PB&J | Issue 3

“A river of ink is spilt over these pages. Wading though these uncharted waters would reveal that behind each carefully penned letter is an unrestrained storm of ideas, bringing a rainfall of enlightenment to water the seeds of your mind.”

- Munazza Khan

CoverDescription

Inadiversestudentcommunity,youhavethepower to make choices that lead you towards your ultimate goal. Amidst the chaos of exam seasons, I prioritize self-care and reflection. Sitting upside down symbolizes a unique perspectiveonthechallengesandpressuresofthiscrucialtime. Whileexamsmayturnmyworldupsidedown,Iamwillingto approachthemfrom adifferentangletoovercomeobstacles andsucceed.Thismindsetreflectsmydetermination,andthat of other students, to tackle difficulties with creativity and resilience. Additionally, the rich history and culture of my surroundingsenrichmylearningexperienceasIexploreand absorbknowledge.

RehemaNM Ruby

ElaheNaghavi

“Ocean rowing is very much what you make it. Rowing technique is pretty irrelevant on the ocean. It's the psychology that's important.”

-RozSavage

Weallknowhowtime-consumingwritingis, so much so that we often tend to give up in the middleoftheprocess.Whiletheactofwritingitself maynotbethemostchallengingaspect,theextensive hoursspentresearchingandanalysingcanoftenhold us back. Each stage has its challenges from brainstorming and outlining to crafting sentences withclarityandpurpose.Writersarefinecatalystsfor sharingknowledgeandexperiencewhichiswhytheir dedication is truly invaluable, making us appreciate the commitment of all those who pursue it, and allowingtheissuetosail.

Toensuresmoothsailing,ourskillfuleditors and reviewers successfully navigated the papers through waterways and tuned the sails. It is my sincerehopethattheteamnotonlygainedvaluable takeaways from analysing and handling papers but alsohonedtheirskillsinwaysthatwillbebeneficial beyond this project. Every skill and experience contributes to the toolbox in your canoe, making theirdetailsfundamentalforyourfutureendeavours.

The ocean’s tides may carry you far, but reaching your destination requires your own paddling.Considerthisasbuildingassetsfortackling moreambitiousprojectsinthefuture,whetheritbe reviewing articles for prestigious journals or undertakinglargereditorialtasks.Trainingskillsand habitsyoudevelopnowwillserveyouintheprojects thatlieaheadofyou.

With the issue reaching the shore, we are deeplygratefultoeveryonewhohelpedandenabled us to see the horison after our previous Editor-In-Chiefsailedawayonthegraduationship. Synergy does create beautiful outcomes. We hope that everyone feels empowered and equipped, remembering that even mighty ocean waves can be navigatedwiththeappropriateskillset.

Lastly, we appreciate your readership and hope you dive into this issue with delight. Continuing from the main theme of the previous issue, this issue covers mental health as well as a varietyofothertopics.Thankyouforsupportingus andkeepinguspaddling!

Elahe Naghavi

Progeria:theDiseaseof AcceleratedAgeingProcess

Keywords:progeria;LMNAgene;progerin

Progeria (from the greek πρό, "before" e γέρων, "old") also known as Hutchinson–Gilford syndrome(HGPSsyndrome)ortheBenjaminButton disease, is an extremely rare, progressive genetic disorder. The condition is caused by a mutation in the LMNA gene, leading to the production of a defectiveproteincalled“progerin”.Thisarticledeals with the genetic basis of progeria, its clinical presentation, and the ongoing scientific efforts to unravelitscomplexities.

The LMNA gene encodes lamin A and laminCproteins,essentialcomponentsofthenuclear envelope that provide structural support to the cell nucleus. The mutation responsible for progeria resultsintheproductionof“progerin”,atruncated

and toxic form of lamin A.1 Progerin, then, accumulates in the nucleus, causing abnormal nuclearmorphologyandcellulardysfunction.

