countries.
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Países em Desenvolvimento , Cuidados Paliativos , HumanosRESUMO
In March 2020, WHO declared SARS-CoV-2 a global pandemic and lockdowns were enforced in most of the United States. Self-protective measures and travel restrictions were implemented, and schools/universities initiated online learning. Consequently, the global incidence and hospitalization rates of seasonal respiratory infections decreased significantly up to early 2021. Despite the decrease in hospitalization rates due to respiratory illnesses other than Covid-19, hospitals and healthcare providers faced huge stressors regarding workload dueto the pandemic. Furthermore, higher vaccination rates across the United States decreased non pharmaceutical interventions (NPI) implementation increasing the risk of major seasonal viral outbreaks. This editorial discusses the increased Rhinovirus/Enterovirus infections in the United States, challenges faced by healthcare providers and provides recommendations to address the issue.
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COVID-19 , Doenças Transmissíveis , Enterovirus Humano D , Infecções por Enterovirus , Influenza Humana , Humanos , Estados Unidos/epidemiologia , Infecções por Enterovirus/epidemiologia , Rhinovirus , Pandemias/prevenção & controle , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , COVID-19/epidemiologia , SARS-CoV-2 , Controle de Doenças Transmissíveis , Pessoal de SaúdeRESUMO
The Russo-Ukrainian Conflict has had significant repercussions on Ukraine's healthcare system, resulting in civilian casualties and damage to healthcare institutions. The disruption of personnel, medical supplies, and patient transportation has created considerable challenges for healthcare services. However, there are successful approaches from comparable contexts that can serve as a catalyst for post-conflict healthcare reformation in Ukraine. Key strategies include improving healthcare accessibility for marginalized populations through standardized essential health and surgical care packages, rehabilitating damaged facilities, strengthening primary care provisions, and supporting war survivors with disabilities. By adopting these proven practices, Ukraine can strengthen its healthcare system and facilitate a sustainable recovery, contributing to the country's resilience and ensuring essential healthcare services for its population.
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Etnicidade , Sobreviventes , Humanos , Atenção à SaúdeRESUMO
The tremendous evolution in modern technology has led to a paradigm shift in neurosurgery. The latest advancements such as augmented reality, virtual reality, and mobile applications have been incorporated into neurosurgical practice. NeuroVerse, representing the application of the metaverse in neurosurgery, brings enormous potential to neurology and neurosurgery. Implementation of NeuroVerse could potentially elevate neurosurgical and interventional procedures, enhance medical visits and patient care, and reshape neurosurgical training. However, it is also vital to consider the challenges that may be associated with its implementation, such as privacy issues, cybersecurity breaches, ethical concerns, and widening of existing healthcare inequalities. NeuroVerse adds phenomenal dimensions to the neurosurgical environment for patients, doctors, and trainees, and represents an incomparable advancement in the delivery of medicine. Therefore, more research is needed to encourage widespread use of the metaverse in healthcare, particularly focusing on the areas of morality and credibility. Although the metaverse is expected to expand rapidly during and after the COVID-19 pandemic, it remains to be seen whether it represents an emerging technology that will revolutionize our society and healthcare or simply an immature condition of the future.
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COVID-19 , Neurocirurgia , Humanos , COVID-19/epidemiologia , Pandemias , Procedimentos Neurocirúrgicos/métodos , Atenção à SaúdeRESUMO
With increasing prevalence and an expected rise in disease burden, cancer is a cause of concern for African healthcare. The cancer burden in Africa is expected to rise to 2.1 million new cases per year and 1.4 million deaths annually by the year 2040. Even though efforts are being made to improve the standard of oncology service delivery in Africa, the current state of cancer care is not yet on par with the rise in the cancer burden. Cutting-edge technologies and innovations are being developed across the globe to augment the battle against cancer; however, many of them are beyond the reach of African countries. Modern oncology innovations targeted to ward Africa would be promising to address the high cancer mortality rates. The innovations should be cost-effective and widely accessible to tackle the rapidly rising mortality rate on the African continent. Though it may seem promising, a multidisciplinary approach is required to overcome the challenges associated with the development and implementation of modern oncology innovations in Africa.
