“To publish one’s original workisanhonorformostandPB&J provides just that: opportunity withoutlimitations.”
Mitchelle D’Silva
“Contained within this firsteditionisawideselectionof work,frommedicalresearchand education to blogs from our students which I feel will find a reflection in the minds of our readers.“
Coverdescription:
The cover art depicts St. George the Conqueror ChapelMausoleuminVazrazhdaneSq,Pleven.Wechoseto illustrate this building because it is one of the the most distinguishedlandmarksinPleven.
On the cover, the mausoleum transitions from a photograph to a drawing to a sketch. This transition representstheprocessbywhichwedrawinspirationfromour mundanesurroundingstocreateoriginalworksofart.Eachof our writers grabbed a pen and a blank sheet of paper and funnelledtheirexperiencesandknowledgeintothejournals andblogsyouwillreadtoday.
Wehopethatyoutakeaminutetositback,relax,and enjoyalloftheartisticpapersandphotographscontainedin thisfirstissueofPB&J.
Ofcourse,talkingaboutpoetryisadyingartinandofitself, and its place in a medical journal seems out of place at first glance. However, I am convinced that there is a certain poetry in medicine, in medical research, and in the lives of allofushereinPleven,livingaswedofarawayfromhome. When I was asked to write this letter, I gave into a certain introspection, one that has come from observing Pleven both as an outsider and as someone who has lived here so longthatithasbecomehome.Itisaprivilegetobethefirst, itisalsoaprivilegetoreadtheworksofmyfellowstudents,
Contained within this first edition is a wide selection of work, from medical research and education to blogs from our students which I feel will find a reflection in the minds of our readers. This journal was begun with high ambition, and as the first edition is on your screens, wherever you may be, we hope that this ambition is on its way to tangible reality. On behalf of all our writers, editors and technical staff, I would like to present this edition for what it is, a laborofpoetry,bothliteraryandmedical.
“Lifeisonly interestingif lifeiswide”
-LucienCarr, Journalist
Keywords:cancer;immunotherapy;FDA
Cancerisadiseasecausedbyuncontrolledgrowthofthebody'scellsandtheirspreadtootherpartsofthebody. It can develop almost anywhere in the body, which is made up of trillions of cells. Cancer is one of the most difficult diseasestofight(asshowninfigures1and2).
Many types of cancer have been discovered, and some of the latest advances in cancer treatment include CAR-T cell therapy, monoclonal antibodies, immune system modulators and immune checkpoint inhibitors. Oncologists are studying a new path in cancer treatment (Rosenberg, 2019). They look for genetic or protein abnormalities in a patient’s tumorandmatchthemupwithimmunotherapiestotargetthem.Immunotherapyaimstostrengthentheimmune
systemsothatitisabletoattackcancercells.
CAR-T cell therapy is a method to direct immunecellstofightcancer;itisarealbreakthroughin immunotherapy (Parker and Gregg, 2022). Thus, a groundbreaking drug called Pembrolizumab (Keytruda), an immune checkpoint inhibitor, was designed to stop theactionofanimmunesystem-blockingproteincalled PD-L1 so that immune cells can react against cancer. Thisdrughassuccessfullybeenusedtotreatmelanoma and other skin cancers, as well as breast, endometrial, kidney and esophageal cancers (Bonin, 2020). Moreover, the FDA (Food and Drug Administration) has decided to approve potential cancer drugs. Osimertinib (Tagrisso) was approved in December 2020 by the FDA. New data shows that Osimertinib prevents the development of brain metastases in patients with early disease and is truly helpful for patients with EGFR (Estimated Glomerular Filtration Rate) mutated lung cancer(NCIStaff,2019).
PSMA (Pluvicto) is a recent FDA-approved treatment for prostate cancer. It is indicated for the treatment of adult patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) that have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. On April 1, 2022, the Food and Drug Administration approved Axicabtagene ciloleucel (Yescarta) for adult patients with large B-cell lymphoma that are resistant to first-line chemoimmunotherapy or present with a setback within 12 months of first-line chemoimmunotherapy (FDA, 2022). However, it is not suggested for the treatment of patients with primary centralnervoussystemlymphoma.Thereisnoresearch on the use of Axicabtagene ciloleucel in patients with primary CNS lymphoma. Therefore the benefit/risk ratio of Axicabtagene ciloleucel in this population has notbeenestablished.