As regards the clinical manifestation, childrenaffectedbyprogeriaappearnormalatbirth but start developing the first symptoms within the first two years of life. Common features include growth failure, alopecia (hair loss), loss of subcutaneous fat, joint stiffness, and cardiovascular complications.Unfortunately,theirlifeexpectancyis highly reduced: affected individuals often succumb duetocardiovascularproblemsatanaverageageof 14years.2

Research is going on to understand the genetic and molecular causes of this disease. Specifically,startingfrom2003inwhichtheprogeria genewasidentified,toMarch2021wecanmention optimisticresults.Indetail,bothstudiestargetedthe samebasictreatmentstrategy,inhibitingproduction of RNA coding for the abnormal protein, progerin.3,4

One study, led by Francis Collins, MD, PhD, Director of the NIH (National Institute of Health) showed that treating Progeria mice with a drugnamedSRP2001reducedtheharmfulprogerin mRNA and protein expression in the aorta. As a consequence,themicedemonstratedanincreased

Figure1.TheCellNucleusandAging:TantalizingCluesandHopefulPromises.ScaffidiP, GordonL,MisteliT.PLoSBiologyVol.3/11/2005,e395doi:10.1371/journal.pbio.0030395

survival of over 60%. More recent work on the project includes the discovery that rapamycin (a macrolide exhibiting potent antitumor and immunosuppressive activity) may be beneficial by stimulating autophagic removal of progerin complexes.

Theotherstudy,ledbyTomMisteli,PhD, Director of the Center for Cancer Research, NationalCancerInstitute,NIH,showeda90–95% reduction of the toxic progerin-producing RNA in different tissues after treatment with a drug called LB143. Misteli’s lab found that progerin protein reduction was most effective in the liver. However, the Progeria Research Foundation International Patient Registry currently identifies 131 children living with progeria worldwide. The foundation estimatesthattheremaybeasmanyas250patients aroundtheworldwhostillareundiagnosed.5,6

In addition, another promising approach involves the use of farnesyltransferase inhibitors (FTIs), which aim to prevent the abnormal attachment of a farnesyl group to progerin, inhibiting its toxicity. Clinical trials involving FTIs haveshownsomepositiveeffects,butmoreresearch isneededtoestablishlong-termefficacyandsafety.

Nowadays, certain therapies may ease or delaysomeofthesymptomsofprogeria.Togiveyou anexample,Lonafarnib(Zokinvy)isanoralmedicine thathelpstopreventthetranslationofprogerinand progerin-like proteins in cells. Preventing this, progressionofsymptomsthatoccurinprogeriacan slow and help some children to live longer. The medicine is approved by the U.S. Food and Drug Administrationforchildren1yearandolder.Also,a daily low dose of aspirin can prevent heart attacks andstrokes.Dentalcareisalsorelevantsincedental problemsarecommoninprogeria.7,8

Inconclusion,progeriaisstillachallenging andraregeneticdisorderthatdeeplyaffectsthelives of both children and their families but advanced geneticresearchandtherapeuticinterventionscould bethehopeforabetterfuture.

References

1. Progeria[Internet].WikimediaFoundation;2023[cited2023Sept 24].Availablefrom:https://en.wikipedia.org/wiki/Progeria

2. TalukderP,SahaA,RoyS,GhoshG,DuttaRoyD,BaruaS. Progeria-aRareGeneticConditionwithAcceleratedAgeing Process.ApplBiochemBiotechnol.2023Apr;195(4):2587-2596. doi:10.1007/s12010-021-03514-y.Epub2022Apr21.PMID: 35445924.