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Atenção à Saúde , Neoplasias , Humanos , África/epidemiologia , Efeitos Psicossociais da Doença , Neoplasias/terapia , Saúde GlobalRESUMO
The conflict in Ukraine, which started when Russia invaded and violated its sovereignty, has led to the country's worst war since the annexation of Crimea in 2014. The war has resulted in a significant number of casualties, displaced millions of people, and damaged the healthcare system, which was already struggling before the conflict. The neurosurgical field, in particular, has been severely affected, with infrastructure and healthcare systems routinely demolished or interrupted in conflict zones, making fundamental medical operations unavailable to victims of armed conflict. As a result, neurosurgeons have been compelled to conduct surgeries outside of their areas of competence, in makeshift settings or under challenging conditions, with limited access to materials and equipment. The war has also severely damaged specialised neurosurgery facilities, causing a severe shortage of crucial supplies and equipment. To address the challenges facing neurosurgery care in Ukraine, it is essential to rebuild and repair the damaged neurosurgical centres and provide them with the necessary equipment and supplies to successfully administer neurosurgical treatments. Training programs for neurosurgeons and other medical specialists must also be organised to manage complex neurosurgical problems under difficult conditions.
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Neurocirurgia , Humanos , Ucrânia , Neurocirurgia/educação , Neurocirurgiões , Procedimentos Neurocirúrgicos , Conflitos ArmadosAssuntos
COVID-19 , Vírus Nipah , COVID-19/epidemiologia , Humanos , Índia/epidemiologia , Pandemias , SARS-CoV-2RESUMO
OBJECTIVE: Primary brain tumors have the potential to present a substantial health hazard, ultimately resulting in unforeseen fatalities. Despite the enhanced comprehension of many diseases, the precise prediction of disease progression continues to pose a significant challenge. The objective of this study is to investigate cases of unexpected mortality resulting from primary brain tumors and analyze the variables that contribute to such occurrences. METHODS: This systematic review explores research on individuals diagnosed with primary brain tumors who experienced unexpected deaths. It uses PRISMA standards and searches PubMed, Google Scholar, and Scopus. Variables considered include age, gender, symptoms, tumor type, WHO grade, postmortem findings, time of death - time taken from first medical presentation or hospital admission to death, comorbidity, and risk factors. RESULTS: This study examined 46 studies to analyze patient-level data from 76 individuals with unexpected deaths attributed to intracranial lesions, deliberately excluding colloid cysts. The cohort's age distribution showed an average age of 37 years, with no significant gender preference. Headache was the most common initial symptom. Astrocytomas, meningiomas, and glioblastoma were the most common lesions, while the frontal lobe, temporal lobe, and cerebellum were common locations. Meningiomas and astrocytomas showed faster deaths within the first hour of hospital admission. CONCLUSION: The etiology of unforeseen fatalities resulting from cerebral tumors elucidates an intricate and varied phenomenon. Although unexpected deaths account for a very tiny proportion of total fatalities, it is probable that their actual occurrence is underestimated as a result of underreporting and misdiagnosis.
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Neoplasias Encefálicas , Cistos Coloides , Glioblastoma , Neoplasias Meníngeas , Meningioma , Humanos , Adulto , Meningioma/complicações , Morte Súbita/etiologia , Glioblastoma/complicações , Neoplasias Meníngeas/complicações , Neoplasias Encefálicas/patologiaRESUMO
Terrorism has emerged as an increasingly pressing global issue, giving rise to escalating casualties and devastating implications for peace and security. The low- and middle-income countries (LMICs), already grappling with inadequate healthcare services and an estimated annual mortality toll ranging from 5.7 to 8.4 million, face further setbacks as terrorism exacerbates their prevailing healthcare deficiencies. Among the aspects of how terrorism affects healthcare in LMICs are high morbidity, mortality, and treatment wait times. The four principal areas of reverberation encompass amplified vulnerabilities in healthcare systems, financial shortfalls in LMIC healthcare systems, worsened personnel shortages in healthcare, and the devastating impact on healthcare facilities. In response to these challenges, international organizations and countries have played a pivotal role in mitigating the impact of terrorism on healthcare systems. Additionally, to improve healthcare in these regions, investing in infrastructure, supporting healthcare workers, and ensuring safety are paramount. Implementing mobile health interventions, traditional medicine, and mobile laboratories may enhance healthcare accessibility. Further, employing blockchain technology for data security and supply chain management may strengthen healthcare systems in these areas.