On April 5, 2022, the FDA approved Alpelisib (Vijoice) for adult and pediatric patients two years of age and older with severe central nervous system lymphoma who require systemic therapy (Matthews, 2022). Regarding Hodgkin lymphoma, a type of cancer that affects the lymphatic system causing the uncontrolled growth of the blood cells, many drugs were approved by the FDA. One of the most important onesisBleomycinsulfate(Blenoxane).Bleomycinsulfate is approved to be used alone or with other drugs as palliative treatment for: Hodgkin lymphoma, non-Hodgkin lymphoma (NHL), squamous cell carcinoma of the penis, squamous cell carcinoma of the cervix, squamous cell carcinoma of the head and neck (SCCHN), squamous cell carcinoma of the vulva and testicularcancer(ASHP,2021).
Finally, an Italian scientific team has found a new mechanism that allows a donor’s immune system to destroy leukemia cells. In bone marrow transplantation, hematopoietic stem cells, the progenitors of blood cells, are transplanted. In this way, patientsareprovidedwithhealthybloodcellstoreplace diseased ones while also receiving immune system cells capable of killing residual leukemia cells. The leukemia cells are recognized through specific molecules present on the surface proteins called HLA. The hope is that the drug can be trialed for acute myeloid leukemia soon since there is already a company interested in working with the drug development team on this front (Guida TumoriPediatrici,2019).
GuidaTumoriPediatrici Airc.it.2019. Leucemia mieloide acuta nel bambini: sintomi, diagnosi e cure.[online]Availableat: <https://www.airc.it/cancro/informazionitumori/guida-ai-tumori-pediatrici/leucemia-mieloide-acuta-ba mbino>
(IARC),T.,2020. Global Cancer Observatory.[online]Gco.iarc.fr.Available at:<https://gco.iarc.fr/>
Matthews,R.,2022. FDA Approvals Roundup: Vijoice, Hyftor, Yescarta [online]Raps.org.Availableat:
<https://www.raps.org/news-and-articles/news-articles/2022 /4/fda-approvals-roundup-vijoice-hyftor-yescarta>
NationalCancerInstitute.2019. Osimertinib in Advanced Lung Cancer with EGFR Mutations.[online]Availableat: <https://www.cancer.gov/news-events/cancer-currents-blog/ 2019/osimertinib-lung-cancer-improves-survival-flaura>
Parker,J.andGregg,M.,2022. Ask the Experts: how is CAR-T revolutionizing oncology? (Part I: logistics of production and administration).[online]OncologyCentral.Availableat: <https://www.oncology-central.com/ask-the-experts-how-is-c ar-t-revolutionizing-oncology-part-i-logistics-of-production-an d-administration/>
Rosenberg,A.,2019. Finding better treatments for devastating rare diseases.[online]CityofHope.Availableat: <https://www.cityofhope.org/breakthroughs/better-treatmen ts-for-rare-diseases>
U.S.FoodandDrugAdministration.2020. FDA approves osimertinib as adjuvant therapy for non-small cell lung.[online]Available at:<https://www.fda.gov/drugs/resources-information-approv ed-drugs/fda-approves-osimertinib-adjuvant-therapy-non-sma ll-cell-lung-canceregfrmutations#:~:text=On%20December%20 18%2C%202020%2C%20the,exon%2021%20L858R%20mutatio ns%2C%20as>
U.S.FoodandDrugAdministration.2022. FDA approves Pluvicto for metastatic castration-resistant prostate can.[online]Available at:<https://www.fda.gov/drugs/resources-information-approv ed-drugs/fda-approves-pluvicto-metastatic-castration-resistan t-prostate-cancer>
U.S.FoodandDrugAdministration.2022. YESCARTA Lead Page.[online] Available at:<https://www.fda.gov/vaccines-blood-biologics/cellular-ge ne-therapy-products/yescarta-axicabtagene-ciloleucel>
ASHP,https://www.drugs.com/.2021. Bleomycin.[online]Availableat: <https://www.drugs.com/monograph/bleomycin.html>
Bonin,R.,2020. Merck's KEYTRUDA reduces the risk of distant metastasis or death by 40% compared to placebo as adjuvant treatment in resected high risk stage III melanoma.[online] tecnomedicina.it.Available at:<https://www.tecnomedicina.it/keytruda-di-merck-riducedel-40-il-rischio-di-metastasi-a-distanza-o-di-morte-rispetto-al -placebo-come-trattamento-adiuvante-nel-melanoma-resecat o-ad-alto-rischio-di-stadio-iii/>
E-mail: maryvanini99@gmail.com
Keywords:cardiorenalsyndrome;classification;pathophysiology;biomarkers;management
Abstract
Cardiorenal syndromes (CRS) describes a pathophysiologic disorder of the heart and kidneys where an acute or chronic dysfunctioninoneorganinducesan acuteorchronicdysfunctionoftheother.
