Author: ModernMedia

Categories : CancerTags :

Ancient Virus DNA Lurking in Human Genome Fuels Modern-day Cancers

On By ModernMedia
Photo by Sangharsh Lohakare on Unsplash

Peek inside the human genome and, among the 20 000 or so genes that serve as building blocks of life, you’ll also find flecks of DNA left behind by viruses that infected primate ancestors tens of millions of years ago.

These ancient hitchhikers, known as endogenous retroviruses, were long considered inert or “junk” DNA, defanged of any ability to do damage. New CU Boulder research reported in Science Advances shows that, when reawakened, they can play a critical role in helping cancer survive and thrive. The study also suggests that silencing certain endogenous retroviruses can make cancer treatments work better.

“Our study shows that diseases today can be significantly influenced by these ancient viral infections that until recently very few researchers were paying attention to,” said senior author Edward Chuong, an assistant professor of molecular, cellular and developmental biology at CU Boulder’s BioFrontiers Institute.

Studies show about 8% of the human genome is made up of endogenous retroviruses that slipped into the cells of our evolutionary ancestors, coaxing their hosts to copy and carry their genetic material. Over time, they infiltrated sperm, eggs and embryos, baking their DNA like a fossil record into generations to come – and shaping evolution along the way.

Even though they can no longer produce functional viruses, Chuong’s own research has shown that endogenous retroviruses can act as “switches” that turn on nearby genes. Some have contributed to the development of the placenta, a critical milestone in human evolution, as well as our immune response to modern-day viruses like COVID.

“There’s been a lot of work showing these endogenous retroviruses can be domesticated for our benefit, but not a lot showing how they might hurt us,” he said.

Switching cancer genes on

To explore their role in cancer, Chuong and first author Atma Ivancevic, a research associate in his lab, analyzed genomic data from 21 human cancer types from publicly available datasets. 

They found that a specific lineage of endogenous retrovirus known as LTR10, which infected some primates about 30 million years ago, showed surprisingly high levels of activity in several types of cancer, including lung and colon cancer. Further analysis of tumors from dozens of colorectal cancer patients revealed that LTR10 was active in about a third of them.

When the team used the CRISPR gene editing tool to snip out or silence sequences where it was present, they discovered that critical genes known to promote cancer development and growth also went dark.

“We saw that when you silence this retrovirus in cancer cells, it turns off nearby gene expression,” said Ivancevic.

Experiments in mice yielded similar results: When an LTR10 “switch” was removed from tumor cells, key cancer-promoting genes, including one called XRCC4, switched off too, and treatments to shrink tumors worked better. 

“We know that cancer cells express a lot of genes that are not supposed to be on, but no one really knows what is turning them on,” said Chuong. “It turns out many of the switches turning them on are derived from these ancient viruses.”

Notably, the endogenous retrovirus they studied appears to switch on genes in what is known as the MAP-kinase pathway, a famed cellular pathway that is adversely rewired in many cancers. Existing blockbuster drugs on the market, known as MAP-kinase inhibitors, likely work, in part, by disabling the endogenous retrovirus switch, the study suggests.

Reawakening ancient viruses

The authors note that just this one family of retrovirus regulates as many as 70 cancer-associated genes in this pathway. Different lineages likely influence different pathways that promote different cancers.

The team plans to look into some of them next.

“Any time we can find out how genes or pathways that are inherently altered in tumours are regulated, that is really helpful,” said co-author Todd Pitts, associate professor of medical oncology with the CU Cancer Center on the Anschutz Medical Campus. “It allows us to potentially find new therapies or find patients that might respond better to current therapies.”

The study is not the first to implicate ancient viruses in cancer. Previous studies suggest they may emit toxic compounds or spark genetic mutations. And two other recent studies show that they switch on cellular pathways in leukaemia and prostate cancer.

