Inside The Pulse - Part 1

Inside The Pulse

Volume 1

Contents

[Part 1]

By DMS Coordinators:

Potential of Citrus Fruit Peels as Mosquito Repellent in Africa

- Jimin Park [DC] Page. 8

How the English government can start to address staff shortages in the NHS

- Eisha Aqil [DC] Page. 12

The Chemistry Behind Composites Fillings

- Ayush Surendran [CIS] Page. 16

Using Machine Learning to Diagnose Breast Cancer

- Rana Babikir [CIS] Page. 20

How Will Integration of AI Revolutionize Genetic Research

- Uddayvir Singh [NAS] Page. 24

From DC, CIS, NAS, NLCS:

Prenatal Genetic Screening

- Xinyu Gu_Page. 27

Neuroplasticity: A Key to Unlocking Alzheimer’s Treatment

- Fatema Jasvi & Mario Elmir_Page. 30

Can Alzheimer’s Disease Be Inherited?

- Mieke Visser_Page. 33

Technically Cyborg: Putting Together Cells and Synthetics to Keep Life Ticking

- Dewmi Amasha Marasinghege_Page. 35

Save Canine Lives from Heatstroke

- Alexandra Hide_Page. 38

Transforming Cancer Care: The Promise of Stem Cell Therapy

- Ananya Gopinath_Page. 40

Hydronephrosis

- Tilly Black_Page. 43

Impact of Air Pollution on Respiratory Health in China

- Aryan Verma_Page. 44

Is Suicide Contagious?

- Rehab Khan_Page. 48

Personalized Medicine

- Maria Michailidou_Page. 50

[Part 2]

To What Extent is Sunak’s 15 Year ‘Transfer’ in the NHS Workforce Viable?

- Charlotte Holt_Page. 6

Advances in Ophthalmology Technology: A 2023 Overview

- Eisha Aqil_Page. 9

Phage Therapy: a virus ‘gone good’ and a battle against MRSA

- Ayush Surendran_Page. 11

How Does Smoking Influence Lung Cancer?

- Jimin Park_Page. 14

The Rise of Cryotherapy in Sports Medicine: A Modern Solution for Athletes

- Harrison Cox_Page. 17

NHS Medical Apprenticeships

- Anna Zaman_Page. 19

Peto’s Paradox: Why Blue Whales Can’t Get Cancer

- Prithvi Gupta_Page. 20

How Does Alcohol Influence Liver Cancer?

- Suemin Park_Page. 22

Ethics in Medicine

- Huichan Jung_Page. 25

The Link Between Babies Born by Caesarean Sections and Allergies

- Alexander Gunson_Page. 27

Effects of Climate Change on Ecosystems and Proposed Mitigation Strategies

- Khrysha Arya_Page. 28

How Cocaine Affects the Brain, and How Addiction To It Can Be Treated

- Alexander Mantzavinatos_Page. 30

To Complex Dynamics of Obesity in a Globalized World

- Mishel Kudel_Page. 32

Neurofeedback Therapy

- Sunaina Nambiar_Page. 33

What is CRISPR?

- Elisa Westerhof_Page. 36

Steady Does It: CRISPR- A Peek Of The Future

- Chantille Qi-En Marican_Page. 39

Nanotechnology: Mini Missiles in the War on the Cancer

- Anushree Shah_Page. 41

Alliance for hypocritic medicine

- Delisha Dias_Page. 43

The Prickly Secrete: Sea urchins and cancer

- Leila Ghandour_Page. 47

Principles of Medical Ethics and Their Importance

- Devyansh Pandey_Page. 49

Editor’s Notes:

This publication, Inside The Pulse, is the first volume of a collaborative magazine organized by Dubai Medical Society (DMS) with contributions from four schools in Dubai. DMS aims to be a platform for aspiring medics, dentists and scientists to share their research and insights. This magazine is an attempt to reflect our commitment to interdisciplinary approach, bringing together the different perspectives.

As lead coordinator, I had the privilege of curating and editing an impressive collection of articles covering a wide range of topics. Our vision at DMS is to continue supporting students in developing their interests and deepening their insight into their chosen fields. We look forward to publishing the next volume in 2025 which will include even more high-quality contents.

I would like extend my thanks to my fellow DMS coordinators Ayush Surendran and Uddayvir Singh for their support in producing this magazine. Special thanks to Mieke Visser and Anna Zaman for allowing us to include contents from DC’s medical magazine Beneath Our Skin, where some of the articles in this issue were originally published. Lastly, thank you to all the writers from DC, CIS, NAS and NLCS for their contributions!

Jimin Park

[Editor in Chief - Dubai College DMS Coordinator]

By DMS Coordinators

POTENTIAL OF CITRUS FRUITS PEELS AS MOSQUITO REPELLENT IN AFRICA

Jimin Park

Introduction

Mosquito-borne diseases remain a persistent and severe public health challenge in many regions worldwide, particularly in Africa with 233 million cases in 2022, accounting for about 94 percent of cases globally. (World Health Organization, 2023) Despite many of these diseases being curable, many lives are often lost due to delays in treatment and inadequate access to medical care. (Kenya. Ministry of Health. Malaria Control, 1994) The pain and suffering caused by mosquito-borne diseases are profound, yet the gap between theoretical prevention and the reality on the ground remains stark. (White et al., 2014) Public hospitals frequently face shortages of essential therapeutic drugs, and private healthcare services are prohibitively expensive for many.(White et al., 2014) Additionally, cultural beliefs and reliance on superstitions further complicate eradication efforts.

As much as treatment being considered important, preventative medicine is also a crucial part of healthcare. My medical outreaches to Uganda and Kenya also depicted the urgent need for effective, affordable and safe mosquito repellents. While synthetic products are in use in some regions, the importance of sustainability and accessibility in the prevalent regions cannot be understated; limonene will be discussed throughout this article in order to provide evidence for its suitability as a mosquito repellent in mid-African regions.

Synthetic mosquito repellent DEET and alkyl phthalates

For more than 50 years, the synthetic compound DEET (N,N-diethyl-m-toluamide) (Fig. 1), has been the single most effective repellent for mosquito species and is the basis for many commercial repellent products on the market. (Rodriguez et al., 2015) Despite reports of severe toxic properties which can dramatically affect adults and especially young children including dermatitis, allergic reactions, neurological (seizures, coma) and cardiovascular toxicity, the risk of serious toxic effects from DEET is considered slight. Nevertheless, DEET should always be used at the lowest effective dose possible. (Ghali & Albers, 2024; Koren et al., 2003) Also, dimethyl and di-n-butyl phthalates (DMP and DBP, respectively) (Fig. 2 and Fig. 3 respectively), which are effective mosquito repellents and were widely used in the last century, are no longer generally recommended for use as repellents due to their toxicity. (Zhang et al., 2019)

Fig. 1

Fig. 2

Fig. 3

Why Limonene?

Limonene is an abundant component of citrus fruit (oranges, mandarins, lemons, limes etc) especially in their peels, and have been traditionally valued for their aromatic properties in various cultures. It has recently garnered attention for its potential as a mosquito repellent.(Dutta et al., 2024)

The abundance of citrus in the targeted regions plays a big role in the choice of limonene. Citrus fruits are widely cultivated across Africa, with significant production in several regions of the continent. Countries such as South Africa, Egypt, Morocco, and Kenya are notable for their extensive citrus orchards, contributing to a substantial supply of fruits like oranges, lemons, and limes. In South Africa, citrus farming thrives in the Limpopo and Mpumalanga provinces, while Egypt and Morocco are major producers in the Mediterranean region. Kenya's coastal and central highlands also support large-scale citrus cultivation. (Fig. 4) With increased in the citrus production, agricultural wastes have become a worrying concern worldwide, so the smart ways of utilizing the citrus waste into biological applications are becoming a significant issue. (Tabisa Diniso1 & Oyedeji 2024) Furthermore, these citrus abundancy region in mid-Africa is well matched with the malaria endemic areas in sub Sahel region. (Fig. 5)(Sharp, 1999)

Fig. 4 The map shows the geographical distribution of the citrus fruit production and abundancy in the mid-African region.

Fig. 5 The citrus abundancy region in mid-Africa is well matched with malaria endemic area in subSahel region.

The abundant availability of these fruits presents a promising opportunity for sustainable mosquito control in African communities.

Effects of Limonene on the Nervous and Olfactory Systems of Mosquitoes

Citrus fruits are rich in a variety of bioactive and chemical compounds including limonene (CH) ₁₀₁₆ (Fig. 6), citral (CHO), linalool (CHO), citronellal and Aurantimaric acid. (Dhanashree K. P., et ₁₀₁₆₁₀₁₈ al., 2023; Asadollahi, et al., 2019) Limonene is a colorless liquid, aliphatic hydrocarbon classified as a cyclic monoterpene, and is particularly abundant in the peels of citrus fruits such as oranges, lemons, and limes. This compound not only contributes to the distinctive scents of these fruits but also plays a crucial role in their biological activity. (Anandakumar et al., 2021)

Its effectiveness as a mosquito repellent is a consequence of its ability to interfere with the olfactory and nervous systems of mosquitoes. Mosquitoes detect humans through olfactory and thermal cues mediated by sensory systems. The primary olfactory detection mechanism involves odorant receptors (ORs) located on the antennae and maxillary palps. Notably, the receptors OR1, OR2, and OR7 are sensitive to volatile compounds emitted by humans, such as carbon dioxide (CO), lactic acid, and ₂ various fatty acids. CO is particularly detected by the CO-sensitive receptor neuron, ionotropic ₂₂ receptor IR21a, which is highly responsive to the miniscule changes in atmospheric CO concentration ₂ that occur due to human respiration. (Olsson, et al., 2022) When mosquitoes are exposed to limonene, it disrupts and desensitizes their sensory perception which prevents them from detecting CO and ₂ other chemicals emitted by humans. Studies show that binding of limonene to ORs can alter the signaling pathways: by affecting the activation of G proteins and the production of secondary messengers like cyclic AMP (cAMP), limonene can disrupt the normal signal transduction process, impairing the ability of olfactory neurons to transmit accurate information about human odors. (Khan, et al., 2015) This effect significantly reduces the likelihood of mosquito locating and biting the hosts, thereby reducing the incidences of mosquito-borne diseases.

Additionally, mosquitoes utilize thermal cues detected by thermoreceptors such as TRPA1 (Transient Receptor Potential Ankyrin 1), which are sensitive to body heat and infrared radiation. These receptors allow mosquitoes to sense the warmth of a human body from a distance, further aiding in host localization. As shown, studies demonstrate that limonene can affect mosquito's nervous system and alter their feeding behavior, further enhancing its repellent properties.(Bohbot, 2022; McCall & Eaton, 2001; Nematollahi et al., 2021)

References

Anandakumar, P., Kamaraj, S., & Vanitha, M. K. (2021). D-limonene: A multifunctional compound with potent therapeutic effects. J Food Biochem, 45(1), e13566. https://doi.org/10.1111/jfbc.13566

Asadollahi, A., Khoobdel, M., Zahraei-Ramazani, A. et al. (2019). Effectiveness of plant-based repellents against different Anopheles species: a systematic review. Malar J 18, 436. https://doi.org/10.1186/s12936-019-3064-8

Bohbot, D. M. R. J. D. (2022). Sensory ecology of disease vectors, Chapter 3: The molecular and neural determinants of olfactory behaviour in mosquitoes (C. R. L. R. Ignell, M.G. Lorenzo and S.R. Hill, Ed.). https://doi.org/10.3920/978-90-8686-932-9

Fig. 6

Limonene

Dhanashree K. P., Vaibhav V. D., Ankit C. R., Vaishnavi S. C. (2023). Preparation of Mosquito Repellent Dhoop from Orange Peels. International Journal for Multidisciplinary Research, 5(2), IJFMR23022694.

https://www.academia.edu/115988191/Preparation_of_Mosquito_Repellent_Dhoop_from_ Orange_Peels?sm=b

Dutta, R. S., Sahu, S., Baishya, R., Pachuau, L., Kakoti, B. B., & Mazumder, B. (2024). Essential oils extracted from Citrus macroptera and Homalomena aromatica (Spreng.) Schott. exhibit repellent activities against Aedes aegypti (Diptera: Culicidae). J Vector Borne Dis, 61(1), 107116. https://doi.org/10.4103/0972-9062.392256

Ghali, H., & Albers, S. E. (2024). An updated review on the safety of N, N-diethyl-meta-toluamide insect repellent use in children and the efficacy of natural alternatives. Pediatr Dermatol, 41(3), 403-409. https://doi.org/10.1111/pde.15531

Kenya. Ministry of Health. Malaria Control, P. (1994). Epidemiology of malaria in Kenya. Afr J Med Pract, 1(1), 5-6. https://www.ncbi.nlm.nih.gov/pubmed/12287810

Khan, H. A., & Hassan, M. M. (2015). "Limonene as a Natural Mosquito Repellent: A Review." Journal of Vector Borne Diseases, 52(2), 123-130.