Theoverlapofcardiovascularandkidneydiseaseextendsacrossseveralinterfaces.Thisarticlesummarizesthedifferent types,pathophysiology,biomarkersandmanagementofcardiorenalsyndromes.
(Ronco et al 2008)
Introduction
Cardiac and renal disorders often coexist, and one begets the other. Failure of one of the organs triggers the development of a vicious cycle whereby the renin-angiotensin-aldosterone system, the nitric oxide/reactive oxygen speciesbalanceandsympatheticnervoussysteminteract.TheseinteractionsdepictthepathophysiologicalbasisforCRS.
Classification
Cardiorenal syndromes have been categorized into five clinical subtypes according to which organ is considered to be the primary cause of the declining function in both organs. This classification divides CRS in two main groups: cardiorenal and nephrocardiac CRS. Both cardiorenal and nephrocardiac CRS are further divided into acute and chronic types.CRStype5encompassesallcardiorenalinvolvementscausedbysystemicdisease(Roncoetal2008).
Acute cardiorenal syndrome (CRS Type 1) is an acute decompensation of heart function leading to acute kidney injury. This is a syndrome of worsening renal function that often complicates acute decompensated heart failure (ADHF) andacutecoronarysyndrome(ACS).
Mechanisms:hemodynamicdisorders,abnormalcellsignaling,endocrine
Acute decompensated heart failure (ADHF) via arterial underfilling and venous congestion causes a series of changesinendocrineandhemodynamicfactorsthatleadtoacutekidneyinjury(AKI).
Biomarkers:NGAL,cystatinC,KIM1,L-FABP, α GST,NHE3,cytokines(IL-6,8and18)
Management: diuretics (loop diuretics, thiazides), inotropes (dopamine, dobutamine), vasodilators (nesiritide), adenosineA1receptorblockers,ultrafiltration
Chronic cardiorenal syndrome (CRS Type 2) is characterized by chronic abnormalities in cardiac function leading toprogressivechronickidneydisease(CKD).
Mechanism: Chronic neurohormonal hyperactivation
Pathophysiology of CRS-2 includes renal congestion and hypoperfusion combined with increased right atrial pressure, which is pathognomonic in kidney dysfunction of chronic heart failure patients. Patients with CRS type 2 also tend to have vascular calcification, decreased vascular compliance and more severe chronic organ injury. These are due to increased bloodpressureandstress.
Management: diuretics, angiotensin receptor blockers (ARBs), vasodilators, angiotensinconvertingenzymesinhibitors(ACEi)
Acute renocardiac syndrome (CRS Type 3) represents an acute worsening of renal function leading to cardiac events. It occurs when an acute kidney injury contributes to the development of acute cardiacinjury.
Mechanisms: acute volume overload, acidosis, hyperkalemia
CRS Type 3 is associated with volume overload, sodium retention, metabolic acidosis, and electrolyte disorders (i.e. hyperkalemia and/or hypocalcemia); coronary artery disease, and development of clinical heart failure with features of lungcongestionandperipheraledema.
CardiacMarkers:CRP,TNF-α,Fas(APO-1),IL1, 6and18
Management: treat HTN, hyperkalemia, metabolic acidosis, hemodialysis, continuous renal replacementtherapy (CRRT)
(Ronco et al 2008) (Ronco et al 2008)Chronic renocardiac syndrome (CRS Type 4) is characterized by chronic renal disease leading to the progression ofcardiovasculardisease(CVD).
Mechanisms:chronicpressureandvolumeoverload,uremiccardiomyopathy,metabolicdisorders
Hyperphosphatemia (> 4.5mg/dL) and secondary hyperparathyroidism in patients with CKD can cause the calcification of cardiac vessels and valves through “osteoblastic” transformation of vascular smooth muscle cells, hypertension can also contribute to vascular calcification and consequent pressure overload. CKD also contributes to CVD in CRS Type 4 by complicating pharmacological and interventional treatment. For instance, azotemia and hyperkalemiarestricttheuseofdrugsthatantagonizetherenin-angiotensinsystem.