Chuong said that while these shadow viruses are likely an underappreciated source of genetic influence across all cancer types, this study doesn’t show they cause cancer. Rather, cancer itself wakes them up, empowering them to activate other disease-promoting processes to help keep it alive.

He suspects that as people’s cells age, their genomic defenses break down, enabling other ancient viruses to reawaken and contribute to other health problems too. 

“The origins of how diseases manifest themselves in the cell have always been a mystery,” said Chuong. “Endogenous retroviruses are not the whole story, but they could be a big part of it.”

Source: University of Colorado Boulder

Categories : Injury & Trauma NeurologyTags :

Less Invasive Method for Measuring Intracranial Pressure After TBI

On By ModernMedia
Coup and contrecoup brain injury. Credit: Scientific Animations CC4.0

Researchers at Johns Hopkins explored a potential alternative and less-invasive approach to evaluate intracranial pressure (ICP) in patients with serious neurological conditions. This research, using artificial intelligence (AI) to analyse routinely captured ICU data, was published in Computers in Biology and Medicine.

ICP is a physiological variable that can increase abnormally if one has severe traumatic brain injury, stroke or obstruction to the flow of cerebrospinal fluid. Symptoms of elevated ICP may include headaches, blurred vision, vomiting, changes in behaviour and decreased level of consciousness. It can be life-threatening, hence the need for ICP monitoring in selected patients who are at increased risk. But the current standard for ICP monitoring is highly invasive: it requires the placement of an external ventricular drain (EVD) or an intraparenchymal brain monitor (IPM) in the functional tissue in the brain consisting of neurons and glial cells by drilling through the skull.

“ICP is universally accepted as a critical vital sign – there is an imperative need to measure and treat ICP in patients with serious neurological disorders, yet the current standard for ICP measurement is invasive, risky, and resource-intensive. Here we explored a novel approach leveraging Artificial Intelligence which we believed could represent a viable noninvasive alternative ICP assessment method,” says senior author Robert Stevens, MD, MBA, associate professor of anaesthesiology and critical care medicine.

EVD procedures carry a number of risks including catheter misplacement, infection, and haemorrhaging at 15.3 %, 5.8 %, and 12.1 %, respectively, according to recent research. EVD and IPM procedures also require surgical expertise and specialised equipment that is not consistently available in many settings thus underscoring the need for an alternative method in examining and monitoring ICP in patients.

The Johns Hopkins team, a group that included faculty and students from the School of Medicine and Whiting School of Engineering, hypothesised that severe forms of brain injury, and elevations in ICP in particular, are associated with pathological changes in systemic cardiocirculatory function due, for example, to dysregulation of the central autonomic nervous system. This hypothesis suggests that extracranial physiological waveforms can be studied to better understand brain activity and ICP severity.

In this study, the Johns Hopkins team set out to explore the relationship between the ICP waveform and the three physiological waveforms that are routinely captured in the ICU: invasive arterial blood pressure (ABP), photoplethysmography (PPG) and electrocardiography (ECG). ABP, PPG and ECG data were used to train deep learning algorithms, resulting in a level of accuracy in determining ICP that rivals or exceeds other methodologies.

Overall study findings suggest a completely new, noninvasive alternative to monitor ICP in patients.

Stevens says, “with validation, physiology-based AI solutions, such as the one used here, could significantly expand the proportion of patients and health care settings in which ICP monitoring and management can be delivered.” 

Source: John Hopkins Medicine

Categories : Cancer GeneticsTags :

Prostate Cancer Blood Test Equally Effective Across Ethnic Groups

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Photo by Nicholas Swatz

The Stockholm3 blood test, developed by researchers at Karolinska Institutet, is equally effective at detecting prostate cancer in different ethnic groups, according to a new paper published in The Journal of Clinical Oncology. The test produces significantly better results than the current PSA standard.

Stockholm3, a prostate cancer test developed in Sweden, runs a combination of protein and genetic markers from a blood sample through an algorithm to find the probability of a patient having clinically significant cancer. 

