An Overview of Healthcare Systems in Comoros: The Effects of Two Decades of Political Instability.

Background: There is ongoing scientific evidence pointing out the adverse effects of conflict on population health and development. Union of Comoros has experienced nearly two decades of political instability and military rule. This comprehensive review was carried out to ask whether the health crisis in Comoros is attributable to the consequences of the chronic political instability. Methods: This study involved a series of semi-structured interviews with key informants complemented by a comprehensive literature search of electronic databases and grey literature. A literature search was performed using all identified keywords associated with health indicators in Comoros to identify potential eligible publications in both English and French from 1975 to July 2020. Results: The analysis demonstrated that political instability and lack of proper leadership from the Government undermine the establishment of health policies which contributed dramatically to the decline in health performance. Additionally, the resurgence and emergence of old and new diseases such as cholera, chikungunya, malaria, HIV/AIDS as indicators of inadequate health services were most likely during political turmoil. Data also showed an out-migration of the health workforce and an increased overseas medical treatment demand, which indicate less attractive working conditions and weak health systems in the country. Meanwhile, an increasing performance of health status indicators was observed after the comprehensive peace process of the 2000-Fomboni Declaration. Conclusions: The chronic political instability in Comoros has contributed to the health crisis facing the Union of Comoros. It has hampered the implementation of proper institutions, which might guarantee the socio-economic development and prosperity of the population. Further studies were needed to evaluate the health burden associated with the two decades of political instability and military rule.

Current and future biomarkers in gastric cancer.

Gastric cancer is the fourth most common worldwide cause of cancer-related death. Early gastric cancer has no associated symptoms, for this reason, patients come to the attention of the clinicians only in advanced stages. This paper aims to give a global view on the biomarkers for gastric cancer and the therapy in use. We discuss VEGF family, HER family, E-cadherin, PD-L1, and PD-L2, FGFR, mTOR. Finally, we considered emerging biomarkers as MET, microsatellite instability, and microRNA variations. Furthermore, we have analyzed in depth the chemotherapeutic and adjuvant therapies used in the clinic nowadays, comparing the overall and progression-free survival between them. Identifying and validating diagnostic, prognostic, predictive, and pharmacodynamic biomarkers will be mandatory to the huge impact on patients' outcomes and for improving the efficiency of the drug development process.