3. Homepage[Internet].2023[cited2023Sept24].Availablefrom: https://www.progeriaresearch.org/

4. [Internet].[cited2023Sept24].Availablefrom: https://www.asbmb.org/

5. Top-rankedhospitalinthenation[Internet].MayoFoundationfor MedicalEducationandResearch;[cited2023Sept24].Available from:https://www.mayoclinic.org/

6. TimF.Greten,M.D.[Internet].U.S.DepartmentofHealthand HumanServices;[cited2023Sept24].Availablefrom: https://irp.nih.gov/pi/tim-greten

7. KoblanLW,ErdosMR,WilsonC,CabralWA,LevyJM,Xiong ZM,TavarezUL,DavisonLM,GeteYG,MaoX,NewbyGA, DohertySP,NarisuN,ShengQ,KrilowC,LinCY,GordonLB, CaoK,CollinsFS,BrownJD,LiuDR.Invivobaseeditingrescues Hutchinson-Gilfordprogeriasyndromeinmice.Nature.2021 Jan;589(7843):608-614.doi:10.1038/s41586-020-03086-7.Epub 2021Jan6.PMID:33408413;PMCID:PMC7872200.

8. ErdosMR,CabralWA,TavarezUL,CaoK,Gvozdenovic-Jeremic J,NarisuN,ZerfasPM,CrumleyS,BokuY,HansonG,Mourich DV,KoleR,EckhausMA,GordonLB,CollinsFS.Atargeted antisensetherapeuticapproachforHutchinson-Gilfordprogeria syndrome.NatMed.2021Mar;27(3):536-545.doi: 10.1038/s41591-021-01274-0.Epub2021Mar11.PMID: 33707773;PMCID:PMC10158310.

E-mail:maryvanini99@gmail.com

EnsuringSafetyinHealthcare: ALifelineforPatients

Keywords:healthcaresafety;patientsafetymeasures; healthcareriskmanagement

Introduction

Intherealmofhealthcare,ensuringsafetyis paramount.Patientsentrusttheirlivestohealthcare providers, making it imperative to maintain the highest standards of safety and care.1 In this blog, we’llexplorethecrucialaspectsofhealthcaresafety, themeasuresinplacetoprotectpatients,andthevital role of risk management in safeguarding lives. By delvingintothesecriticaltopics,weaimtoshedlight onthecontinuouseffortstoprovidenotonlymedical treatment but also a peaceful experience, ensuring peaceofmindforpatientsandthetranquilhealthcare experience.

ImportanceofHealthcareSafety

Healthcaresafetyinvolvesacomplexwebof practices, protocols, and regulations designed to protectpatientsfromharm.2Itencompassesabroad spectrumfrompreventingmedicationerrorsto

maintaining sterile environments in hospitals. The significanceofhealthcaresafetycannotbeoverstated, aserrorsorlapsescanleadtodireconsequencesfor patients and their families. Let's take the case of medication administration, for instance. A minor oversightindosageoramix-upinprescriptionscan resultincatastrophicconsequences.Forinstance,ifa patient were to receive a medication intended for another individual due to a label mix-up, the repercussions could be severe, potentially leading to complications and an extended hospital stay. This example vividly highlights the indispensable role of precise medication administration protocols in avertingsuchmishaps.

Additionally, surgical procedures demand meticulousattentiontosafetymeasures.The"Time Out" procedure, for example, is a standard practice beforesurgerywhereintheentiresurgicalteampauses toconfirmthepatient'sidentity,thesurgicalsite,and the procedure to be performed. This simple yet essential step helps prevent wrong-site surgeries, a potentiallycatastrophicerror.

These examples illuminate the multifaceted natureofhealthcaresafetyandunderscorethecritical importanceofrobustprotocols.Byprioritisingsafety in every aspect of care, healthcare providers uphold theirdutytoprotectandpromotethewell-beingof theirpatients.

AkshitaVyas

FadiEjaz

Figure1.InfuseSafety.5WaystoImproveStaffSafetyinHealthcare[Internet].Availablefrom: www.infusesafety.com/5-ways-to-improve-staff-safety-in-healthcare.AccessedMarch1,2024.