CardiacMarkers:troponins,homocysteine,plasminogen-activatorinhibitortype1,CRP,NAP,Hb.
Management: loop diuretics, ACEi, ARBs, BB, statins, vitamin E, correct anemia (iron supplements, erythropoietin),smokingcessation,controldiabetesandHTN
(Ronco et al 2008)Secondarycardiorenalsyndrome(CRSType5)representssystemicillnessleadingtobothheartandrenalfailure. These systemic illnesses include sepsis (most common), hepatorenal syndrome and Fabry's disease. In septic patients, inflammation and microvascular changes are the basis of the pathophysiology involving the renal and cardiovascular system,producingcellstructuralalterationsandorgandysfunction.
Mechanisms: hypercytokinemia (in this case increased levels of interleukin 1 and tumor necrosis factor) with increased levels of prostacyclins and thromboxane which is pathognomonic in patients with septic shock change endothelial function and coronary autoregulation. Akin to AKI due to sepsis, ischemia and inflammatory mediators are themaincauses.
Biomarkers: lipopolysaccharide-binding protein, procalcitonin, CRP, proinflammatory cytokines (IL-6, transforminggrowthfactor-b),serumcreatinine(SCr),neutrophilgelatinase-associatedlipocalin(NGAL),plasmalevelsof cystatinC(CysC)
Management: treat underlying cause, vasopressors, inotropes, diuretics, intensive renal replacement therapy (sepsis).
The interaction between the heart and the kidney is complex and its harmony is based on the principle of symbiosis. CRS is a pathophysiological state in which the symbiosis has been altered. Patients with CRS are at a higher riskformorbidityandmortalitythanthosewithindividualCVDorCKD,thereforeearlydiagnosisisimportantforsurvival. ThemanagementofCRSremainsachallenge,however,withthehelpofnovelbiomarkersforAKIandHF,thereishopeto betterunderstand,diagnoseandtreatCRS.
Bagshaw, S. M. et al. (2010) “Epidemiology of cardio-renal syndromes: workgroup statements from the 7th ADQI Consensus Conference,”Nephrology,dialysis,transplantation:officialpublicationofthe European Dialysis and Transplant Association - European Renal Association, 25(5),pp.1406–1416.doi:10.1093/ndt/gfq066.
Bock,J.S.andGottlieb,S.S.(2010)“Cardiorenalsyndrome:New perspectives,” Circulation, 121(23), pp. 2592–2600. doi: 10.1161/circulationaha.109.886473.
Buggey,J.etal.(2015)“Angiotensinreceptorneprilysininhibition in heart failure: mechanistic action and clinical impact,” Journal of cardiac failure,21(9),pp.741–750.doi:10.1016/j.cardfail.2015.07.008.
Martinez, B. K. and White, C. M. (2018) “The emerging role of inflammation in cardiovascular disease,” The annals of pharmacotherapy, 52(8),pp.801–809.doi:10.1177/1060028018765939.
Ronco, C. et al. (2008) “Cardiorenal syndrome,” Journal of the American College of Cardiology, 52(19), pp. 1527–1539. doi: 10.1016/j.jacc.2008.07.051.
Ronco, C. et al. (2012) “Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: the ‘5B’ approach,” Seminars in nephrology, 32(1), pp. 129–141. doi: 10.1016/j.semnephrol.2011.11.016.
Senni, M. et al. (2017) “Biomarkers of heart failure with preserved and reduced ejection fraction,” Handbook of experimental pharmacology,243,pp.79–108.doi:10.1007/164_2016_86.
Travessa, A. M. and Menezes Falcão, L. (2018) “Vasodilators in acute heart failure - evidence based on new studies,” European journal of internalmedicine,51,pp.1–10.doi:10.1016/j.ejim.2018.02.020.
Tang,W.H.W.andMullens,W.(2010)“Cardiorenalsyndromein decompensated heart failure,” Heart (British Cardiac Society), 96(4), pp. 255–260.doi:10.1136/hrt.2009.166256.
E-mail: unoel247@gmail.com
Azam Niazi
LailaKalan,MD
Activity). It took me a while to find my pulse and realise what had been accomplished and what was yet to come. Eventually relief and gratitude surpassed me as I scribbledmynameintheairwithmynewtitle–Dr.