Studies in more than 90 000 men have shown that Stockholm3 produces significantly better results than the current PSA standard. The test improves prostate cancer diagnosis by reducing unnecessary MRI and biopsies and by identifying significant cancers in men with low or normal PSA values.   

Ethnically diverse group

However, previous studies have been conducted primarily in Scandinavia on a mainly White population with uncertain generalisability to the rest of the world. A Swedish-American research group has now examined how well it works in an ethnically mixed group of men in the USA and Canada. 

The study included over 2000 men at 17 different clinics, 16% of whom were Asian, 24% African-American, 14% Latin American and 46% White American.  All participants had a referral for a prostate biopsy on the basis of an elevated PSA score, abnormal rectal examination, MRI scan or other suspicious clinical finding.  

Before the biopsy was performed, a blood test was taken along with clinical data pertinent to the Stockholm3 test, which was conducted blinded to the biopsy results. 

Halving the number of unnecessary biopsies

The analysis shows that clinically relevant prostate cancer cases were found in a total of 29% of the men, somewhat more in African Americans and slightly fewer in Asians. 

It also shows that the Stockholm3 test could almost halve the number of unnecessary biopsies (45 per cent fewer: 673 as opposed to 1226) while being no less effective at detecting all clinically relevant cases. The results were similar across the different ethnic groups. 

“The study demonstrates that the Stockholm3 test is just as effective on an ethnically mixed group as it is on a White, Swedish population,” says the study’s lead author Hari T. Vigneswaran, doctor and PhD student at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. 

According to him, the research answers several important questions and will lead to a more widespread use of the method: 

“Colleagues in other countries are very interested in these data, which show that Stockholm3 works for a non-Swedish population and among minorities.” 

Source: Karolinska Institutet

Categories : Medical IndustryTags :

Opinion Piece: Claims on the Increase

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Gap cover providers are seeing more claims of higher values than ever before

Photo by Cottonbro on Pexels

By Brian Harris, General Manager Operations at Turnberry

As medical inflation has continued to rise and the cost of medical procedures has increased, medical aid companies are faced with the juggling act of keeping premiums affordable while still offering adequate cover. In addition, new procedures such as robotic-assisted surgery and new cancer drugs offer better outcomes, but at a greatly increased cost.

As a result, we are seeing increased medical expense shortfalls, particularly when it comes to specialists, as well as increased co-payments and sub-limits. The upshot of this, for the consumer, is vastly increased out-of-pocket expenses, which is why gap cover has become critical. Given the increase in both the frequency and Rand value of claims, having gap cover in place has never been more important.

The state of gap cover

The frequency and value of gap cover claims have increased dramatically over the years as the gap between what medical aid covers and what specialists and providers charge continues to widen.

In 2023, Turnberry paid out R119 968 466 in claims, proportionately this accounted for 56% of the total claims, with medical aid covering the remaining 44%. This figure includes a significant number of high value claims, with many of them exceeding R100 000. Three of the highest claims in 2023 were R129 193.60 for heart disease, R128 485.43 for a nasal polyp, and R125 735.08 for a spinal fusion surgery.

These are figures paid out over the course of a single year and for a single diagnosis. Gap cover policies are subject to an overall annual limit (OAL) per individual covered by the policy, and this limit is increased in April each year, and is currently R198 660.43 per insured person. This limit resets every year, which means that over a lifetime, the amount paid out for individuals and families is far higher. At Turnberry, the top three lifetime claims are figures in the hundreds of thousands of Rands: R502 983, R450 225, and R414 331 respectively.

What does this mean for me?

The most common procedures we see as a gap cover provider are spinal disc problems, cancer, heart disease, cataract surgery and maternity, and these claims can and often do exceed R100 000 per incident. These figures highlight the fact that in South Africa, gap cover is essential for anyone wishing to access private healthcare without potentially incurring significant out of pocket expenses.