Koren, G., Matsui, D., & Bailey, B. (2003). DEET-based insect repellents: safety implications for children and pregnant and lactating women. CMAJ, 169(3), 209-212. https://www.ncbi.nlm.nih.gov/pubmed/12900480

McCall, P. J., & Eaton, G. (2001). Olfactory memory in the mosquito Culex quinquefasciatus. Med Vet Entomol, 15(2), 197-203. https://doi.org/10.1046/j.0269-283x.2001.00304.x

Nematollahi, N., Ross, P. A., Hoffmann, A. A., Kolev, S. D., & Steinemann, A. (2021). Limonene Emissions: Do Different Types Have Different Biological Effects? Int J Environ Res Public Health, 18(19). https://doi.org/10.3390/ijerph181910505

Laura A., Beatriz G., et al. (2023). World Malaria Report 2023. World Health Organization. 18. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023

Olsson, S. B., & Söderlund, J. (2022). "Mosquito Olfaction and Host Detection: The Role of Odorant and Thermoreceptors." Journal of Experimental Biology, 225(11), jeb243560. DOI: 10.1242/jeb.243560.

Rodriguez, S. D., Drake, L. L., Price, D. P., Hammond, J. I., & Hansen, I. A. (2015). The Efficacy of Some Commercially Available Insect Repellents for Aedes aegypti (Diptera: Culicidae) and Aedes albopictus (Diptera: Culicidae). J Insect Sci, 15(1), 140. https://doi.org/10.1093/jisesa/iev125

Sharp, J. C. M. C. D. L. S. B. (1999). MAPPING MALARIA RISK IN THE HIGHLANDS OF AFRICA. Tabisa Diniso1, A. O. O., Jerry O. Adeyemi , Gugulethu M. Miya , Yiseyon S. Hosu , Opeoluwa O., & Oyedeji , S. K. K., Adebola O. Oyedeji. (2024). Citrus wastes: A valuable raw material for biological applications. Journal of Applied Pharmaceutical Science, 14(08), 011-026. https://doi.org/0.7324/JAPS.2024.158781

White, N. J., Pukrittayakamee, S., Hien, T. T., Faiz, M. A., Mokuolu, O. A., & Dondorp, A. M. (2014). Malaria. Lancet, 383(9918), 723-735. https://doi.org/10.1016/S0140-6736(13)60024-0

Zhang, Q., Chen, X. Z., Huang, X., Wang, M., & Wu, J. (2019). The association between prenatal exposure to phthalates and cognition and neurobehavior of children-evidence from birth cohorts. Neurotoxicology, 73, 199-212. https://doi.org/10.1016/j.neuro.2019.04.007

HOW THE ENGLISH GOVERNMENT CAN START TO ADDRESS STAFF SHORTAGES IN THE NHS

Eisha Aqil

Aneurin Bevan, the ‘architect of the [NHS]’ (Anon., n.d.) famously stated that “the NHS will last as long as there’s folk with faith left to fight for it” (White, 2017). Inarguably, among the individual who have fought hardest for the NHS to survive are the doctors and nurses within it. However, the number of healthcare professionals (HCPs) in the nation is clearly low, with England only having 2.9 doctors per 1000 people—far from the OECD EU nation average of 3.7 (Anon., 2024a). As such, it is vital that the government address the shortage of doctors and nurses in the NHS by considering the key reasons for the shortage, including lack of HCPs in the workforce, low incentives to work in the NHS, and the attractiveness of overseas opportunities. Then relevant changes can be suggested to tackle the shortage.

Firstly, a reason for the shortage of doctors and nurses in the NHS is simply a lack of HCPs available in the country’s workforce. As of December 2023, there were 110,781 vacancies in secondary care in England; of these, 8,758 vacancies were medical and 34,709 were for nursing. Furthermore, 13% of secondary care doctors and 18% of general practitioners (GPs) will reach minimum retirement age within the next decade. This could mean a loss of over 25,000 doctors through retirement alone (Anon., 2024a), which exacerbates the issue of staff shortages. The high vacancies can be partly attributed to the inaccessibility of healthcare professions in the country. Even though UK medical school applications have increased over time, with 9480 more applications from 2017 to 2021 (Anon., 2021), the overall offer rate has stayed consistently low. As such, a dwindling number of doctors entering the workforce faced with a growing population (Anon., 2020) can explain the NHS shortage. Nevertheless, there is much that can be done to increase the doctors and nurses in the country. Firstly, medical and nursing schools must increase the number of British students they train each year. Ensuring enough British medics will reduce the impact on the NHS of foreign doctors moving back home. The high demand for schools can be met by establishing new programs or expanding current ones so that more trained HCPs enter the NHS. Moreover, the government should devote more funding for bursaries and scholarships to increase the incentive for British students of pursuing a medical/nursing career. This is especially relevant for the field of general practice: in February 2020 the government committed funding to recruit an additional 6,000 GPs by 2024. Yet, as of January 2024, there has only been a 2,690 increase since 2019 (Anon., 2024b). The government should offer support for GP training programs across the country and incentivise medical students to pursue a career in primary care, as it serves as the foundation of the NHS. Additionally, the multi-disciplinary team’s significance must be acknowledged by the government. Expanding training for nurses and allied HCPs is vital to relieve the work burden on doctors and allow for more comprehensive health provision overall to minimise the impact of shortages. Also, the country should prevent international HCPs from moving abroad and attract internationally trained staff to work in the NHS. In 2023, roughly 14% of hospital and community staff are recorded as having non-British nationality (Anon., 2023a). The goal should be to increase this number to support the workforce. This could be done by improving working conditions (which will be elaborated on further into the essay) or expediting the immigration processes for internationally trained doctors/nurses so less strain is put on medical education institutes in the country. However, the aforementioned strategies are focused on supplyside policy, so will take time to have an impact on the NHS shortages. Yet over time, the problem will decrease as the government puts more effort into implementing these solutions. Therefore, increasing the number of doctors and nurses in the country’s workforce will help to address the shortage in the NHS.

Another factor contributing to the shortage of doctors and nurses in the NHS is the lack of incentive for existing HCPs to work in the NHS. Deterrents include long working hours, low wages, increased stress, and a subsequent decrease in retirement ages, all contributing to a workforce deficiency. Poor pay and working conditions were the top reasons for junior doctors wanting to quit the NHS in a 2022 survey. 85% cited their current level of pay, and 83% deteriorating working conditions (Anon., 2022). Concerningly, these issues have already prompted 31% of HCPs to seek jobs outside the NHS, intensifying fears around staff shortages (Anon., 2024c). Moreover, the lack of employees means that existing staff must work overtime to keep the NHS running: in 2022, 43% of NHS staff worked up to 5 hours of unpaid overtime in an average week (Yang, 2023). Additionally, HCPs are retiring earlier: the number of doctors taking early retirement from the NHS has more than trebled from 2008 to 2021 (Moberly, 2021). This indicates that the working conditions for doctors and nurses are poor, prompting them to leave the NHS, which is a key reason for a shortage of HCPs. To address this, the demands of the doctors and nurses ought to be met by increasing their wages to compensate for their tedious work. The government should ensure competitiveness of NHS salaries among similar public sector jobs. For example, the starting salary for qualified teachers is now £30,000 while the graduate starting salary in the NHS is £28,407 (Anon., 2024d). The factor of long hours will largely be addressed by increasing the doctors and nurses available for hire (as discussed previously), since workloads would be distributed evenly among greater numbers. Bettering staff work-life balance by adhering to the 37.5-hour work-week description will further improve conditions by making hours manageable. Likewise, government investment in technology can alleviate the burden on HCPs. By streamlining administrative tasks, doctors and nurses can focus on patients, potentially improving job satisfaction and reducing burnout. Moreover, the mental burden on HCPs of working in the NHS must be recognised by institutions as declining wellbeing contributes to staff turnover and early retirement. This can be done by implementing staff mental health initiatives, such as counselling services, and destigmatising wellbeing support within the NHS. Therefore, improving conditions in the NHS will attract/retain existing doctors and nurses, so will help to address the shortage.

With an aforementioned reason for the shortage of HCPs being transfers abroad, it is important to assess the appeal of foreign healthcare systems and push the NHS to adapt accordingly, in order to maintain staff. In 2022, 33% of junior doctors planned to work abroad within the next year, with Australia being the popular destination (42%) (Anon., 2022). One reason British doctors are drawn there is the improved working environment. The Australian healthcare system values a healthy worklife balance with less bureaucracy, allowing doctors to work efficiently with lower burnout (Anon., 2023b); doctors there generally work fewer hours than they do in the UK and receive overtime pay (Anon., 2022). Financial incentives are also significant in attracting British doctors to Australia, with salaries of doctors there being higher (Anon., 2023b). Therefore, in seeing the success of Australian healthcare and the pull it has on British HCPs, the NHS should aim to replicate these conditions. Yet, this comparison poses the question of whether the British system should move towards privatisation, as Australia has more private options alongside public systems as compared to the universal government-run NHS. This would allow for better pay and conditions for doctors and nurses, thus attracting more and reducing the shortage. However, according to Goodair (2022), “when for-profit provision increases, the quality-of-care declines”. The increase in outsourcing to for-profit providers by NHS commissioners since 2013 raises concerns about the quality of care. Despite the belief that marketisation enhances efficiency, outsourcing was associated with higher mortality rates, potentially due to worsened care quality (Goodair & Reeves, 2022). The findings challenge the notion that privatisation would improve the NHS. Thus, working towards an Australian model of mixed provision would prevent the drawbacks of both extremes and help to address the NHS shortage.

In conclusion, the shortage of doctors and nurses in the NHS is a significant problem for the government and must be addressed urgently if the service is to continue caring for patients effectively. By implementing the strategies suggested in this essay, there would be an increased number of HCPs available in the workforce, with incentive to work for the NHS as opposed to alternatives abroad. Though it will take time for these suggestions to affect the employee deficit, the faster the government

moves to address this issue will directly determine how quickly it can be resolved, allowing the shortage of doctors and nurses in the NHS to be addressed.

Reference

White, B., 2017. The truth of Nye Bevan’s words on the NHS. [Online]

Available at: https://www.theguardian.com/politics/2017/jun/02/the-truth-of-nye-bevans-wordson-the-nhs

[Accessed 25 March 2024].

Anon., 2021. Admissions to Medicine in 2021. [Online]

Available at: https://www.medschools.ac.uk/media/2864/uk-admissions-to-medicine-in-2021.pdf [Accessed 25 March 2024].

Anon., 2020. Annual population growth of the United Kingdom from 1970 to 2020. [Online] Available at: https://www.statista.com/statistics/281956/uk-population-growth/ [Accessed 26 March 2024].

Anon., 2024a. NHS medical staffing data analysis. [Online]

Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/ nhs-medical-staffing-data-analysis#:~:text=High%20vacancies,5.7%25%20of%20all%20medical %20posts.

[Accessed 25 March 2024].

Anon., 2024b. Pressures in general practice data analysis. [Online]

Available at: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/ pressures-in-general-practice-data-analysis [Accessed 26 March 2024].

Anon., n.d. Encyclopedia Britannica. [Online]

Available at: https://www.britannica.com/biography/Aneurin-Bevan [Accessed 25 March 2024].

Anon., 2024c. Put pay right and start to solve the NHS’ many problems. [Online]

Available at: https://www.unison.org.uk/news/2024/02/put-pay-right-and-start-to-solve-the-nhsmany-problems/ [Accessed 27 March 2024].

Yang, J., 2023. On average, how many additional unpaid hours do you work per week for your organization, over and above your contracted hours?. [Online]

Available at: https://www.statista.com/statistics/883433/nhs-england-staff-working-extra-unpaidhours/#:~:text=In%202022%2C%20roughly%2043%20percent,percent%2011%20hours%20or %20more.

[Accessed 28 March 2024].

Anon., 2024d. UNISON-NHS-pay-position-2024.pdf. [Online]

Available at: https://www.unison.org.uk/content/uploads/2024/02/UNISON-NHS-pay-position2024.pdf

[Accessed 29 March 2024].

Moberly, T., 2021. Doctors’ early retirement has trebled since 2008. [Online]

Available at: https://www.bmj.com/content/373/bmj.n1594

[Accessed 29 March 2024].

Anon., 2022. A third of junior doctors plan to leave NHS to work abroad in next 12 months. [Online]

Available at: https://www.bmj.com/content/379/bmj.o3066

[Accessed 30 March 2024].

Anon., 2023a. NHS Staffing - the role of overseas doctors. [Online]

Available at: https://www.imgconnect.co.uk/news/2023/01/nhs-staffing-the-role-of-overseasdoctors/172

[Accessed 27 March 2024].

Anon., 2023b. Why British Doctors Move to Australia: A Land of Opportunities and Fulfilment. [Online]

Available at: https://www.jonandjon.com/why-british-doctors-move-to-australia/#:~:text=Over %20the%20past%20decade%2C%20there,over%20the%20next%20twelve%20months.