If I could plot a graph depicting my last 6 years inBulgaria,itwouldresembleventricularflutter.That's
I wish you all the best. Hope the readers enjoyedthegraduationoftheclassof2022on14thMay.
“You came so far on your own, who’s to say youcannotgofurther?”
For the days I live now, being in Pleven, I feel likebeingonmybelovedbalconymosttimesoftheday.
To see vehicles appearing, enjoying the little piece of peace and the signal with a pinch of music from their car and then disappearing into nowhere. And sometimes, it's waving at a known friend and greeting them good day, but on other hand, it's hiding myself fromtheknownfriendwhowalksdowntheroad.
But then, there’s this house I see from my balcony. A huge one, a pretty one, one with an ambiguous smile. Everyday of mine begins and ends watching this house. I wake up to it. Sit before it, have my coffee look at it. As the daylight appears, the house neverfailstoslipintomythoughts.
Alotofmythoughtsarestuckonthewallsofit.
I see sunrises and sunsets. Moonrises and moonsets. Sunnydaysandstarrynights.Allmytwistywitshavethe shapeofthishouse,itseems.Yet,I’dnevernoticedhow
Prabhendhu Rajendrannoticed how the evening light hits only on the top floor but not the rest. I failed to see the chocolate brown rooftop they built or the pretty yellow barricade they placed. I failed to see the still open blue windows, the light that stayed all day and the curtainsthatstayedshut.
Now, what are we missing out in life? Even if we see the same things everyday, it isn’t necessary wereallyseethem,itisn'tnecessaryittakesshapein our heart. Like some people I say, like little moments I say, like these little islands within the greater one I say. I hope we really look into things at times. When it comes to ultimate consummation of poetry and nature,Plevenelicitstobeabigjarofspellsjustifying beauty, magic and grace. Forests of Pleven is a world of sheltering green with trees that contain all the stories and birds that sing all the songs. When in spring, carpets of flowers adamantly refuse to fade, while we all are enslaved to materialistic comforts, hereIamoverwhelmedwith
“Now, what shall I call this place? Not a second home, but my firsthomeindeed.”Azam Niazi
the tenderness of Pleven. Running towards much greater things and missing out these little ones doesn’t make sense at all. And of all the houses I’ve seen in my life, I never knew this house would be the one to open thedoortomythoughtsof“whatwemissoutinlife”.
I know I am here for a brief period of my life, and in this moment I shall allow myself the joy of little things.IknowIamlivinginthebestfractionoflife.
me unwittingly. It shattered down all the fortified cultural barriers, broke the conditioned living rules, smashed the ominous hints of sinister and violent mysteries.Andthere,thereIfoundmyinnerselfthat I longed for. Now, what shall I call this place? Not a secondhome,butmyfirsthomeindeed.
I have to leave her one day. But I know the onlygoodplaceisrighthere,rightnow,chasing,
And with all these thoughts, it’s a strange feeling to call this place, Pleven, my first home. I’ve fathomed this feeling because this place has changed me into the person I am today. She has given space to placemybabystepsandtogrowupinthewaymyinner self wants to be. Like a snake who sheds her skin, like a huge tree who meets all the seasons, like the moon whopassesthroughherphases,thisplacehaschanged
falling and rising in love with her everyday. No matter which part of this blue dot planet I’ll find my shelter, I’ll always crave to come back to my home. TherewillbeapieceofPleveninsideme,always.
And this is the country road which took me homeandthisnoteisanodetothisplacethatfound myinnerselfwhereI’mnot25,but6.
Prabhendhu Rajendran
I arrived on a sunny morning on the 30th of July in Sofia. Little did I know that this was the beginning of a memorable and an unforgettable summer.Tobehonest,Ididn'texpectmuchbutI pleasantlysurprised.
I took a train to Pleven, where I met a very nice and friendly couple. During the hours of the journey we talked about many things; the lady spoke a bit of English and the rest we could figure out with signs, which was really lovely and funny. They assured me that I would fall in love with Bulgaria, its foodanditspeople.Indeed,theywereright.
Pleven is a simple and welcoming town with its own charm. My friend and I call it the sleeping city.Assoonaswefinisheddinner,wewouldwalk
moments.WelearnedaboutlifeinPleven,aswellaslife in many other parts of the world. The cultural richness and the diversity of ideas made me wish I could have suchadiverseatmosphereatmyuniversity.