PatientSafetyMeasures

Awell-trainedmedicalteamisthefirstline ofdefenceagainsterrors,andcontinuoustrainingis essential to ensure that healthcare professionals remain up to date with the latest advancements in medicineandsafetyprotocols.3Criticalprotocolsin the healthcare environment encompass clear communication, achieved through standardised handovers, structured reporting channels, and communication tools. These practices safeguard against misunderstandings. Whistleblowing policies are equally vital in empowering healthcare professionals to report concerns, free from fear of reprisal, fostering a culture of transparency and accountability. This is complemented by legal protections for whistleblowers. Equally important are balanced work hours and ample rest periods. Providing reasonable shifts and adequate breaks is paramount in preventing fatigue-induced errors, ensuringthathealthcareprofessionalscandeliversafe andeffectivecare.

Additionally, the use of healthcare technology, including electronic health records (EHRs) and barcode medication administration systems, plays a pivotal role in enhancing accuracy and reducing the risk of human error.2 EHRs provide healthcare professionals with instant access tocomprehensivepatientinformation,reducingthe likelihood of miscommunication or oversight. Barcode medication administration systems, on the other hand, ensure that the right medication is administeredtotherightpatientbycross-referencing the medication barcode with the patient's unique identifier.Thisdouble-checkingprocesssignificantly minimises the potential for medication errors, ultimately contributing to a safer healthcare environment.

Maintaining strict infection control measures, such as doctors wearing PPE, there only beingonepatientperroomandusingaseptic

techniquesarevitaltopreventhealthcare-associated infections.2Comprehensivehandhygienepractices, including regular and thorough handwashing with soap and water, or the use of hand sanitizers, significantly reduce the spread of pathogens from healthcare professionals to patients and among the healthcare team. Additionally, ensuring the proper sterilisation and disinfection of medical equipment andsurfacesfurtherfortifiesthisdefence.Rigorous adherencetoprotocolsforcleaning,disinfection,and sterilisation not only minimises the risk of contamination but also safeguards patients from potential sources of infection. By consistently implementing these measures, healthcare facilities establish a robust barrier against healthcare-associated infections, promoting a safer environment for patients and healthcare professionalsalike.

Furthermore, prioritising medication safety throughtheeducationofpatientsontheproperuse of medications can significantly reduce the occurrence of medication errors.2 Finally, patient engagement,achievedthroughopencommunication andinformeddecision-making,empowerspatientsto takeanactiveroleintheircare,contributingtotheir safetyandoverallwell-being.3

Figure2.CentersforMedicare&MedicaidServices.CMSQualityStrategyoverview[Internet]. Baltimore(MD):CentersforMedicare&MedicaidServices;2016.Availablefrom: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiatives

RoleofHealthcareRiskManagement

Healthcareriskmanagementisaproactiveapproach aimed at identifying, assessing, and mitigating risks withinhealthcaresettings.Itinvolves:

- Risk Assessment: Identifying potential risks and vulnerabilities within healthcare processesandsystems4

- Risk Mitigation: Developing strategies to minimise identified risks, such as implementing safety protocols, enhancing stafftraining,andimprovingtechnology4

- Incident Reporting and Analysis: Encouragingacultureofreportingincidents ornear-missessothatlessonscanbelearned, andimprovementscanbemade1

Conclusion

- In healthcare, patient safety is a non-negotiable priority. Through robust patient safety measures and diligent healthcare risk management, healthcare providers can create an environment where patients receive the highest quality of care whileminimisingtheriskofharm.1

References

1. InstituteforHealthcareImprovementandPatientSafety: https://www.ihi.org/topics/PatientSafety

2. Title:“PatientSafety”-AgencyforHealthcareResearchand Quality:https://www.ahrq.gov/patient-safety/index.html

3. Title:“ToErrIsHuman:BuildingaSaferHealthSystem” Author:CommitteeonQualityofHealthcareinAmerica, InstituteofMedicine: https://www.ncbi.nlm.nih.gov/books/NBK225182/

4. Centreforclinicalstandardsandquality: https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/QualityInitiativesGenInfo/Downlo ads/CMS-2016-Quality-Strategy-Slides.pdf

E-mail:akshitavyas@icloud.com

NavigatingtheSilentStorm: MentalhealthIssuesin MedicalStudents

Keywords:mentalhealthawareness;futuredoctors;stopstigmatisation

Medical school has long been synonymous withhardwork,dedication,andarelentlesspursuitof knowledge. However, behind the white coats and stethoscopesliesahiddenreality–theprevalenceof mental health issues among medical students. This silent epidemic often goes unnoticed, but its consequencescanbesevere.