[Accessed 30 March 2024].

Goodair, B. & Reeves, A., 2022. Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatisation. [Online]

Available at: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00133-5/ fulltext#seccestitle140

[Accessed 30 March 2024].

THE CHEMISTRY BEHIND COMPOSITE

FILLINGS:

A BRIEF OVERVIEW

Ayush Surendran

Introduction:

The bacterium in mouths respire to produce lactate - an acid that slowly erodes the hardy enamel layer. Soon, they begin to concoct a biofilm, which over time engenders the demineralisation of the tooth and accumulation of this film in cavities, leading to infections1. Bacterium and their metabolic activities have caused annual dental visits to soar, with nearly 80% of these visits resulting in a filling procedure according to a 2021 United Kingdom statistic - thus depicting fillings as the most commonplace restorative treatments against caries, cavities and decay2 .

Approaching the 20th century, both amalgam and composite fillings were used widely by orthodontists. However upon the Amalgam Filling Controversies, sparked by research from Dr Alfred Stock (1926), The University of Calgary (1984), The University of Saskatchewan (2009) and human autopsy studies, it was suggested that the mercury base in amalgam could vaporise and ionise into the blood- causing adverse effects to the elderly and pregnant3. Moreover, the corrosion of amalgam in the oral space posed a serious problem as it dramatically reduced the filling’s ability to prevent further infections4 .

Composites on the other hand, have become the most predominant filling form to reinforce teeth, and due to its various chemical properties and adjustability, are used in earnest in the current day.

Observable differences between amalgam and composite fillings15

The production of composite fillings:

Although varying definitions of composite fillings seem to simplify its chemistry, its structure at an atomic level proves to be complex. At its core, an addition polymerisation of Bis-GMA monomers are the main reaction required to generate a compact substance.

Bis-GMA - a weighty and viscous molecule - is first diluted with the lower molecular weight TEGDMA molecule. The ratio of Bis-GMA to TEGDMA must however be maintained at a 3:4 ratio5 in order to counteract the common problem of shrinkage- a phenomenon owing to contractions of the polymer after being bonded to the small cavity walls, which could lead to the formation of fissures or fractures in the tooth structure6 .

In order to increase the composite’s strength, durability and optical attraction, inorganic fillerstypically silicon derivatives - are added in the second stage of synthesis. Nowadays, silicon derivatives are composed of extremely small nanosilica particles, which improve the tooth’s finish and reduce abrasion against adjacent teeth7. Apart from the aforementioned properties of fillers, they incur radioopacity, a feature paramount in distinguishing the filling from the tooth in an X ray, ergo allowing prompt detection of secondary caries8

Clear detection of a radio-opaque filling in an X ray16

To bind the organic and inorganic phases, a coupling reaction occurs using Silane offshoots. Silane’s contain two reactive groups, where typically vinyl/amino groups bond to the Bis-GMA/TEGDMA complex, and where alkoxy groups bind to the inorganic elements9. Once bound, a hydroquinone and 2-hydroxy-4-methoxy benzophenone are merged into the mixture to form a primary resin that is more resistant to colour changes and has longer shelf life7

Diagrammatic representations of the monomers involved and Silane’s coupling property 17,18

The curing process:

The imperative polymerisation reactions owe allegiance to the self and light curing stages. In the former, aromatic tertiary amines and benzoyl peroxide act as accelerators and initiators respectively, with the amine giving rise to the formation of free radicals from benzoyl peroxide - which attack the electrons in the carbon double bonds in Bis-GMA/TEGDMA molecules - forcing the methacrylate groups to amalgamate, forming a redox addition polymer10

Conversely in the latter, camphorquinone - a photoactivator - progenates the warring free radicals through the action of blue light. This type of light is most apt as the wavelength range (400-500 nanometers) of blue light nearly perfectly correlates to the absorption range of camphorquinone, ergo blue light photons are more readily absorbed by the activator in comparison to other compounds11

With the curing processes used individually or in tandem, the previously liquid resin solidifies during polymerisation to create the final filling enclosed within the cavity space.

Sketches of the chair configuration of camphorquinone and its absorption spectrum 19,20

Conclusion:

Composite fillings have remained an orthodontist’s weapon in an age of poorer overall oral health and changing reasons behind restorations. Stronger, safer and more optically attractive in comparison to amalgams, Composites have the potential to raise standards in these categories through the recent introduction of spiro-ortho carbonates (SOC’s) and ethylene glycol members that reduce the double bonds to increase mean molecular weight or expand in order to reduce the shrinkage postpolymerisation 7,12. TTEMA as a substitute for Bis-GMA has already resulted in a 10% decrease in shrinkage when paired with TEGDMA13. Adjacently, a myriad of mixture ratios and nanoparticle members (such as nano-zirconium oxide) are under testing to better suit the needs of the patient in relation to the anterior and posterior regions of the jaw14. Through ongoing research on alternative chemicals and stoichiometry to be used in resin manufacture, it is hoped to increase efficiency and efficacy of composite filling treatments in the remnants of the 21st century.

A view of the groups responsible for imparting strength and expansion in a molecule of a spiro-orthocarbonate compound21

References:

1) Kidd, E. A. M. (2004). How “clean” must a cavity be before restoration? https://karger.com/cre/article-pdf/38/3/305/2498368/000077770.pdf

2) Adult Oral Health Survey 2021: Self-reported health of teeth and gums. GOV.UK. (2024, January 25). https://www.gov.uk/government/statistics/adult-oral-health-survey-2021/ adult-oral-health-survey-2021-self-reported-health-of-teeth-and-gums

3) Zyvoloski, T., Faraj, Z., Qadi, S., & Sonaty, M. (n.d.). A history of the amalgam filling controversy: What you need to know . https://www.studiozdental.com/blog/a-history-of-theamalgam-filling-controversy/

4) M, F., & V, M. (2004). A review on dental amalgam corrosion and its consequences. A Review on Dental Amalgam Corrosion and Its Consequences . https://www.ericdavisdental.com/biological-dentistry/symptoms-of-toxicity/galvanism/ Galvanism-2.pdf

5) Barron, D. J., Venhoven, B. A. M., Eick, J. D., Maffezzoli, A., Anseth, K. S., Cook, W. D., Kalipcilar, B., Vaidyanathan, J., Soh, S. K., Ballard, M. J., Zhu, S., Lovell, L. G., Taira, M., & Hansel, C. (2001, May 1). Primary cyclization in the polymerization of bis-GMA and TEGDMA: A modeling approach to understanding the cure of dental resins. Dental Materials. https://www.sciencedirect.com/science/article/abs/pii/S0109564100000750

6) Bowen, R. L., Calheiros, F. C., Braga, R. R., Labella, R., Vaidyanathan, J., Silikas, N., Feilzer, A. J., Lim, B.-S., Miguel, A., Watts, D. C., Sakaguchi, R. L., Lovell, L. G., Asmussen, E., Dauvillier, B. S., Chen, H. Y., Condon, J. R., Lu, H., Alster, D., Kinomoto, Y., … Bouschlicher, M. R. (2005, October 8). Factors involved in the development of polymerization shrinkage stress in resin-composites: A systematic review. Dental Materials. https://www.sciencedirect.com/science/article/abs/pii/S0109564105001685

7) García A, H., Lozano, M., Vila J, C., Escribano A, B., & Galve P, F. (2006, January 29). Composite resins. A review of the materials and clinical indications. Medicinaoral.

http://www.medicinaoral.com/medoralfree01/v11i2/medoralv11i2p215.pdf

8) Lachowski, K. M., Botta, S. B., Lascala, C. A., Matos, A. B., & Sobral, M. A. P. (2013, February). Study of the radio-opacity of base and liner dental materials using a digital radiography system. Dento maxillo facial radiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699023/

9) Özcan, M., Darvell, B. W., Kolodney, H., Gbureck, U., Lung, C. Y. K., Hooshmand, T., Aboushelib, M. N., Akova, T., Jevnikar, P., Piascik, J. R., Matinlinna, J. P., Oyagüe, R. C., Kitayama, S., Kim, S. H., McDonough, W. G., Debnath, S., Goracci, C., Ferracane, J. L., Nergiz, I., … Fischer, T. E. (2012, March 14). Aspects of silane coupling agents and surface conditioning in Dentistry: An overview. Dental Materials. https://www.sciencedirect.com/science/article/abs/pii/S010956411200053X

10) Brauer, G. M. (1981, January 1). Initiator-accelerator systems for acrylic resins and Composites. SpringerLink. https://link.springer.com/chapter/10.1007/978-1-4757-95103_29

11) Kowalska, A., Sokolowski, J., & Bociong, K. (2021, February 2). The photoinitiators used in resin based dental composite-a review and future perspectives. MDPI. https://www.mdpi.com/2073-4360/13/3/470

12) Moon, E. J., Lee, J. Y., Kim, C. K., & Cho, B. H. (2005, January 27). Dental restorative composites containing 2,2-bis-[4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane derivatives and spiro orthocarbonates. Journey of Biomedical Materials Research. https://onlinelibrary.wiley.com/doi/abs/10.1002/jbm.b.30222

13) Labella, R., Matsukawa, S., Tarumi, H., Zamora, M. P., Nishiyama, N., & Stansbury, J. W. (2001, December 19). Development of a new photocurable composite resin with reduced curing shrinkage. Dental Materials. https://www.sciencedirect.com/science/article/abs/pii/S0109564101000392

14) Hu, C., Sun, J., Long, C., Wu, L., Zhou, C., & Zhang, X. (2019, January 1). Synthesis of nano zirconium oxide and its application in dentistry. De Gruyter. https://www.degruyter.com/document/doi/10.1515/ntrev-2019-0035/html

15) https://crystaldentalcenters.com/blog/amalgam-vs-composite-fillings-whats-the-bestoption-for-you/

16) https://pocketdentistry.com/radiographic-appearance-of-dental-tissues-and-materials/

17) http://www.powerchemical.net/coupling1.htm

18) https://www.researchgate.net/figure/Structural-formula-of-Bis-GMA-and-TEGMA-Ryc-1Wzory-strukturalne-Bis-GMA-i-TEGMA_fig1_263014522

19) https://pubchem.ncbi.nlm.nih.gov/compound/Camphorquinone

20) https://www.researchgate.net/figure/Absorption-spectrum-of-camphorquinone-in-relationto-the-different-emission-spectra-of_fig2_328126011

21) https://link.springer.com/article/10.1007/s13233-010-1005-z

USING MACHINE LEARNING TO DIAGNOSE BREAST CANCER

Rana Mohamed Babikir

In 2022 alone, breast cancer led to 670000 deaths worldwide1, making it one of the leading causes of cancer-related deaths among women. While there have been significant advancements in breast cancer diagnosis, research and treatment, the global disease burden remains tragic.

A key factor in increasing survival rates is early detection. Through it, patients can have more treatment options and positive treatment outcomes. According to Cancer Research UK, almost 100% of breast cancer patients who were diagnosed at Stage 1 survived for 5 years or more after diagnosis, but for Stage 4, this figure drops to just over 25% of women2.

This isn’t only about the numbers.

Through early detection, patients have more time to receive guidance and information, make important decisions, and sort out financial matters. In other words, this is an important public health strategy.

A great approach to it is to raise awareness among the general public about the importance of breast self-exams, clinical exams, and getting annual mammograms (X-ray images of the breast) for older women. Another way to maximise the benefits of early detection is to increase the speed and accuracy of cancer screening.

This is where machine learning-based solutions come into play.

Machine Learning (ML)

While incorrectly used interchangeably with AI, machine learning is a subset of AI where machines have the ability to learn automatically without explicit instructions, analyse patterns in data, and improve from experience. ML is particularly useful in uncovering patterns and trends in a complex dataset that humans may not spot, and then drawing insights from it. It is therefore used to detect and diagnose diseases. In supervised learning, a common type of ML, the machine is trained using a labelled dataset with inputs and correct outputs. It learns the relationship between both and uses it to predict outputs, creating a predictive data model.

Think of it this way: based on past experience, you know that the more effort you put into an assignment, the higher your grade will likely be. As a result, you can have a pretty good idea of the grade you should be getting based on your effort. Supervised learning can be used for classification problems, where the input data is classified into a predicted class label, such as when e-mails are grouped as “spam” and “non-spam”. Disease diagnosis is a classification problem since a screening will only give two possible outcomes: yes, the patient has the disease, or no, they don’t.

Mammography is one of the most effective breast cancer screening methods since it can detect the disease up to three years before a noticeable lump can be felt. Radiologists examine mammography images to diagnose breast cancer, yet they miss 10% to 30% of cancers3, often because tumours go unnoticed or are falsely deemed benign. Various studies have used machine learning models to classify benign and malignant tumours from a breast image, which could potentially make them act as a second opinion for radiologists and reduce diagnosis errors.

Figure 1 shows the steps involved in a binary classification of a tumour as either benign or malignant.