The reality is that even young and healthy people could need costly medical procedures, and as your age and life stage changes, your medical needs do too. Accidents can happen to anyone, regardless of age, and injuries related to sports and physical activity are also common in younger age groups. Starting a family inevitably involves increased medical expenses, from pregnancy and childbirth to raising children who frequently need medical attention. Health issues related to stress are also on the rise, including anxiety and depression. In later life stages, chronic diseases like high blood pressure, high cholesterol, and prediabetes become more common. Cancer can strike anyone and is increasingly seen in younger population groups.

The cost of quality medical care continues to increase, and medical expense shortfalls as well as co-payments and sub-limits are becoming more and more common, at higher amounts. This means that any medical treatment, regardless of your age or life stage, can end up costing tens of thousands of Rands out of pocket. Over a lifetime, these sums could potentially add up to millions.

It is important to engage with your broker to make sure you have the right medical aid in place first, and then to supplement this with appropriate gap cover, to ensure that you are able to access the medical care you need without the financial burden of out-of-pocket expenses resulting from medical expense shortfalls, co-payments and sub-limits.

About Turnberry Management Risk Solutions

Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.

With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.

Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Women Lose More Years of Life After a Heart Attack Than Men

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Photo by Joice Kelly on Unsplash

A new study shows that women lose more years of life after a heart attack than men. A 50-year-old woman with a large heart attack loses an average of 11 years, while an 80-year-old man with a small heart attack loses an average of 5 months of life. The results of the study, led by researchers at Karolinska Institutet and Danderyd Hospital, are published in the journal Circulation.

The new study examined 335 000 individuals with first-time myocardial infarction registered in the SWEDEHEART quality registry during the period 1991-2022. The individuals with myocardial infarction were compared with 1.6 million individuals without myocardial infarction using data from Statistics Sweden and the National Board of Health and Welfare. Using the comparator population and new statistical methods, the difference in life expectancy between heart attack individuals and comparison individuals could be calculated, providing a measure of how much life expectancy was shortened due to the disease. 

“We found that there were large differences between groups. Women and young individuals lost the most life expectancy when they had a heart attack. If the cardiac function was impaired after the infarction, the effects were even greater. For example, a 50-year-old woman with impaired cardiac function loses an average of 11 years in 2022 compared to an 80-year-old man with normal cardiac function who loses an average of 5 months in life expectancy,” says first author Christian Reitan, researcher at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut. 

Parameters affecting heart attack risk

The researchers were also able to take into account differences in income, education, other illnesses and medication at the time of the illness – which helped to measure the effect of the heart attack itself when everything else was taken into account.

“The results showed that a fairly large part of the reduction in life expectancy disappeared, that is, much of the reduction in life expectancy is explained by factors other than the heart attack itself, but which may still be associated with heart attack, such as socioeconomics or other diseases such as hypertension and diabetes. Provided that the patient had preserved cardiac function, we saw that the gender difference had disappeared. We interpret this to mean that the effect of the heart attack, and thus also the care for heart attacks, is similar between the sexes and that the large reduction in life expectancy we see in women is due to differences in risk factors, other diseases and socioeconomics,” says Christian Reitan. 

According to the researchers, there is a lack of individualized heart attack care in Sweden for women. The study shows that women who have a heart attack lose more years of life than men of the same age.

“If a woman had impaired cardiac function, the gender difference was large. We don’t have the data to answer why, but it raises questions about whether women get as good follow-up and treatment for heart failure as men, or whether it is simply a more serious condition for a woman. Our findings are important because they challenge existing guidelines for heart attack treatment today. By identifying high-risk groups, we can hopefully better tailor treatment to the individual. We believe that ‘years of life lost’ is a good and easy-to-understand measure of risk for both doctors and patients. It makes it easier for us to assess and communicate the seriousness of the disease,” concludes Christian Reitan. 