“Take care of yourself in this journey. Being a good doctor starts with valuing your own well-being and self-care.”

-Unknown

Medical training can directly contribute to thedevelopmentofpsychologicaldistressinmedical students. This has catastrophic outcomes such as impaired academic performance, low competency, medicalerrorsandattritionfrommedicalschool.At times, mental health issues may persist into adulthood and create chaos in their social and professional lives if they remain undetected or are treatedinappropriately.Moreover,unhealthycoping mechanisms such as substance abuse, alcohol consumption,chainsmokingandself-harmamongst othersmaybeobservedinmentallyandemotionally distressedmedicalstudents.

Several studies have been conducted regarding the psychological well being of both studentsandresidents.Thesestudiessuggestedthat at the start of training, the medical students had mental health similar to their non-medical counterparts,butastheireducationprogressed,their mental health consequently worsened.1 In a large study in the UK using the 12-item General Health Questionnaire(GHQ-12),30.6%offirst-yearmedical students,30.6%offourthyearand21.9%offifthyear

Figure1.Asurveyof1112medicalstudentsfromUKwasperformedandtheresultswere recorded.Thepictureaboveshowsthementalwellbeingofthestudentswhoparticipated.

medical students scored above the threshold indicatingthatmedicalstudentsweresufferingfrom some sorts of psychological distress. Among them 62%ofparticipantsdrankalcoholatprecariouslevels andtherewerealsohintsofanorexictendenciesand obsessive-compulsivesymptomsinsomeofthem.2

Usingthesamequestionnaire,astudyfrom Turkey indicated that 47.9% of the second-year medical students experienced emotional disorders, well above the percentage of students studying economics(29.2%)andphysicaleducation(29.2%).A study from Malaysia also reported that 41.9% of medical students experienced emotional disturbances. Similarly, 52.7% of medical students fromSouthAsiawerereportedtosufferfrompoor mentalhealthconditionswithincreasedstresslevels and numerous panic attacks, this value was higher than reported from their non-medical peers. The astoundingfactorinallthesestudiesisthefactthat 30%ofalltheseparticipantshadnoproofofmental healthissuesoranxietyproblemspriortothestartof their training. In fact, more than half of them had good upbringing with no traumatic past or childhood.Thisshowsthatmedicaltrainingcanlead tomentaldisordersanddistressifthestudentsaren’t guidedintherightdirection.3

studentstoabsorbvastamountsofinformationina shortspanoftimeanddevelopcriticalthinkingskills. Thelonghoursofstudy,clinicalrotations,andthe constantfearofmakinglife-alteringmistakescantake atollontheirmentalhealth.

1.HighLevelsofStressandAnxiety

Medicalstudentsfrequentlyfacehighlevelsofstress andanxiety.Thefearofacademicfailure,thepressure to excel, and the anticipation of demanding exams contributetothisstress.AstudypublishedinJAMA Pediatrics found that the prevalence of depression andanxietyamongmedicalstudentswassignificantly highercomparedtothegeneralpopulation.

“Being a doctor is a huge responsibility and sometimes this responsibility comes with a even greater price.”

-PreronaDutta

2.SleepDeprivation

Sleep is often sacrificed to meet the demands of medical school. Long study hours and clinical rotationsdisruptstudents'sleeppatterns,leadingto sleep deprivation. Chronic sleep deprivation can exacerbate mental health issues, impair cognitive function,andcompromisephysicalhealth.