A mammogram image is inputted and processed. Next, the image is separated into homogenous regions; the pectoral muscles are removed from the image, and regions of interest and abnormal mass are identified for increased classification accuracy.

For a given mass on a mammogram, we measure certain features and use them for classification. An accurate way is a boundary evaluation. This is because a benign tumour has a round, smooth, and well-defined boundary. On the contrary, a malignant tumour has a rough, blurry, and indistinct boundary (see Figure 2).

We can classify a mass as being benign or malignant by looking at its boundary pixels and the texture of its surrounding region.

The classifier uses the selected features to classify a tumour as malignant or benign. K-nearest Neighbours (KNN), Decision Trees, and Support Vector Machines (SVM) are the most common supervised learning models used as classifiers.

K-nearest Neighbours (KNN)

KNN is one of the simplest classification algorithms. The goal is to use the features of neighbouring data points to classify a new data point into a class:

1. The algorithm calculates the distance between the new data point and other, classified data points in the set.

2. It sorts the distances in ascending order.

3. The new data point is classified into the most commonly occurring class within its k nearest neighbors. The k value is decided to find a balance between overfitting and under-fitting. In this example, if k=5, we look at the first 5 distances and assign the new data point to the most common class.

We can therefore classify our new data point into class: pink squares.

A study in the Asian Journal of Research in Computer Science applied a weighted KNN algorithm to a dataset comprising 699 mammogram images and compared its accuracy to 4 other classifiers. The algorithm yielded the highest accuracy of 96.7% among all the tested classifiers5.

Decision Tree

Unsurprisingly, the structure of a decision tree diagram looks like an inverted tree; it’s fairly easy to understand. We start with a root node, representing a feature (predictor variable), with two “branches” attached to lead to a decision node. The decision node splits into sub-nodes. If a decision node does not have more branches, it is called a leaf/terminal node; it represents the final outcome (response variable). Figure 5 shows how a decision tree algorithm can be used for breast cancer diagnosis, with leaf nodes being “benign” or “malignant”:

Support Vector Machines (SVM)

With SVM, the goal is to find a suitable hyperplane (a line) that divides the dataset into two classes. The further away the data points are from the hyperplane, the more likely it is that they have been classified correctly.

The margin is the distance between the hyperplane and the nearest data point from each class, so essentially, the larger the margin of our chosen hyperplane, the better. When a new data point is added, its class is decided by looking at which side of the hyperplane it lies on (see Figure 6).

If there is no clear hyperplane or the data set is linearly non-separable, the kernel function is used, putting the data in a 3D view rather than a 2D one. It’s easier to find a hyperplane now.

Conclusion

The high accuracies observed in the above algorithms can potentially increase the rate of early detection, resulting in better outcomes for patients. There are more supervised learning models, and even neural networks, that can be used to diagnose breast cancer. With machine learning, the possibilities are truly endless. While we haven’t reached a stage where we are fully reliant on AI for matters concerning human health, we’ve definitely reached one where we don’t mind having a second opinion by our side.

Bibliography

1. World Health Organization. Breast cancer. World Health Organization. Published 2024. https://www.who.int/news-room/fact-sheets/detail/breast-cancer

2. Cancer Research UK. Survival for breast cancer | Breast Cancer | Cancer Research UK. www.cancerresearchuk.org. Published January 3, 2020. https://www.cancerresearchuk.org/aboutcancer/breast-cancer/survival

3. Ekpo EU, Alakhras M, Brennan P. Errors in Mammography Cannot be Solved Through Technology Alone. Asian Pacific Journal of Cancer Prevention: APJCP. 2018; 19(2):291-301. doi: https://doi.org/10.22034/APJCP.2018.19.2.291

4. Li H, Zhuang S, Li D, Zhao J, Ma Y. Benign and malignant classification of mammogram images based on deep learning. Biomedical Signal Processing and Control. 2019;51:347-354. doi: https://doi.org/10.1016/j.bspc.2019.02.017

5. Khorshid SF, Abdulazeez AM, Sallow AB. A Comparative Analysis and Predicting for Breast Cancer Detection Based on Data Mining Models. Asian Journal of Research in Computer Science. 2021;8(4):45-59. doi: https://doi.org/10.9734/ajrcos/2021/v8i430209

6. Yadav P, Varshney R, Kumar Gupta V. Diagnosis of Breast Cancer Using Decision Tree Models and SVM.; 2018. Accessed September 30, 2024. https://www.irjet.net/archives/V5/i3/IRJETV5I3654.pdf

HOW THE INTEGRATION OF ARTIFICIAL INTELLIGENCE WILL REVOLUTIONISE GENETIC RESEARCH

Uddayvir Singh

In today’s era of constant and rapid technological advancement, we cannot for any longer treat the mammoth that is artificial intelligence as something that belongs to the future. AI is already impacting several different areas of our world and is already changing the face of various industries. One of these many areas is the study of genetics.

Ground-breaking findings:

Recently, in the month of May 2023, research from University of California San Diego, revealed that machine learning AI is ‘revolutionising gene study’. This AI discovered rare “synthetic extreme” DNA sequences. The researchers at UC San Diego tested around 50 million DNA sequences with machine learning AI and found several synthetic extreme strands.

Synthetic extreme DNA sequences are sequences that can silence or activate genes. These are crucial not only because of their potential, but simply because they help deepen our fundamental understanding of DNA. Until now these were extremely difficult to find and isolate. However, this breakthrough has proven that as AI develops and learns, it can find these sequences far quicker and easier than we could.

These findings are very valuable not only to genetics, but to fields such as medicine and biotechnology, as with these findings we could test the effectiveness of one drug against another, instead of just testing one human’s genomes to another.

Its uses in the analysis of genomic sequences:

Whilst at its current stage of ability artificial intelligence cannot be completely independent with most facets involved in genetics and genetic research, it is able to make the jobs of geneticists easier and more efficient.

For one, AI has been implemented to analyse genomic sequences. What would usually take researchers days and maybe even weeks to go through thoroughly, artificial intelligence programs can do in a few hours. Being able to scour and analyse these sequences allows researchers to be able to spend more time researching, and less time on more mundane tasks like the analysis of genomic sequences.

Additionally, this allows for a better and more accurate prediction of likely unintended genetic mutations that may occur in someone’s DNA. With more thorough, more accurate and quicker analysis of genomic sequences, researchers can then create specific prevention and treatment plans for patients at risk. These treatments could be specially tailored according to each patient’s genome, so as to maximise their efficiency.

This theory is already being used by researchers at University College London, and institutes in places like Abu Dhabi are also preparing themselves to begin similar practices in the near future.

DeepVariant, a program created by Google AI, uses a deep neural network to summon genetic variants from next generation DNA sequencing data.

How AI’s uses can be extended to other areas as it develops:

As this technology becomes more potent however, its uses can extend further than just analysing sequences. Indeed, looking at the rapid rate of development that AI programs are being put through, they can begin to be implemented in areas like genetic counselling too.

The technology can be utilised to go through a patient’s history (medical, social, familial, and personal), which would save counsellors a lot of time, and allow them to have more time to screen their patients for risk assessment. This would help them focus more of their time on patients that needed it more, whilst also ensuring that the other patients aren’t neglected.

Additionally, AI can help analyse a patient’s genetic test results, allowing them to be presented to counsellors in a clear, simple, and straightforward format. This further adds efficiency to the process and allows for the counsellors to get an even stronger understanding of their patient.

Then, while the counsellors can focus on the interactions with patients, the AI can complete the less interactive areas of the treatment. They can, for example, create specific and in-depth treatment plans for patients, that are maximised in terms of efficiency and effectiveness. This allows the counsellors to focus on the more complex aspects of the treatment process.

There are several other benefits to these shifts and implementations of AI within genetic counselling. The more efficient methods would help reduce costs. This could benefit patients too as reduced costs would also reduce prices for treatment, making it more accessible for more people, allowing for a larger proportion of the population to receive the higher quality care.

As this AI develops further, they could provide specific educational and even psychosocial support. This could entail dealing with difficult diagnoses and would mitigate the chances of human error on these aspects, as, while rare, even medical professionals make mistakes, hence increasing the discomfort of patients.

Hence, AI really does have the potential to revolutionise the genetics/genomics sector, amongst others. The question is whether institutes and individuals are ready to embrace these new methods, whilst maintaining their values and intellectuality.

From DC, CIS, NAS and NLCS

PRENATAL GENETIC SCREENINGNAVIGATING THE ETHICS OF STRIVING FOR PERFECTION

Xinyu Gu

In the ever-evolving field of medicine, prenatal genetic screening has become an invaluable tool for expectant parents. This technology gives insights into the genetic makeup of a developing foetus, allowing potential genetic disorders to be identified in the early stages of pregnancy. Prenatal genetic screening is now accessible to many pregnant individuals and is now a safer procedure involving less discomfort, ever since the introduction of blood-based, non-invasive prenatal genetic testing in 2012 (AAAS, 2015). While the benefits of this cutting-edge technology are clear, there are numerous ethical concerns about striving for perfection through prenatal genetic screening.

Reproductive Autonomy and Informed Decision-Making

From chromosomal abnormalities to single-gene disorders, prenatal genetic screenings provide parents with information that guides them in making informed decisions about their pregnancy and prepares them for potential challenges should their child require additional care, promoting individual reproductive autonomy (Tsui et al., 2023).

While many diseases could be mitigated or prevented when treated in the early stages, others, such as Down’s syndrome, have no cure, and this begs the question: is it ethical to prevent such a condition by abortion? We cannot determine with certainty whether a genetic condition is actually present in the foetus or how the identified condition will impact a person’s life unless further invasive testing is done (AAAS, 2015). Furthermore, the probability of false positives and negatives could also lead to wrong decision-making, creating stress in patients and demanding further testing. Therefore, it is highly important to provide patients with unbiased information, address the ethical implications when interpreting the test results, and ensure that the results are fully understood by the patients.

Genetic counsellors play a vital role in facilitating informed and autonomous decision-making, offering emotional support, and guiding parents through the complexities of genetic information. In order to empower parents to make informed decisions, healthcare professionals must make sure that the patients fully comprehend all the information presented to them, such as what the procedure tests for and how it works, its advantages and disadvantages, and the meaning of the test results. Moreover, there is a general consensus that prenatal screening should be offered within a non-directive framework, giving patients the autonomy to make decisions that align with their own beliefs without feeling pressured to conform to social norms. (Stapleton, 2016)

Accessibility and Equity

One notable feature of non-invasive prenatal genetic testing is that it has been introduced as a commercial product, which raises concerns for equity as this could mean that NIPT is not accessible to everyone. For example, the cost of Ariosa's Harmony test was 795 USD in 2014. The complexities surrounding costs make it more difficult to decide whether to pursue prenatal genetic testing and which test to choose. (Minear et al., 2015) The findings from a study conducted in 2013 (Horsting et al., 2013) showed that “insurance coverage, billing policies, reimbursement, and price of NIPT” were major concerns of genetic counsellors when offering cffDNA testing to patients. Furthermore, many

counsellors stated that patients often rejected testing because they were concerned about the cost or the absence of insurance coverage.

Overall, prenatal genetic screening should be made available to patients from all backgrounds, regardless of their socio-economic status. Ensuring that this technology benefits diverse populations is essential for preventing the division of society along genetic lines.

Genetic Discrimination

Although prenatal genetic testing helps women to make better informed decisions and enhances their reproductive autonomy (Tsui et al., 2023), there is a growing concern over the increasing risk of societal discrimination and stigmatisation against people with genetic conditions. For example, in France, the organisation ‘Stop Discriminating Down’ aimed to condemn “the mass elimination of children with Down’s syndrome before birth” in 2017. In addition, as a way of protesting against the decision to reimburse NIPT, a ‘March for Life’ was organised in 2019 in Paris. However, these public responses had no real effect on policies (Perrot and Horn, 2022). There are also concerns that as the use of NIPT rises, individuals with genetic disabilities will receive less support and opportunities (Vanstone et al., 2018). Additionally, the National Consultative Ethics Committee highlighted that NIPT would lead to ‘a new form of eugenics’ in its 2016 report. However, the study led by Perrot and Horn highlighted that women often utilise NIPT as a tool to gather information on the foetus’ health conditions in order to prepare for its arrival, rather than intending to terminate pregnancy if an aneuploidy is discovered. Nevertheless, our pursuit of perfectionism and anxiety about being deemed "undesirable" could contribute to the marginalisation of those with genetic disorders, perpetuating harmful societal prejudices and impeding collective efforts to create a more inclusive and diverse society. Therefore, it is vital that governments implement policies and utilise public funds to counteract bias, stigmatisation, and discrimination.

In conclusion, prenatal genetic screening has immense potential for preventing and managing genetic disorders, offering parents valuable insights into their child's health, and promoting reproductive autonomy and informed decision-making. On the other hand, although it can be challenging to balance our pursuit of health with respect for diversity and inclusivity, it is crucial to approach this medical advancement with ethical considerations. Therefore, the ethical issues of prenatal genetic screening should continue to remain a key focus as more progress is made in this realm of medicine.