Source: Karolinska Institutet

Categories : Cancer Obstetrics & GynaecologyTags :

New Surgical Method for Cervical Cancer Shows Promising Results

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Cervical cancer. Credit: Scientific Animations CC4.0

A recently published study has compared a new surgical method, called cancer field surgery (Total Mesometrial Resection, TMMR), with the current standard treatment for primary management of cervical cancer.

The new TMMR method was developed over 20 years ago by Karolinska Institutet’s partners at the Leipzig University Hospital. Previous publications have suggested favourable results without the need for radiation therapy. Omitting radiation therapy could potentially improve quality of life for treated women.

In the study, the researchers demonstrate that TMMR is associated with improved oncological outcomes for early stages of cervical cancer. The data suggest that TMMR may replace current treatment strategies and radiation therapy could be spared for salvage treatment. This breakthrough motivates continued work in this field.

Research of this kind heavily relies on well-functioning collaborations with other researchers. Beyond providing essential data for the project, it also strengthens international cooperation, facilitating the dissemination of our findings. The researchers plan to further explore the potential of cancer field surgery in gynaecological cancer to establish the method in future treatment strategies.

Source: Karolinska Institutet

Categories : Regenerative MedicineTags :

Breakthrough in Understanding Skeletal Muscle Regeneration

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Photo by Jonathan Borba on Unsplash

Newly published research from the University of Houston College of Pharmacy identifies key mechanisms of skeletal muscle regeneration and growth of muscles following resistance exercise. The findings, published in EMBO Reports, open the door to the development of targeted therapies for various muscle disorders, like Muscular Dystrophy, which affect millions of people worldwide.

When it comes to muscles and muscle disorders, the importance of a discovery like this cannot be overstated.

Muscles’ regenerative powers

Skeletal muscles are formed during embryonic development by the fusion of hundreds of specialised cells called myoblasts. Adult skeletal muscles maintain regenerative capacity, which is attributed to the presence of muscle stem cells, named satellite cells.

After injury, satellite cells undergo several rounds of proliferation followed by their differentiation into myoblasts. These myoblasts once again fuse with each other and to injured myofibres to accomplish muscle regeneration.

In many muscular disorders, this intrinsic capacity of muscles to regenerate is diminished resulting in the loss of muscle mass and function.

Key signalling protein

UH researchers found that Inositol-requiring enzyme 1, a key signalling protein, is essential for myoblast fusion during muscle formation and growth.

“During muscle regeneration, IRE1 augments the activity of X-box binding protein 1 which in turn stimulates the gene expression of multiple transmembrane proteins required for myoblast fusion,” reports Ashok Kumar, professor of pharmacy in the Department of Pharmacological and Pharmaceutical Sciences.

According to researchers, increasing the levels of IRE1 or XBP1 in muscle stem cells outside the body, followed by their injection in patients’ muscle tissues will improve muscle repair and reduce the severity of disease.

“We also found that augmenting the levels of IRE1α or XBP1 in myoblasts leads to the formation of myotubes (muscle cells) having an increased diameter,” said Kumar.

That increase in diameter can be significant.

“Size is very important for muscle. Muscle grows only in size, not in number,” said Aniket Joshi, a graduate student in Kumar’s lab and first author on the article. “Muscular people have larger muscle cells. Larger muscles generally work better- can lift more weight, run and walk faster, and improve overall metabolism of the body and prevent various diseases, such as type II diabetes.”

Flexing their muscles

This new research is not the first flex for Kumar’s team. In 2021, research from Kumar’s lab published in the ELife journal described the role of the IRE1α/XBP1 signaling axis in regeneration of healthy skeletal muscle after acute injury and in models of Duchenne Muscular Dystrophy. In this study, they found that IRE1α/XBP1 signaling axis also plays an important cell autonomous role in satellite cells.