3.IsolationandLoneliness

Medical education is a rigorous and demandingjourneythatplacesimmensepressureon students.Thecurriculumisintense,requiring StrainofMedicalEducation

Medicaleducationcanbeisolating.Thedemanding scheduleleaveslittletimeforsocialactivities,andthe competitivenatureofthefieldcanhindermeaningful connections.Thisisolationcanleadtolonelinessand exacerbatefeelingsofstressandanxiety.

Figure2.TheMentalHealthConditionsof2000PhysiciansintheUSrecordedin2012bythe GHQquestionnaire.

4.FearofStigmatization

Medicalstudentsareoftenreluctanttoseekhelpfor mental health issues due to the fear of stigma. The perception that they should be able to handle the stressand pressure can prevent themfrom reaching out for support. This is prevalent especially in countrieswherepoormentalhealthisseenasamatter oftaboo.4

“Lead by example. Invest in yourself. Believe in yourself. Yourjourneystartsthere.”

-Dr.SarahArachchi

Understandingthecauses

To address mental health issues in medical students, it is crucial to understand the underlying causes.Severalfactorscontributetotheprevalenceof theseissues:

1.HighExpectations:Medicalstudentsoftenhave highexpectationsforthemselves,drivenbythedesire toexcelinacompetitivefield.

2.Perfectionism:Thepursuitofperfectioncanlead to burnout and anxiety as students strive to meet impossiblyhighstandards.

3. Lack of Self-Care: The demanding nature of medical school can make self-care a low priority, leadingtoneglectofphysicalandmentalwell-being.

4.InadequateSupport:Somemedicalschoolsmay lack adequate support systems for students facing mentalhealthchallenges.5

PromotingMentalHealthinMedical Education

1. Mental Health Education: Incorporate mental healtheducationintothemedicalcurriculumtohelp students recognize the signs of stress, anxiety, and depression,bothinthemselvesandintheirpeers.

2. Access to Counseling: Ensure that counseling services are readily available and destigmatized. Encouragestudentstoseekhelpwhenneeded.

3.Work-LifeBalance:Promotetheimportanceof work-life balance. Encourage students to prioritize self-care, exercise, and maintain a social support network.

4. Peer Support Groups: Establish peer support groups where students can openly discuss their challengesandsharecopingstrategies.

5. Faculty Support: Faculty members should be trained to identify signs of distress in students and provideappropriatesupport.

6.ReducingAcademicPressure:Explorewaysto reduce the academic pressure on medical students, such as implementing pass/fail grading systems or providingmoreflexiblestudyschedules.

7. Mental Health Screenings: Regular mental health screenings can help identify issues early and ensuretimelyintervention.5

Claire Collins and Cayla Pichan are both aspiring physicians in the University of Michigan whocaredeeplyabouttheireducation,aswellasthe individualsthattheyworkcloselywith.Buttheyalso havesomethingelseincommon,anoften-overlooked

Figure3.

“Iwillattendtomyownhealth, well-being, and abilities in order to provide care of the higheststandard.”

–AnewpledgeintheDeclarationofGeneva incorporatedintheyear2016.

References

1. MedicalStudentPsychologicalDistressandMentalIllness

RelativetotheGeneralPopulation:ACanadian Cross-SectionalSurveybyMaser,BrandonMD;Danilewitz, MarlonMD;Guérin,EvaPhD;Findlay,LeannePhD;Frank, EricaMD,MPH

https://journals.lww.com/academicmedicine/fulltext/2019/1 1000/medical_student_psychological_distress_and_mental.4 2.aspx