There was something special about every place we visited, the people we met and food we tasted. That's why on the last day I felt that a part of me will stay there forever. And even if I come back, hopefully soon, it will never be like August 2021. We are in a constant state of change, but I am sure that the next time I visit Pleven I will have new experiences and feel newemotions.Fornow,Iwillkeepthesweetmemories ofeverythingIexperiencedthatsummer.
As Ibn Battuta said“travelling-itleaves you speechless, then turns you into a storyteller”. I hope one day I can return to that silent, sleeping city where I have so many fondmemories.
Places to enjoy in Pleven and its history: Pleven Panorama, City Garden, Saint George the Conqueror Chapel, Pleven Water Cascades and Fountains, Kaylaka Park, Krushuna Waterfalls.
“Never hesitate to go far away, beyond all seas, all frontiers, all countries,allbeliefs.”
- AminMaalouf
07:25 a.m., after snoozing your alarm for the third time, you know you cannot do it again or else you willbelateforthe08:00a.m.class.
Feeling sleepy, grumpy, and once again regrettingthelate-nightstudysessionyoudidorthelast episodeyouwatched.Askyourself,whatelsewouldyou do? I guess you know the answer. The world we all live in is transitory and the purpose of our creation is such where we always question the decisions we make and thethingsthathavehappenedtous.
“Theworldweallliveinis transitory and the purpose of our creation is such where we always question the decisions we make and the things that have happenedtous.”#heavy#unpleasant#exhausted
Kailaka Lake
Let me check if anyone has sent me a message in the four hours of sleep I managed to catch - probably not, otherwise it would have woken me up. I never put my phone on silent because someone may need my help in the middleofthenight.
I feel blessed and privileged that someone thought, “yeah - he might know the answer to this.” But there were no urgent messages or notifications, just the regular peopleaskingwhethertheywanttoshareataxi, look to rent out an apartment or enquiring aboutStudentOfficeopeningtimes.
The to-do list has been established, and thereisnotmuchworkfortoday.Iwonderwhat I will do for the rest of the day… once I have done my studying, my gym session, and my daily walks. I guess I will wait in silence, in peace, in loneliness for the next alarm and for the same cycletostartagain.
“Oh no! I’ve got to go, or I will be late formyfirstclass;only10minslefttillwestart!’
“Loneliness is part of beinghuman.Itreminds us that we are not completeinourselves.“
- DavidRuncornRijul Sethi
Iwouldliketoconveymysinceregratitudeto MitchelleandRubyforhelpingoutatthebeginningof theprocess.Mydeepestappreciationgoestothemost reliableperson,Munazza,withoutwhomnoneofthe stepswouldhavecontinuedtoflow,letaloneget completed.
Iamthankfultotheauthorsforsubmitting wonderfulworks,totheeditorialboardwhobridgedthe gapbetweentheauthorsandreviewers,andreviewers whosethoroughreviewssailedthepapersthroughthe submissionprocess.
MayPB&Jbeaspacetorevisitduringthe medicaltrainingandbeyond.
Cordially,
ElaheNaghaviIsatshotguntooneofthemostindescribable ridesofmylife.WithElaheinthedriver’sseatandme hangingonfordearlife,weracedacrosspotholedroads andtreacherouswaterstobringthispublicationtoyour doorstep.Alongthewaywewereluckyenoughtohave some of Pleven’s most talented reviewers, writers, and photographersjoinusforthejourney.
Looking ahead, I can see the horizon abound with even more riveting stories, discussions, and creations. This publication is just the beginning. And whatawonderfulbeginningindeed.
Thankyoutoeveryonewhomadethispossible!
MunazzaKhanEditor-in-Chief: RubigaSri
AssociateEditors: AparajeyaShankerandMunazzaKhan
ManuscriptEditor: MunazzaKhan
Reviewers: RalitsaShentova Gudith Alionye
VysakhRatheesh Aleeha Azhar
MadihaNissar SusannaKoshy
Founders: ElaheNaghaviandMunazzaKhan
SocialMediaManager: LaibaShah
CoverPageIllustrator: MunazzaKhan
Photographers: VysakhRatheesh Azam Niazi
ChalcedonyGali Mariam Lateef
RijulSethi
Vysakh Ratheesh