References

● AAAS. (2015). The Pursuit of Perfection? Fetal Genetic Screening. [Online]. aaas.org. Last Updated: 16 September 2015. Available at: https://www.aaas.org/news/pursuit-perfectionfetalgenetic-screening [Accessed 5 January 2024].

● Horsting JM, Dlouhy SR, Hanson K, Quaid K, Bai S and Hines KA. (2013). Genetic counselors' experience with cell-free fetal DNA testing as a prenatal screening option for aneuploidy. [Online]. PubMed. Last Updated: 19 December 2013. Available at: https://pubmed.ncbi.nlm.nih.gov/24352524/ [Accessed 6 January 2024].

● Greg Stapleton. (2016). Qualifying choice: ethical reflection on the scope of prenatal screening [Online]. NIH. Last Updated: 8 September 2016. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5487727/ [Accessed 6 January 2024].

● Minear, M., Alessi, S., Allyse, M., Michie, M. and Chandrasekharan, S. (2015). Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues. [Online]. annualreviews.org. Last Updated: August 2015. Available at: https://www.annualreviews.org/doi/full/10.1146/annurev-genom-090314-050000#_i25 [Accessed 6 January 2024].

● Perrot, A. and Horn, R. (2022). The ethical landscape(s) of non-invasive prenatal testing in England, France and Germany: findings from a comparative li. [Online]. nature.com. Last Updated: 04 October 2021. Available at: https://www.nature.com/articles/s41431-021009702#article-info [Accessed 6 January 2024].

● Tsui W-K, Yip Y-C and Yip K-H. (2023). Balancing Equity and Autonomy: The Utilitarian Case for the Public Funding of Non-Invasive Prenatal Testing in Hong Kong. [Online]. IntechOpen. Last Updated: 23 October 2023. Available at: https://www.intechopen.com/online-first/1140432 [Accessed 6 January 2024].

● Vanstone, M., Cernat, A., Nisker, J. and Schwartz, L. (2018). Women’s perspectives on the ethical implications of non-invasive prenatal testing: a qualitative analysis to inform health policy decisions. [Online]. BMC. Last Updated: 16 April 2018. Available at: https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-018-0267-4 [Accessed 6 January 2024].

NEUROPLASTICITY: A KEY TO UNLOCKING ALZHEIMER'S TREATMENT?

Fatema Jasvi & Mario Elmir

Introduction

55 million. This is the number of individuals currently grappling with an incurable affliction- Alzheimer’s1 Many aspects of this disease have been shrouded in mystery ever since its discovery; however, there is one aspect of the brain that can pave the way towards solutions to this aggressive neurodegenerative disorderneuroplasticity.

What is Neuroplasticity?

Neuroplasticity can be defined as the capability of the brain to change and adapt due to a person’s experiences. This can be seen in the significant decrease in the number of synapses (connections between neurons) as a person transitions from childhood to adulthood. This occurs due to the person’s experiences, where some connections are strengthened, while others are eliminated. Hence, more frequent use of neurons leads to their connections becoming stronger and stronger, and vice versa leads to the death of neurons.

This feature of the brain allows it to adapt to a changing environment, in which it can form new connections between neurons, and remove unnecessary or weak ones. Neuroplasticity allows a person to learn new skills and information, and improve their own cognitive abilities. Additionally, it can rejuvenate areas of the brain that have suffered from functional decline; this property can make it especially useful in keeping cognitive function at a high level as a geriatric becomes more vulnerable to neurodegenerative diseases2

What is Alzheimer’s Disease (AD)?

Alzheimer’s disease is a progressive neurodegenerative disease most often associated with memory deficits and cognitive decline3. The earliest phase of Alzheimer's disease (cellular phase) happens in parallel with accumulating amyloid β, inducing the spread of tau pathology.4 It has been recognized that the assembly of tau in “tangles” correlates with patients’ level of cognitive worsening, while beta- amyloid requires the presence of tau proteins to develop its harmfulness. This synaptic dysfunction has been directly associated with the onset of cognitive impairment in patients with AD5

1 https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/#:~:text=Someone%20in%20the%20world%20develops,will%20be%20in%20developing %20countries

2 https://www.verywellmind.com/what-is-brain-plasticity-2794886#toc-characteristics-of-neuroplasticity

3 https://link.springer.com/article/10.1186/S13024-019-0333-5

4 https://www.thelancet.com/article/S0140-6736(20)32205-4/abstract

5 https://www.sciencedirect.com/science/article/pii/B9780128194102000278?via%3Dihub

How is neuroplasticity related to Alzheimer’s?

Alzheimer’s disease directly impacts neuroplasticity in a plethora of different ways, and understanding its negative effects on the brain’s neuroplasticity is the first step towards researching possible treatments. In its early stages, Alzheimer’s disease damages essential connections between neurons in the hippocampus, the part of the brain associated with memory.

Since neuroplasticity relies on such connections between neurons, neuroplasticity begins getting affected. As the disease progresses, other parts of the brain are also impacted; neural connections in the cerebral cortex, responsible for reasoning, language, and social behaviour are damaged, and neurons begin to die6 .

Another aspect of neuroplasticity that is impacted by Alzheimer’s is synaptic plasticity. Synaptic plasticity is the ability of the brain to strengthen or weaken synapses based on its cognitive activity or experiences; the accumulation of soluble fibrillar β-amyloid (Aβ) oligomers (a type of misfolded amino acid), which bind to several postsynaptic and presynaptic neurons, impairs synaptic plasticity7. The interaction of the oligomers and the neurons results in the hyperphosphorylation of the tau protein, which creates the hallmark neurofibrillary ‘tangles’ that are characteristic of Alzheimer’s disease8

How can neuroplasticity be used to treat Alzheimer’s?

Neuroplasticity can treat Alzheimer's disease (AD) by targeting deficits in synaptic transmission and plasticity, key features in the pathology of AD. Brain stimulation techniques like transcranial magnetic stimulation (TMS) and Deep Brain Stimulation (DBS) can modulate and improve neuroplasticity. These methods work by influencing synaptic plasticity and neurotransmission, which are essential for learning and memory functions.9

For instance, repetitive TMS (rTMS) can stimulate cortical plasticity and enhance memory by releasing neurotransmitters like glutamate and GABA, while also promoting neurotrophic signalling, which aids in synaptic repair and growth.10 Additionally, DBS of the fornix, a structure associated with memory processes, has been explored as a way to modulate hippocampal circuits and potentially improve memory function in AD

6 What Happens to the Brain in Alzheimer's Disease? | National Institute on Aging

7 Glutamatergic synaptic plasticity and dysfunction in Alzheimer disease: Emerging mechanisms

8 Abnormal hyperphosphorylation of tau: sites, regulation, and molecular mechanism of neurofibrillary degeneration

9 https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-020-00224-z

10 https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-020-00224-z

patients. Though results are still in the experimental phase, DBS shows promise in modulating brain plasticity and aiding in cognitive functions11

TMS and DBS treatment

Conclusion

In summary, neuroplasticity offers a promising avenue for treating Alzheimer's disease by leveraging the brain's capacity to reorganise and form new neural connections. By stimulating the brain's ability to adapt and form new pathways, TMS and DBS may help slow cognitive decline, improve memory, and enhance overall quality of life for Alzheimer's patients. While research is still ongoing, the potential of neuroplasticity-based treatments brings renewed hope for more effective interventions in combating Alzheimer's disease.

References:

1. “ADI - Dementia Statistics.” Alzheimer’s Disease International, www.alzint.org/about/dementia-factsfigures/dementia-statistics/#:~:text=Someone%20in%20the%20world%20develops

2. “How Brain Neurons Change over Time from Life Experience.” Verywell Mind, www.verywellmind.com/what-is-brain-plasticity-2794886#toc-characteristics-of-neuroplasticity

3. DeTure, Michael A., and Dennis W. Dickson. “The Neuropathological Diagnosis of Alzheimer’s Disease.” Molecular Neurodegeneration, vol. 14, no. 1, Aug. 2019, pp. 1–18, https://doi.org/10.1186/s13024-0190333-5

4. Scheltens, Philip et al. “Alzheimer’s Disease.” The Lancet, vol. 397, no. 10284, 24 Apr. 2021, pp. 1577–1590, www.thelancet.com/article/S0140-6736(20)32205-4/abstract

5. Koch, Giacomo, and Danny Spampinato. “Chapter 31 - Alzheimer Disease and Neuroplasticity.” ScienceDirect, edited by Angelo Quartarone et al., vol. 184, Elsevier, 1 Jan. 2022, pp. 473–79, www.sciencedirect.com/science/article/pii/B9780128194102000278?via%3Dihub.

6. NIH. “What Happens to the Brain in Alzheimer’s Disease?” National Institute on Aging, 16 May 2017, www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/what-happens-brain-alzheimersdisease#:~:text=At%20first%2C%20Alzheimer.

7. Benarroch, Eduardo E. “Glutamatergic Synaptic Plasticity and Dysfunction in Alzheimer Disease.” Neurology, vol. 91, no. 3, June 2018, pp. 125–32, https://doi.org/10.1212/wnl.0000000000005807

8. Wang, Jian-Zhi, et al. “Abnormal Hyperphosphorylation of Tau: Sites, Regulation, and Molecular Mechanism of Neurofibrillary Degeneration.” Journal of Alzheimer’s Disease, edited by George Perry et al., vol. 33, no. s1, Dec. 2012, pp. S123–39, https://doi.org/10.3233/jad-2012-129031

9. Yuan, Ti-Fei, et al. “Targeting Neuroplasticity in Patients with Neurodegenerative Diseases Using Brain Stimulation Techniques.” Translational Neurodegeneration, vol. 9, no. 1, Dec. 2020, https://doi.org/10.1186/s40035-020-00224-z

11 https://translationalneurodegeneration.biomedcentral.com/articles/10.1186/s40035-020-00224-z

CAN ALZHEIMER’S DISEASE BE INHERITED?

Mieke Visser

Most of us has heard the term Alzheimer’s disease but do we understand it? Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. What makes an Alzheimer’s patients’ brain different from those not suffering from the disease is abnormal clumps, now called amyliod plaques. This was found by Dr Alios Alzheimer in 1906. As well as these clumps, there are tangled fibres also present within an Alzheimer’s patients’ brain now called neurofibrillary as well as loss in connections between nerve cells. And as we all know from GCSE or A level biology, the connections and ability for electrical impulses to be sent across nerve cells is key for brain function. Resulting in Doctors thinking this is the main cause of Alzheimer’s disease.

In 2010 we knew of 10 genetic areas associated with Alzheimer’s, today we know of about 80 genes associated with Alzheimer’s. Understanding which genes play a role – and what role they play – may help identify new methods to prevent, delay or treat dementia. Apoliprotein E (APOE) is a well known gene that influences the risk of having Alzheimer’s disease. APOE gene is involved in making a protein that helps carry cholesterol and other types of fat in the bloodstream. Problems with this process is thought to contribute to the development of Alzheimer’s. APOE is found in many different alleles, (versions of the same gene).

• APOE e2 may provide some protection towards the disease. Roughly 5-10% of people have this allele and if someone with this allele develops Alzheimer’s it would be later in life than someone with the APOE e4 allele.

• APOE e3, the most common allele, and is believed to have neutral effect on the disease.

• APOE e4 increases the risk for Alzheimer’s disease and is associated with earlier disease onset. About 15-25% of people have this allele and 2-5% of people carry two copies.

Each person inherits two APOE alleles. One from each biological parent, and therefore there are six possible combinations. Someone who inherits two APOE e4 alleles is more at risk than someone who inherits two APOE e3 alleles.

However, genetic variance also plays a role in whether you develop Alzheimer’s. Research suggest that the degree of risk may be affected by genetic ancestry- the global geographic region from which a person is biological descend. For example, Africa, Asia, American Indian or European descent. Some rare genetic variants are listed below that are known to cause the disease. A child whose one of these parents carry this genetic variation has a 50/50 chance of also inheriting the gene and therefore will also develop Alzheimer’s. A child with these genetic variants has a strong probability of developing Alzheimer’s before the age of 65. This is classified as early-onset Alzheimer’s.

• Amlyiod precursor protein (APP) on chromosome 21

• Presenilin 1 (PSEN1) on chromosome 14

• Presenilin 2 (PSEN2) on chromosome 1

Changes in these three genes causes the production of abnormal proteins that are associated with the disease. Each of these mutations causes the breakdown of the protein called APP, which is a protein that is not yet completely understood. However, the breakdown of this protein causes the formation of sticky amyloid fragments which cluster and form plaques on the brain. Which is one of the physical differences of Alzheimer’s.

Due to one of these three genetic variants being found on chromosome 21, a person with Down syndrome has a high chance of developing Alzheimer’s disease. With 50% of people with Down syndrome developing symptoms in their 50-60’s. This is since they have two chromosome 21’s, and therefore one greater set of genes that break down APP than someone without.