Source: University of Houston

Categories : CancerTags :

Diabetic Neuropathy Drug Reduces Drug Resistance in Lung Cancer

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In this image from a genetically engineered mouse model, lung cancer driven by the Kras oncogene shows up in purple. As a key driver in many types of cancer, the Kras gene makes a promising target for new cancer therapies. Credit: National Cancer Institute, National Institutes of Health

A medication used to treat diabetic neuropathy may enhance the effectiveness of chemotherapy for patients with lung cancer, according to new findings from the University of Missouri School of Medicine. Despite surgical and chemotherapy treatment, more than 50% of non-metastatic, non-small lung cancer patients see recurrences, in large part because of drug-resistant cancer cells. Researchers identified a way to make these cells more susceptible to chemotherapy, said Dr Jussuf Kaifi, author of the new study published in Clinical Cancer Research.

“Traditional treatments for lung cancer, including chemotherapy, often have little to no effect on the cancer because of drug resistance,” Kaifi said. “It is a major cause of mortality in patients, so finding ways to circumvent drug and chemotherapy resistance is vital to improving patient outcomes.”

The study examined 10 non-small cell lung cancer tumours, half of which were identified as drug resistant. The drug-resistant tumours showed overexpression of a certain enzyme, AKR1B10. When treated with the diabetic neuropathy medication, epalrestat, the tumours became less drug resistant, causing their sensitivity to chemotherapy to significantly increase.

Epalrestat is available in several countries (excluding South Africa) and well-tolerated by patients, but it is not yet approved for use by the Food and Drug Administration in the United States. The medication is currently in high-level clinical trials as part of the FDA’s approval process. If given FDA approval, epalrestat could be fast-tracked in the US as an anti-cancer drug for lung cancer patients.

“In general, developing new drugs for cancer treatment is an extremely lengthy, expensive and inefficient process,” Kaifi said. “In contrast, ‘repurposing’ these drugs to other diseases is much faster and cheaper. In view of overcoming drug resistance, epalrestat can rapidly be advanced to the clinic to improve cure rates in lung cancer patients.”

Source: University of Missouri

Categories : New Compounds and Treatments OphthalmologyTags :

Repurposed Drug Combination Promising in the Treatment of Retinal Degenerations

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Retina and nerve cells. Credit: NIH

An international team of researchers have tested a combination treatment incorporating three existing drugs and successfully slowed disease progression in pre-clinical retinopathy models. Their results, which used tamsulosin, metoprolol and bromocriptine are published in Nature Communications.

Drug repurposing refers to the use of existing drugs to treat diseases or conditions which they were not originally developed or approved for, and offer a strategy to treat rare diseases for which new drug development is too costly. The new study focused on drug repurposing in the context of inherited retinal degenerations, IRDs. IRDs are a group of genetic diseases that cause the deterioration of retinal anatomy and function, leading to gradual loss of vision and often blindness. Most IRDs are currently inaccessible therapeutically, comprising an unmet medical need for a substantial population worldwide.

A combination treatment incorporating three drugs slowed disease progression 

The researchers found that a combination treatment incorporating three drugs significantly slowed disease progression and decreased disease manifestation in four different animal models of IRD. The combination included the blood pressure and heart failure drug metoprolol, and tamsulosin, which is used for the treatment of benign prostatic hyperplasia, as well as the nowadays less commonly used Parkinson’s disease drug bromocriptine.

“In drug repurposing, it does not matter to which diseases or conditions the drugs were originally developed for, but it is the molecular-level effects of drugs, or pharmacology, that count,” says first author Dr Henri Leinonen, currently Adjunct Professor of Neuropharmacology at the University of Eastern Finland.

In retinal degenerations, intracellular secondary messengers such as cyclic adenosine monophosphate and calcium are believed to be overactive, exacerbating the disease. Metoprolol, tamsulosin and bromocriptine suppress the activity of these secondary messengers via their own distinct cell membrane-receptor actions.