2. MentalhealthofMedicalStudentsinDifferentLevelsof TrainingbyNajmehJafari,AmirLoghmaniandAli Montazeri

storycenteredarounddepressionandanxiety.Inthe Springof2020,CollinsandPichanconnectedwith another peer, Lauren McGee, to collaborate on a student needs assessment that focused on the wellbeingoftheirfellowmedicalstudents.Whitney Begeman,Psy.D.,servesastheleadtherapistforthis MedicalStudentMentalHealthProgram.Shenotes thatthisinitiativeisgroundbreakingintherealmof mental health services for aspiring physicians and helped improve the mental wellbeing of more than 65%ofthestudentsoftheiruniversity.Ifuniversities acrosstheworldadoptthesekindsofmethodstocare for the students well being, the mental wellness is boundtoreachnewpeaks.6

Mental health issues among medical students are a pressing concern that cannot be ignored any longer. The demanding nature of medical education, coupled with high expectations, canleadtostress,anxiety,anddepression.Toaddress this issue, medical schools must prioritize mental healtheducation,offeraccessiblecounselingservices, and foster a culture of support and well-being. By taking these steps, we can ensure that future physiciansnotonlyexcelintheiracademicpursuits butalsoleadmentallyandemotionallyhealthylives. It’s time to lift the veil on this silent storm and provide the care and support that medical students trulydeserve.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399312/

3. MentalhealthissuesamongstmedicalstudentsinAsia:a systematicreview[2000–2015]byAmitNormalCuttilan, AndrewArjunSayampanathan,RogerChun-ManHo

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779785/

4. Medicalstudentsfacehighlevelsofmentalhealthproblems butstigmastopsthemgettinghelpbyEmaWilkinson

https://www.bmj.com/content/381/bmj.p933#:~:text=Medi cal%20students%20are%20more%20likely,factor%20preventin g%20students%20seeking%20help.

5. MedicalStudentsAreAtRiskforMentalHealthIssues: Here’sWhybySoniaMatejko

https://psychcentral.com/health/medical-students-are-facing -serious-mental-health-issues

6. 3medicalstudentsincreaseaccesstomentalhealthservicesfor theirpeersbyJinaSawani

https://www.michiganmedicine.org/health-lab/3-medical-stu dents-increase-access-mental-health-services-their-peers

EffectOfMentalHealth onLife

Keywords:mentalhealth;sociallife;anxiety;depression;OCD

Introduction

Humanmindisthemostintricatesystem; somuchgoesontherethatisnotonlychemicaland physical, but also emotional. Our minds are what makesusdifferentfromoneanotheranditiswhat makesus,us.Itisveryeasytoidentifyandcorrelate a physical problem, but mental issues are hard to identifyandcorrelatewith.Justlikephysicalhealth problems, mental health also interferes with our sociallifeaswell.

Mentalhealthdisorders

Thereisnotonlyonementalhealthdisorder thatcaninterferewithourlives-thereareaton.Here areafewofthem:

A.Anxietyisthemostcommonofthemallandallof us have experienced anxiety at some point in our lives.1 Anxiety is your reaction to the perception of being in danger.1 It all starts with the Amygdala, a bundle of nerves in your brain that sends signals to anotherparttostartaflightorfightresponse.Almost 30%ofthepopulationhasAnxiety.2Anxietyconsists oftwocomponents;stress(physiological)andworry (thinking).Itcanaffectaperson’slifeinthefollowing ways:

- Panicattacksinpublic

- Alwaysoverthinkingandmakingworst-case scenariosinyourhead

- Lackofsleep

- Lack of concentration in class, work, or at gatherings

- Shakinghands

- Socialdistancingbecauseofthethoughtthat everyoneisjudgingyou

B. Depression happens typically when the production of neurotransmitters decreases.3 The main three neurotransmitters are serotonin, norepinephrineanddopamine.Serotoninisthemost important one controlling the other two as well. Depression affects around 21.3% of women and 12.7%ofmenandthisrateislikelytoincreaseabout three times because of genetics.4 A person with depressionmightfeelfollowingsymptoms:

- Lifeisn’tenjoyable

- Severemoodswings

- Attention problems while doing normal tasks

- Cognitiveproblems

- Feelingexhaustedanddrained

- Disturbedsleepingpatterns

- Feelingnohappiness

- Thinkingthatthingswillnevergetbetter

- Suicidalthoughts

- Physicalpain:mayfeelpainintheformof bodyaches,headaches,muscletension,and nausea

Conclusion

Mental illness is as severe as physical illness. It is often hard to notice some of the subtle signs in people which in every way are affecting their day-to-daylife.