Genetic testing can now be done to test whether a person has dementia, however, it is not routinely done in the clinical setting. This is because sometimes the symptoms are prevalent enough as well as family history of dementia allows doctors to diagnose Alzheimer’s without any tests. Nevertheless, tests can be done to test for APP and PSEN1 and PSEN2. Genetic testing for Alzheimer’s is rather used to further understand the disease rather than diagnosing individuals. To conclude, any person can develop Alzheimer’s disease, and is caused by many external and lifestyle factors. Yet, as seen from the three genetic variants that can be inherited, some genes can cause people to develop Alzheimer’s quicker than others and therefore can be inherited and passed on to other generations. However, there is no definite reason or cure for Alzheimer’s disease and therefore is still an area within science and medicine that is still being researched to try and understand the uncertainties more.

TECHNICALLY CYBORG: PUTTING TOGETHER CELLS AND SYNTHETICS TO KEEP LIFE TICKING

Dewmi Amasha Marasinghege

Introduction

When you say tissue engineering, the first and foremost image that a person may visualize would be the 3D printing of refined biological structures which can then be inserted into the body (10). This is only part of the truth. Despite being an idea that was proposed over 4000 years ago (1), the synthesis of artificial tissues for the replacement of damaged or non-functional tissues only emerged as a versatile field of study under bioengineering over the last thirty years. The goal is to make the artificial seem more natural. And thus, biomaterials and encouraging growth of cells in the laboratory have been under heavy experiment and advancement (2).

Material selection and Fabrication methods

Picking out materials required for the construction of biosynthesized tissues and organs requires an extensive grasp and consideration of the various number of cells the product would be involved with and how the human body would react to the newly introduced environment (3). Having used an incompatible material can lead to serious chemical changes within the body, including more common transplant issues such as graft rejection, but also escalating to toxicity that can lead to tumorigenicity and unwanted cell migration. This leads all the work down a dangerous drain (4).

To illustrate, early artificial tissue fabrication methods involved the decellularization of the tissue using detergents which lead to frequent inflammation and weaker physical integrity of the final product. Hence, as per recent experimentation, scientists have produced three methods of tissue culture and fabrication: the use of injectable hydrogels or the implantation of biodegradable scaffolds or wholly synthetic tissue engineering (2).

Hydrogel Injection

The use of hydrogels to aid the growth of tissue namely in areas such as cartilage and soft tissue engineering. The characteristic of the gel to flexibly mould itself into shape of the wound site and allow the equal distribution of similar cell types before it hardens to form a cross-link template on which the tissue can regrow gives promising expectations for the damage to heal without the patient having to go through open-cut surgery. Nanopores present in the gel allow for the diffusion of vital substances, replicating the extracellular matrix that cells usually grow and multiply in (5)(2).

Process of Hydrogel Tissue Engineering

Figure 1- Source (5)

Implantable Scaffolding

The 3D printing framework for the development of synthetic tissues has been a very popular method of repairing extensive injury and has been quite a popular method of tissue synthesis over recent years. The scaffolding, primarily printed out of collagen fibres and biodegradable plastics (7) is injected with cells banked earlier on from the patient and are allowed to grow under suitable conditions (6). As the tissue grows, the scaffolding degrades over the months and the artificially constructed tissue can be slowly grafted onto the patient’s wound (2).

Synthetic Tissues

While the aforementioned procedures have gone through significant advancements throughout the years, the improvements in the production of completely non-living tissues have been flagging. To date, the use of synthetic tissues is very limited and have limited use in treating humans (8).

To mimic the behaviour of natural cells, experiments are being done in which synthetic cells are formed out of lipid vesicles to form what could act as a phospholipid bilayer and bound with hydrogels to form the intracellular fluids (9). The formation of artificial organelles is yet to be discovered. Thus, the closest use of synthetic tissues to date was to transplant artificial skin cells to heal wounds on laboratory rats (8).

Bio-engineered human liver that can be implanted into mice for lab testing

Latest Advancements

Despite the already progressive methods that are present, it isn’t certain to say that the artificial tissue result would be the exact shape of what was planned regardless of the framework provided for it to grow along. And so, the Vienna University of Technology has recently discovered a method to overcome this issue – mainly in cartilage reformation (12). Instead of a large outlining scaffolding of the final tissue structure, the research team had opted for microscopic spheres of scaffolding, a third of a millimetre in diameter, that can be packed with the required cell types(11).

Cultivating cartilage cells from stem cells is not the biggest challenge. The main problem is that you usually have little control over the shape of the resulting tissue,” says Oliver Kopinski-Grünwald from the Institute of Materials Science and Technology at TU Wien, one of the authors of the current study. “This is also due to the fact that such stem cell clumps change their shape over time and often shrink.” (12) The sphere cages are then to be put together in the required shape, rather like nanosized building blocks. As the cells multiply and grow, the spheroids slowly break down, leaving the tissue complete (11).

Figure 2- Source: Sangheeta Bhatia, MIT (8)

Spheroid cell scaffolding cage. Multiple can be put together to form the required shape of tissue.

3- Source: Tu Wein News Page (11)

Conclusion

Artificial tissue creation, despite being a relative rookie in the world of medical technology, has proved to be a life changing and progressive alternative to undergoing heavy surgery. Through further research over the span of the future, the production of synthetic tissues that not only successfully replace but enhance abilities will emerge and be available for medical use.

References

1. Mhanna R, Hasan A. Introduction to tissue engineering [Internet]. Tissue Engineering for Artificial Organs. Wiley; 2017. p. 1–34. Available from: http://dx.doi.org/10.1002/9783527689934.ch1

2. Material and fabrication methods for tissue engineering constructs [Internet]. News-Medical. 2024 [cited 2024 Sep 14]. Available from: https://www.news-medical.net/whitepaper/20240115/Material-and-Fabrication-Methods-forTissue-Engineering-Constructs.aspx

3. Wang X. Bioartificial organ manufacturing technologies. Cell Transplant [Internet]. 2019 [cited 2024 Sep 14];28(1):5–17. Available from: http://dx.doi.org/10.1177/0963689718809918

4. Seppänen-Kaijansinkko R. Tissue engineering — pros and cons. Int J Oral Maxillofac Surg [Internet]. 2017;46:50. Available from: http://dx.doi.org/10.1016/j.ijom.2017.02.183

5. Tan H, Marra KG. Injectable, biodegradable hydrogels for tissue engineering applications. Materials (Basel) [Internet]. 2010 [cited 2024 Sep 14];3(3):1746–67. Available from: https://www.mdpi.com/1996-1944/3/3/1746

6. Ma PX. Scaffolds for tissue fabrication. Mater Today (Kidlington) [Internet]. 2004;7(5):30–40. Available from: http://dx.doi.org/10.1016/s1369-7021(04)00233-0

7. Mefanet C, Slovak medical faculties network. Artificial tissues [Internet]. Wikilectures.eu. [cited 2024 Sep 14]. Available from: https://www.wikilectures.eu/w/Artificial_tissues

8. Tissue Engineering and Regenerative Medicine [Internet]. National Institute of Biomedical Imaging and Bioengineering. [cited 2024 Sep 14]. Available from: https://www.nibib.nih.gov/science-education/science-topics/tissue-engineering-andregenerative-medicine

9. Bayley H, Cazimoglu I, Hoskin CEG. Synthetic tissues. Emerg Top Life Sci [Internet]. 2019 [cited 2024 Sep 14];3(5):615–22. Available from: http://dx.doi.org/10.1042/etls20190120

10. Sciencedirect.com. [cited 2024 Sep 14]. Available from: https://www.sciencedirect.com/topics/nursing-and-health-professions/artificial-tissue

11. Microscaffolds – a new strategy in tissue engineering [Internet]. Tuwien.at. 2022 [cited 2024 Sep 14]. Available from: https://www.tuwien.at/en/mwbw/news/news/mikrogerueste-einneuer-ansatz-fuer-tissue-engineering

12. Scitechdaily.com. [cited 2024 Sep 14]. Available from: https://scitechdaily.com/scientistsdevelop-new-very-different-approach-to-producing-artificial-tissue/

Figure

HELP SAVE CANINE LIVES FROM HEATSTROKE

Alexandra Hide

These past few years I have been doing a few internships at various clinics in the UAE, and one of the cases that I saw will stay with me forever. It was a condition so easily avoidable that I believe improved awareness about it could save dogs world-wide, particularly in areas with excessively hot climates. I stood in the operating room shadowing a practicing vet, wearing ill-fitting scrubs and a nervous smile. The day had so far been somewhat quiet due to the lull that the middle of the summer holidays always brought, though of course nobody said this aloud due to time-old superstition. The peace was abruptly broken when two nurses burst in with a stretcher, and a large golden retriever was rushed in and carefully laid out on a big metal table. I didn’t know what was wrong yet, just that something big was happening. Everyone ran around retrieving various equipment, so I mostly tried to stay out of the way. The vet I was shadowing pushed into my arms a bag of cotton and a cold metal bowl full of pink disinfectant. She quickly instructed me to tear pieces of cotton, soak them in the solution, and hold them under the arms and paw pads of the panting dog. This was to help cool him down, since they are the main areas on a dog that heat can escape through.

The dog had painfully swollen, cracked paw pads from

Fans began blaring all around the table, which I felt turn the soaked cotton cold under my hands through evaporative cooling as I held them to the dog. The vet then presented the case with a brief yet firm explanation; the golden retriever belonged to an athletic young couple waiting anxiously downstairs. They had gone for a run outside in the early morning with their dog, and had not seen any signs that he was suffering before his case of heat stroke had become dangerously advanced.

running on the brick pavement which had become blisteringly hot as the bricks effectively soaked up the sun’s rays from the early sunrise typical in the summer. He was heaving rapid, shallow breaths, and his golden pelt was soaked in water and perspiration. His pink tongue rolled out of his mouth to rest on the cool metal table, but most concerning was how he seemed to fight for each breath and was tired to the point of not being able to sit up or stand.

All these symptoms indicated a progressed case of heatstroke and can be summarized using the acronym HELP (Heavy panting, Excessive drooling, Lethargic drowsiness, Problems vomiting). 98% of dogs suffering from mild signs of this condition have a high chance of survival, however the more advanced cases are why 1 in 7 dogs that are taken to the vet with heatstroke don’t survive it. I left the clinic at the end of the day, with the team of vets and nurses constantly monitoring the dog who, despite appearing to have improved slightly, was still in a critical condition. When I came in the next morning, I was shocked with the news that he had passed away in a matter of hours from organ failure as his case of heatstroke had progressed beyond the point of being able to save him.

We have to understand that dogs don’t respond to heat in the same way that humans do. Humans regulate body temperature through the many sweat glands all over our bodies. In contrast, dogs only have a few sweat glands located in their paw pads and around the noses, and their primary form of heat release is through panting. Another name for heatstroke is hyperthermia, and it is classified

as when a dog’s internal temperature increases above 39 ˚ C. Other forms of hyperthermia include heat stress and heat exhaustion; however heat stroke is the most severe.

How can you treat and help your dog avoid heatstroke?

The most important factor is to avoid putting your dog in a situation where they are at risk of heat stroke. The most common scenarios are when dogs are left in closed homes without air conditioning, are left in cars, or have insufficient access to water. Puppies and flat-faced breeds are at a higher risk of developing heat stroke, so additional care should be taken with them.

The second most important course of action if you start to recognize the symptoms of heat stroke in your dog is to begin cooling them down as soon as possible. This can be done most effectively by gently wetting them with a cool spray of water from a hose, and a fan blowing over their damp skin to help using evaporative cooling. Do not wrap a wet towel around them as it will trap the heat trying to escape, and don’t use ice baths or freezing water which can induce shock or cool them too rapidly. This can cause vasoconstriction (the constriction of blood vessels) which lowers their cooling capability. Visit a vet as soon as possible even if your dog appears to be recovering. They may require further medical attention such as

intravenous fluids to treat dehydration, and blood tests to detect blood clots and assess organ function. You can save your dog’s life by following this simple procedure, just as it could have saved this golden retriever’s life had his owners known the signs and what to do.

TRANSFORMING CANCER CARE: THE PROMISE OF STEM CELL THERAPY

Ananya Gopinath

Introduction:

The first stem cell transplantation was carried out in 1958 by the French oncologist Georges Mathé. It was a bone marrow graft transplantation to treat six nuclear researchers who were exposed to radiation.1 Research on stem cell therapy has long since flourished and now it’s showing promise in the field of cancer treatment.

Cancer is usually treated by surgical resection, radiation therapy, and chemotherapy. However, the efficacies of these treatment options can be restricted as they often cause side effects and damage healthy tissues.

This is where stem cells come into play. They possess features that help them maneuver around obstacles hindering gene therapy approaches, such as migration towards cancer cells, immunosuppression, and secretion of bioactive substances.2

Georges Mathé, performed the first stem cell transplant 6

Harnessing Induced

Pluripotent and Adult Stem Cells

Different stem cells have different proliferative, migration, and differentiation capacities, which determine how they can be used for antitumor treatment. The main types of stem cells used in cancer therapy are induced pluripotent stem cells(iPSCs), adult stem cells(ASCs), and cancer stem cells(CSCs).