“We hypothesised that the combined effect of these drugs would alleviate the disease, which it indeed did in several distinct animal models of IRDs. However, the efficacy and safety of this combination in humans with retinal degeneration is not guaranteed, and controlled clinical trials to test these are needed,” Dr Leinonen notes.

It is noteworthy that none of the drugs used in the study were effective against retinal degeneration on their own; instead, their combination was necessary for efficacy. According to Dr Leinonen, the same phenomenon may apply to many diseases that are currently untreatable, and especially in multifactorial diseases, effective treatment may require multiple drugs to be used simultaneously.

Drug repurposing could provide solutions especially for the treatment of rare diseases

Rare diseases, IRDs included, are seldom of major interest for the pharmaceutical industry due to a lack of economic incentives. But drug repurposing, actively researched in academia, is a promising method to find solutions for rare diseases that remain therapeutically inaccessible.

The most significant advantages of drug repurposing can be found in faster drug development times and lower costs. Since repurposed drugs have already undergone several mandatory safety tests and early stages of clinical trials, their market entry is considerably faster and cheaper than that of completely new drugs. Drug safety is also an important aspect, as the relative safety of repurposed drugs compared to a completely new chemical reduces risks and uncertainty, which is often considered the most critical point in the drug development process.

Source: University of Finland

Categories : IT in HealthcareTags :

‘Medicine in the Dark Ages’: Healthcare Hit Hard by Global IT Outage

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Photo by Joshua Hoehne on Unsplash

On Friday, users around the world began encountering a “blue screen of death”, signalling the start of a day of chaos. About 8.5 million Microsoft devices were affected by a bug, resulting in significant global disruption from airlines to finance and even small businesses. Healthcare infrastructure was also affected, which may have endangered an unknown number of lives because of missed appointments, inaccessible patient records, prescriptions and inventory data.

Worldwide, hospitals reported being unable to use their systems to access key information such as schedules, patient medical records and logistics. Reports emerged of cancelled procedures, and non-urgent patients being turned away.

“Many hospitals are cancelling elective procedures today. Patients should direct any questions to their providers because this is a practice-by-practice, hospital-by-hospital decision,” said the Massachusetts Department of Public Health in a statement.

In the UK, NHS England warned of delays and the British Medical Association advised of a backlog for normal GP service.

‘Like practising medicine in the dark ages’

All across Africa reported that many hospitals and clinics depend on Microsoft 365 and cloud services for crucial functions, Nehanda Radio reported. The outage highlights how critical infrastructure has become dependent on the stability of a handful of platforms.

“Our entire hospital was thrown into disarray. We couldn’t access patient files, schedule surgeries, or coordinate with suppliers,” said Dr Amina Salim, the chief medical officer at a major hospital in Abuja, Nigeria.

“It was like practising medicine in the dark ages. Our doctors and nurses were forced to resort to hand-written notes and countless phone calls just to provide basic care.”

“I went to refill my HIV medication and the pharmacist said their computers were down, so they couldn’t look up my prescription. I was worried I’d have to go without my treatment,” said Thembi Ndlovu, a patient in Johannesburg.

The problem was worsened in rural and underserved areas that are heavily reliant on the internet and cloud services for remote consultations, sharing of medical expertise and centralised databases.

“Our telemedicine program came to a screeching halt. We couldn’t video conference with specialists, access test results, or update patient records,” said Dr Khalid Elmahdi, the director of a rural health clinic in Morocco. “It was devastating for communities that have few other options for advanced care.”

The crashes were traced to an update from a security service provider, Crowdstrike – which ironically provides protection solutions against ransomware, a problem that has been plaguing healthcare.

While most services seem to be up and running after the weekend, experts say that it may take weeks for full recovery. Fixing the problem often requires physically accessing the system and installing a USB dongle with recovery software, which can be difficult in certain locations, such as remote clinic.