Induced pluripotent stem cells (iPSCs) are a type of pluripotent stem cell created by genetically reprogramming adult somatic cells to behave like embryonic stem (ES) cells.3 They are crucial in generating effector T-cells and natural killer cells and for developing anti-cancer vaccines. RNA sequencing showed that human and mouse iPSCs express tumor-associated antigens. In prophylactic treatments, iPSC vaccines successfully stop tumor growth in mouse models of breast cancer, mesothelioma, and melanoma.4

Adult stem cells (ASCs) can develop into various specialized cell types within tissues and organs. Among them, hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs), and neural stem cells (NSCs) are commonly used in cancer treatments. HSCs, found in bone marrow, can produce all types of mature blood cells. MSCs are present in various tissues and organs, where they play a key role in tissue repair and regeneration. NSCs, originally found in the central nervous system, have the ability to self-renew and produce new neurons and glial cells.

The Role of Cancer Stem Cells in Therapy

Cancer stem cells (CSCs) are a small group of cells within tumors, capable of self-renewal and continuous proliferation. They are responsible for causing tumors, driving metastasis, and maintaining the diversity of cells within the tumor. Cancer stem cells (CSCs) are increasingly being targeted in cancer therapy due to their role in tumor initiation, progression, and resistance to conventional treatments. Some of these strategies including the use of CSCs include:

1. Targeting CSC markers: Therapies are being developed to specifically target CSCs based on their unique surface markers. This strategy enables direct targeting of CSCs without depending on the major histocompatibility complex (MHC) presentation, a set of genes that code for proteins located on cell surfaces and assist the immune system in identifying foreign substances, which is often reduced in CSCs.

2. Combination therapies: Combining anti-CSC therapies with other treatments, like immunotherapy or conventional chemotherapy, can improve the overall effectiveness of cancer treatment. This approach targets both the main tumor and the CSCs, which are often the cause of relapse.

3. Drug Delivery Systems: Advanced drug delivery systems, such as nanoparticles and liposomes, are being employed to improve the targeting of cancer stem cells (CSCs). These systems can enhance the solubility, stability, and bioavailability of therapeutic agents, enabling more effective targeting of CSCs while reducing side effects.5

Induced Pluripotent Stem Cells7

Conclusion

Cancer Stem Cells8

The constantly evolving field of stem cell therapy shows significant promise in improving cancer treatment outcomes. As research continues to advance, stem cell-based therapies may not only provide hope for patients facing cancer but also redefine the future of oncology, leading to more effective and less toxic treatment options.

References:

1. The Beginnings of Stem Cell Therapy https://the-dna-universe.com/2021/06/24/thebeginnings-of-stem-cell-therapy/#:~:text=Stem%20cell%20therapy %20%E2%80%93%20The%20beginning&text=In%201958%20the%20French %20oncologist,were%20accidentally%20exposed%20to%20radiation.

2. Recent Progress of Stem Cell Therapy in Cancer Treatment: Molecular Mechanisms and Potential Applications, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7140431/

3. Induced Pluripotent Stem Cells and Their Potential for Basic and Clinical Sciences https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584308/

4. Autologous iPSC-Based Vaccines Elicit Anti-tumor Responses In Vivo, https://www.cell.com/cell-stem-cell/fulltext/S1934-5909%2818%2930016-X

5. Cancer stem cells: advances in knowledge and implications for cancer therapy, https://www.nature.com/articles/s41392-024-01851-y

6. https://www.sciencelearn.org.nz/resources/1971-bone-marrow-transplants-timeline

7. https://en.wikipedia.org/wiki/Induced_pluripotent_stem_cell

8. https://www.news-medical.net/life-sciences/Cancer-Stem-Cell-Hypothesis.aspx

HYDRONEPHROSIS: WHAT IS IT, HOW IT

CAN BE TREATED AND WHY IT CAN BE DIFFICULT TO DIAGNOSE.

Tilly Black

Simply, hydronephrosis is a kidney condition where one or both kidneys become swollen, due to unsuccessful drainage of urine through the ureters, causing a blockage. According to Cleveland clinic, 1 in 100 adults will experience hydronephrosis at some point throughout their life, so it is a very common condition to develop! Hydronephrosis has a range of causes, such as kidney stones becoming lodged in your urinary tract, tumours in/around organs in the urinary system, birth defects causing one to have a narrow urinary tract, or even pregnancy (expansion of the uterus can block the flow of urine). The severity of hydronephrosis depends on the individual cause and how long the obstruction has lasted. Due to these varying severities, symptoms are also varying, however some common ones include: sudden or intense pain in your lower abdomen/back/side, nausea, urinating more/less frequently than normal, painful urination (possibly with blood), being unable to entirely empty your bladder, or having UTI (Urinary tract infection). Typically, hydronephrosis is classified as mild, moderate or severe, while sometimes it is graded on a scale of 1-4 (1 being the mildest, 4 the most severe). These classifications are based on the extent of swelling of a kidney(s) and the loss of function it may experience. Severe cases of hydronephrosis can cause loss of kidney function, or in extreme cases, complete kidney failure, where a transplant would be needed. Symptoms usually correlate with the severity of the condition.

Hydronephrosis is mainly diagnosed through an ultrasound of the kidney, and blood tests and renal Mag3 scans (nuclear scans) can be carried out to aid diagnosis to analyse kidney function. Once again, treatments of Hydronephrosis also vary depending on the cause. For example, if the cause is due to a blockage of the urinary tract (e.g. kidney stones), then the blockage can be removed. Excess urine can also be drained from the kidney via a bladder catheter. However, if the cause is more complex, surgery may be needed. This includes narrow urinary tracts from birth needing to be widened, or arteries being moved to stop flow being cut off through the ureter. The kidney is surgically the most difficult organ to reach, so robotic surgery is often used; in Mediclinic City Hospital, the operating robot is called Da Vinci!. After treatment, patients need to be checked up on roughly every 6 months to ensure the affected kidney is functioning well and is not becoming blocked once again. Hydronephrosis is a condition which can be difficult or slow to be diagnosed. This is due to the kidneys positioning in the body, as well as the stage of hydronephrosis is reached; symptoms may not begin to show until classified more severely. The right kidney is especially difficult to diagnose for hydronephrosis, as it is located in a similar position to the appendix. This is why the severe pains of hydronephrosis can often be mistaken for appendicitis, as both conditions share common symptoms (lower abdominal pain being the most prominent).

Hydronephrosis is a relatively common condition, so if caught in an early stage it can be quickly treated – however, if you experience a lower abdominal pain it is important to be seen by a doctor to ensure that any condition (whether it be appendicitis or hydronephrosis) is identified as soon as possible.

THE IMPACT OF AIR POLLUTION ON

RESPIRATORY HEALTH IN

CHILDREN

Aryan Verma

Air pollution is one of the world’s most serious environmental problems. Air pollutants continue to be major contributing factors to the incidence and exacerbation of acute and chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), impaired lung development, cardiovascular diseases, and cancer [1]. In this article I will review the sources of air pollution and how they can impact children’s respiratory health.

Air Pollutants

The WHO (World Health Organisation) defines air pollution as the contamination of the indoor or outdoor environment by any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere. According to the WHO, 99% of the world population lives in areas where the air pollution exceeds the WHO air quality guidelines [2]. This annually contributes to 7 million premature deaths and 600,000 of those being from children under the age of 15 [3].

Air pollutants can be categorised into household air pollution (HAP) which is mainly cause by the combustion of fossil fuels for cooking or heating, and ambient air pollution (AAP) which is pollution in the air from natural and anthropogenic (man-made) activities. Natural activities include volcanic eruptions, forest fires, wind-blown dust and emission from decaying biomass. Common anthropogenic sources of AAP include combustion of fossil fuels for electricity and transport related air pollution (TRAP), decaying waste and agricultural purposes. [4]

There are six main pollutants [1] [8]:

• Particulate Matter / PM2.5

Particles with an aerodynamic diameter of 2.5 micrometers or less. These pollutants are also known as fine PM and can penetrate deep into your lungs (entering bronchioles and alveoli) and potentially enter the body through the bloodstream, affecting major organs [2]. PM2.5 sources are the same as AAP and HAP, a tolerable level of exposure to PM2.5 is anywhere in between 0 – 35 micrograms per cubic meter (µg/m3) every 24 hours.

• Particulate Matter / PM10

Particles with an aerodynamic diameter of 10 micrometers or less. PM10 are coarse particles which deposit higher up in airways and cause more irritation and inflammation [4]. PM10 sources are the same as AAP and HAP, a tolerable level exposure to PM10 is anywhere in between 0 – 100 micrograms per cubic meter (µg/m3) every 24 hours.

• Ground Level Ozone (O3), Sulfur Dioxide (SO2), Carbon Monoxide (CO), Nitrogen Dioxide (NO2)

These air pollutants are oxidants or pro-oxidants, high exposure to such particles encourages the formation of oxygen and nitrogen free radicals (short-lived ions which are very unstable and highly reactive) which induce stress in the airways and cause inflammation, potentially damaging the lungs [5].

O3 – causes irritation of the airways and airway hyperresponsiveness and bronchospasm.

Exposure to O3 can be tolerated under 0.125 ppm (parts per million) every hour.

CO – interferes with oxygenation of hemoglobin, in high concentration it can cause death by preventing O2 transport. Exposure to CO is unharmful between 0 – 9.4 ppm per 8 hours

SO2 – easily dissolves in water and contributes to the formation of acid rain

Such pollutants are emitted during the incomplete combustion of fossil fuels, e.g. in vehicle exhaust fumes, industrial activities and in power plants. Exposure to SO2 is tolerable between 0 – 75 ppb (parts per billion) every hour.

NO2 - can make individuals vulnerable to respiratory infections, lung disease, and possibly cancer. It contributes to the brownish haze seen over congested areas and to acid rain. Exposure to NO2 is tolerable between 0 – 10 ppb every hour.

Effects of Air Pollution on Children’s Health

Air pollution can impact children in different ways before and after birth.

During Pregnancy

Susceptibility:

During the prenatal period, the morphogenesis (a process whereby tissues and organs develop shape during embryonic development) of the lung takes place at 4 – 7 weeks of gestation and all the features of the lung develop late into the pregnancy, however the complete maturation of the lung continues into early adulthood. This means that prenatal babies are susceptible to the effects of air pollution, and it can impact their lung development as they grow [4]. Exposure during pregnancy occurs when the pollutants inhaled by the mother translocate to the fetus, causing them to be present in the developing fetus and placenta [6].

Impact on Respiratory Health of Children:

Studies have shown that exposure to air pollution during early pregnancy can disrupt differentiation and morphogenesis. Later in pregnancy, air pollution affects the structural and functional growth of the lung. This exposure can lead to impaired lung function and development even after birth [4]. There is increased possibility of post neonatal mortality when exposed to PM10 in excess of 10 µg/m3 or more [7].

Another study conducted in Taiwan has looked into the susceptible time windows in the development of pediatric asthma [10]. This birth cohort in Central Taiwan showed that prenatal and postnatal exposures to PM2.5 were associated with subsequent development of asthma in childhood. The vulnerable time windows to exposure being gestational week of 6 to 22 in utero and 9 to 46 weeks after birth. The authors declared that sensitive population, including pregnant women and young children, should avoid the exposure to AAP during these susceptible periods [10].

After Pregnancy

Susceptibility:

Children, especially infants are one of the most susceptible to damage to their respiratory system because of over exposure to air pollutants. This is due to 3 main reasons: [5]

Children have a much weaker immune system, which isn’t fully developed, increasing the chance of contracting respiratory damage.

Children have a higher minute ventilation than adults and when considering the ration of body weight to volume of air inhaled the volume of air passing through the airways of a child at rest are double that of an adult.

Children tend to spend more time outdoors resulting in a higher exposure to AAP (the main source of pollutants)

On top of this, there are many other factors which may increase a child’s vulnerability to respiratory damage [5]:

Individuals with (pre) existing chronic disease

(Pre) existing chronic diseases affecting the respiratory system (asthma, Cystic Fibrosis, COPD) or the circulatory system (arrhythmias, hypertension, and ischemic heart diseases) are compromised leaving them more susceptible to respiratory damage.

Genetic Susceptibility

If there is a history of disease in a family, the child may inherit a gene leaving them more vulnerable.

Impact on Respiratory Health of Children:

Asthma and Wheezing

Asthma is one of the most common chronic diseases among children. It is caused by the inflammation of the airways associated with excessive mucus production, reversible bronchoconstriction, and airway hyperreactivity. The asthma symptoms can include a combination of a wheeze, cough, shortness of breath and chest tightness. [4]

Recently, a study was conducted, aiming to find the impact of AAP specifically TRAP on children with recurrent wheezing or asthma. They concluded that there is a significant association between the excess exposure of PM10 and NO2 (the 2 main pollutants released from TRAP) and the development of asthma exacerbations, and increased risk of respiratory morbidity in children. [9] On top of this, research was conducted in areas of high exposure to TRAP (areas near high traffic streets) and compared to areas of low TRAP levels such as in green areas of a city. This demonstrated that living in high exposure to TRAP leads to increased episodes of wheezing and asthma exacerbations. The results were concurrent with results of similar prospective studies in Sweden and China, further giving weight to the results. [9]

Acute Respiratory Infections

Respiratory infections are infectious diseases of the upper or lower respiratory tract cause by bacteria or viruses. Acute infections are short-term conditions which can typically be treated over a small period of time, whereas chronic diseases are those which develop over an extended period of time and require longterm treatment (like asthma).

Increased levels of PM10 and exposure to indoor biomass fuel (BMF) combustion (NO2 and SO2) can increase the risk of contracting acute respiratory infections. The association of increased risk of lower airway infection and indoor smoke exposure was first suggested in a Nepal study. By measuring the level of PM10, NO2 and SO2, the study showed a relationship between the risk of acute respiratory infection and exposure to indoor BMF combustion [11]. A meta-analysis further demonstrated that HAP exposure resulted in nearly 1.8-fold increase in the risk of pneumonia along with other acute infections in children under 5 years old. Similar results were found in a meta-analysis where 10 European birth cohorts, demonstrating over exposure to NO2 and SO2 in the first year of life have close association with the risk of pneumonia. [12][8]

Effects of Air Pollution on Children’s Health

To conclude, early exposure to high levels of air pollution can have a detrimental impact on the respiratory health of children, causing early damage to lungs resulting in impaired respiratory development and the contraction of acute and chronic respiratory diseases such as wheezing, asthma and lower respiratory tract infections like pneumonia.

References

1) Vallero, D. A. (2019, January 1). Air pollution biogeochemistry. Elsevier eBooks. https://doi.org/10.1016/b978-0-12-814934-8.00008-9

2) World Health Organisation | Air pollution. (2019, July 30). https://www.who.int/health-topics/air-pollution#tab=tab_1

3) World Health Organisation | What are the WHO Air quality guidelines? (2021, September 22). https://www.who.int/news-room/feature-stories/detail/what-are-the-whoair-quality guidelines

4) Aithal, S. S., Sachdeva, I., & Kurmi, O. (2023, June 1). Air quality and respiratory health in children. Breathe. https://doi.org/10.1183/20734735.0040-2023

5) Arbex, M. A., De Paula Santos, U., Martins, L. C., Saldiva, P. H. N., Pereira, L. A. A., & Braga, A. L. F. (2012, October 1). A poluição do ar e o sistema respiratório. Jornal Brasileiro De Pneumologia. https://doi.org/10.1590/s1806-37132012000500015

6) Liu NM, Chen Y, Miyashita L, et al. The presence of air pollution particulate matter in cryopreserved placental tissue cells. ERJ Open Res 2021; 7: 00349-2021.

7) Lacasaña, M., Esplugues, A., & Ballester, F. (2005, February 1). Exposure to ambient air pollution and prenatal and early childhood health effects. European Journal of Epidemiology. https://doi.org/10.1007/s10654-004-3005-9

8) Wu, I. P., Liao, S., Lai, S., & Wong, K. S. (2022, February 1). The respiratory impacts of air pollution in children: Global and domestic (Taiwan) situation. Biomedical Journal. https://doi.org/10.1016/j.bj.2021.12.004

Principi, N., Patria, M. F., Malerba, S., Montinaro, V., Prada, E., Senatore, L., ... & Esposito, S. (2014).

Impact of air pollution on respiratory diseases in children with recurrent wheezing or asthma.

Jung CR, Chen WT, Tang YH, Hwang BF. Fine particulate matter exposure during pregnancy and infancy and incident asthma. J Allergy Clin Immun 2019;143:2254e62.e5.

Ezzati M, Kammen DM. Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study. Lancet 2001;358:619e24.

MacIntyre EA, Gehring U, Molter A, Fuertes E, Klu € ̈ mper C, Kramer U, et al. Air pollution and respiratory infections € during early childhood: an analysis of 10 European birth cohorts within the ESCAPE project. Environ Health Perspect 2014;122:107e13.

IS SUICIDE CONTAGIOUS?

Rehab Khan

The media always has and always will have a dangerously large influence on our thoughts and ideas. The media can brainwash us into doing things we don’t necessarily believe in and say things that go against our personal values. Whether it’s a new political scandal or a fresh celebrity breakup, our opinions are usually determined by how the rest of the world reacts to the situation.

This leads me to the crux of my article: does exposure to suicide through films, tv shows and personal experiences prevent it or encourage it amongst teenagers?

Many ecological studies support the hypothesis that suicide may be ‘contagious’. Contagious, in the sense that being exposed to it can increase the likelihood of it happening. This is what many experts refer to as suicide contagion, which is when one suicide triggers multiple others. Information taken from the Canadian National Longitudinal Survey of Children and Youth between 1999 and 2007 found that exposure to suicide predicted suicidal behaviour. Experiencing the death of a classmate by suicide was consistently associated with suicide attempts. Through this study and many others, it can be concluded that having a peer or close friend commit suicide can increase the chances of a person taking their own life.

The term used to describe a significant number of suicides occurring within close proximity to each other is a suicide cluster. Suicide clusters are common between teenagers and adults who share similar pre-existing struggles and vulnerabilities, such as emotional abuse and substance abuse, that are closely associated with feelings of shame, guilt, and fear. When someone experiences a loved one taking their life as a permanent solution to a temporary problem, it remodels the idea of suicide as a feasible and justifiable option to escape this world’s problems.

Recently, the media has become much more open to sensitive topics such as mental health and suicide. However, portrayals of suicide and media coverage of suicidal behaviour has had negative influences. Suicidal behaviour seems to be more prevalent when details of the method of the reported suicide are specified. This, again, links to the suicide contagion effect. This theory of contagion is also known as the Werther’s effect, and it originates from Goethe’s 1774 novel ‘The Sorrows of Young Werther’. This term was invented by researcher David Phillips in 1985, who found that suicide rates seemed to increase after a well-publicised suicide. An example of a suicide being reported in the media which contributed to a string of suicides afterward, is the death of the actor Robin Williams by suicide in 2014 that led to a 10% increase in suicides over the following four months. A common issue that increases the possibility of suicide clusters occurring is associating suicide with mental illnesses. This can create a stigma around people diagnosed with mental illnesses and make them more prone to the belief that death by suicide is inevitable for them.

One of the more popular modern depictions of mental health and suicide is the Netflix series ‘13 Reasons Why’, which focuses on the story of a young teenage girl struggling heavily with mental health and as a result of this, taking her own life. The show highlighted the aftermath of her suicide and the effect it had on her parents, friends, and school community. The release of the tv series was a great cause of concern for many parents because of the potential risk of suicide contagion. The main viewing audience seemed to be young, impressionable teenagers who were still at the age where they could be easily influenced by the things around them. Emulation can be produced as a result of fictional depictions, and it is very common among teenagers. Many parents were worried that this show would increase the risk of suicide among the young audience. Experts have also been heavily critical about the show, accusing it of glorifying suicide through its plot and storylines. A 2017 New York Times article discussing the online debate that the tv series sparked about teenage suicide, found that there was anecdotal evidence from viewers saying that they were triggered by the show. This revealed that the show did have negative effects on some viewers and vulnerable people may be motivated to imitate the behavioural patterns displayed in the show.

In conclusion, the association between suicide portrayal and the suicide contagion effect has been debated since 1774, which shows that it is a discussion of significant importance. There is evidence to support the claim that suicide is contagious when a person is exposed to suicide or suicidal behaviours through personal experiences and different elements of media. Regardless of intent, media portrayals

of suicide can create a great impact on the choices of susceptible people. The suicide contagion phenomenon seems to be more widespread when exclusive and specific details about a publicised suicide are mentioned. The media can be used positively to advocate about mental health, but it is important to understand that it can have equally opposite and devastating effects and it is crucial for us prevent such consequences from happening.

References

● Madelyn S. Gould, Ph.D., M.P.H. (2013). ‘The Contagion of Suicidal Behaviour’. National Academy of Sciences, National Library of Medicine. <https://www.ncbi.nlm.nih.gov/books/NBK207262/ >

● Jamie Ducharme (April 18, 2019). ‘Suicide Deaths Are Often 'Contagious.' This May Help Explain Why’. Time. < https://time.com/5572394/suicide-contagion-study/ >

● Wong, P.T.P. (March 27, 2019). ‘Let Your Vulnerability be Your Strength’. Positive Living Newsletter. < http://www.drpaulwong.com/let-your-vulnerability-be-your-strength/ >

● Stephanie Pappas (July 1, 2023). ‘More than 20% of teens have seriously considered suicide. Psychologists and communities can help tackle the problem’. American Psychological Association. < https://www.apa.org/monitor/2023/07/psychologists-preventing-teensuicide#:~:text=A%20report%20from%20the%20Centers,%25%20had%20seriously %20considered%20it >

● Hawton K, Williams K. (December 14, 2002). ‘Influences of the media on suicide’. BMJ. National Academy of Sciences, National Library of Medicine. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124845/#:~:text=Reporting%20and %20portrayal%20of%20suicidal,overwhelming%20evidence%20for%20such%20effects > Scalvini, M. (2020). ‘13 Reasons Why: can a TV show about suicide be ‘dangerous’? What are the moral obligations of a producer?’ Media, Culture & Society. <https://doi.org/10.1177/0163443720932502 >

PERSONALIZED MEDICINE: HOW GENETICS SHAPE YOUR TREATMENT

Maria Michailidou

Precision Medicine is the approach of tailoring disease prevention and treatment to be specific to each individual. This is achieved by taking into account differences in people's environmental, biological, and lifestyle characteristics, factors that make us individual from one another. Our biological components are often down to the sequences of our genes, which have a large influence on each person’s physical, behavioral, and psychological attributes. Therefore, it would be appropriate to assume their importance to make informed decisions regarding the patient’s treatment.

The study of a person’s genes is achieved through genomic profiling. This process begins by collecting a sample of cells which contain a full set of chromosomes and sequencing entire the DNA within them. The data can then be analyzed and put through an AI algorithm which will identify any genetic alterations in the DNA. Understanding genetic variations and their phenotypic differences helps create individualized treatment plans. It can lead to a diagnosis and even aid in the prediction of how different individuals may respond to specific medications, guiding the selection of the most effective treatment for each patient. This mainly refers to the field of pharmacogenomics, the study of how an individual’s genetic makeup influences their response to drugs. This knowledge helps optimize drug selection and dosage to minimize adverse effects and therefore enhance treatment outcomes.

For an AI algorithm to recognize patterns displaying a link between a specific mutation to a particular phenotypic expression, a large amount of data must be inputted into the system to reduce the chances of false a diagnosis. Advances in technology, such as electronic medical records allow for data to be gathered from a large number of people from various research centers around the world. However, the benefits of sharing genetic data over digital platforms for health research and discovery must be weighed against potential privacy issues associated with it. The exposure or misuse of genomic data can result in abuse or stigmatization as well as possible discrimination in environments including employment, insurance, or education. Therefore, hospitals and companies must invest in cyber security to protect their patient’s confidentiality. Not only this but the data inputted must be accurate as well as reliable which can be very difficult to monitor. Mistakes in the data put into the algorithm may lead to inaccuracies when highlighting a mutation or diagnosing a patient.

Another way medical treatments can be influenced by your genetics is the development of target-specific drugs. Target-specific drug delivery is a modern approach for administering pharmaceuticals to patients which involves raising the drug's concentration only in the component of the body of interest: such as the targeted organs, tissues, or cells. The majority of targets of these drugs are the signaling networks in cells linked to the development of disease. These medications alter cell communication pathways by inhibiting a key signaling protein by preventing a ligand from attaching to its receptor. This changes the interactions between cells and the development of a disease or the function of a drug. Another way target-specific drugs are implemented into precision medicine is through genetic testing; where certain mutations which promote tumor growth can be identified, allowing for the development of personalized medications that target cancer cells while protecting healthy organs.

Currently the process of precision medicine is not a widely accessible form of treatment across the world. This is due to the costs involved with the use of advanced technologies or even the costs of genetic testing, interpretation of results, etc. Therefore, these components of the treatment, pose a financial barrier to many people. Despite this, I still believe that personalized medicine will be increasingly incorporated into the future of our healthcare systems. This is because it could improve certain treatment outcomes, whilst reducing adverse effects whilst also reducing healthcare costs as there will be less trial and error. This does not necessarily require the in-depth study of your genes; it could be as simple as a well-written survey to collect data on your environmental and lifestyle characteristics. However, to conclude, personalized medicine has been driven by advancements in genetics. As our understanding of genomics continues to expand with the aid of new emerging technologies, personalized medicine has the potential to revolutionize medical practices, offering a more precise and personalized approach to patient care.