References

1. PenninxBW,PineDS,HolmesEA,ReifA.Anxietydisorders. Lancet.2021Mar6;397(10277):914-927.doi: 10.1016/S0140-6736(21)00359-7.Epub2021Feb11.Erratumin: Lancet.2021Mar6;397(10277):880.PMID:33581801;PMCID: PMC9248771.

2. KasperS.Anxietydisorders:under-diagnosedandinsufficiently treated.IntJPsychiatryClinPract.2006;10Suppl1:3-9.doi: 10.1080/13651500600552297.PMID:24931537.

3. DelgadoPL.Depression:thecaseforamonoaminedeficiency.J ClinPsychiatry.2000;61Suppl6:7-11.PMID:10775018.

4. NobleRE.Depressioninwomen.Metabolism.2005May;54(5 Suppl1):49-52.doi:10.1016/j.metabol.2005.01.014.PMID: 15877314.

C.Obsessivecompulsivedisorder(OCD)isatype of anxiety disorder that causes obsessions and compulsions. It makes a person believe that their compulsion and rituals would stop something bad fromhappening.6

Obsessions are recurrent intrusive thoughts and compulsions are the actions to reduce anxiety from obsessions. About 2% of the population is affected with men and women being equally affected.5 It usually starts from childhood or teen years. Compulsions come from obsessions, a commononebeinggermphobiainwhichcleaningis acompulsionandgermsareanobsession.OCDcan affectaperson’slifeinthefollowingways:

- Frequentcleaning

- Checkingthings

- Repeating certain things and thinking that somethingbadwillhappen

- Arranging(disordercausesanxiety)

5. SassonY,ZoharJ,ChopraM,LustigM,IancuI,HendlerT. Epidemiologyofobsessive-compulsivedisorder:aworldview.JClin Psychiatry.1997;58Suppl12:7-10.PMID:9393390.

6. BrockH,HanyM.Obsessive-CompulsiveDisorder.2023May29. In:StatPearls[Internet].TreasureIsland(FL):StatPearlsPublishing; 2023Jan–.PMID:31985955.

E-mail:moizziman@gmail.com

Rijul Sethi

“It's

Just...!”

#mentalhealth#well-being#awareness

A few weeks ago, I was sitting down and playingcatchupontheWhatsappgroupchatinstead ofenjoyingtheviewofthetrainroutefromSofiato Pleven. I went on to jot down a few things on my stickynoteapptoremindmyselftocheckwithmy older sister about her decision to pursue a BSc in Mental Health at 18. I then jumped onto the USMLEMedBootCampsite,mygo-tofortheright awarenessofsomesynopsistopics.Funnilyenough,it was the first time I’d seen psychiatry extensively covered. So I browsed through the videos and downloaded the pdf content for future reference. This handout allowed me to gain a greater understandingofpsychiatry.

RehemaNM

“You are not your illness. You have an individual story to tell. You have a name, a history, and apersonality.Stayingyourselfis partofthebattle”

-JulianSeifter

Mentalhealthisascrucialasphysicalhealth; itaffectshowyouthink,feel,andact.Withoutit,no one can make sense of anything, let alone thrive in life. Due to this reason, one would expect health professionals to face it with the highest degree of seriousnessanddedication.Unfortunately,thatisnot the case with most medical students. Instead, psychiatry is totally out of the picture in medical school. When you ask medical students their thoughtsonPsychiatry,theywillrespondwith,''it's justPsychiatry.”Whendiditcometothis?Howdid suchapracticalandtheoreticaldisciplinebecomeso irrelevantandjustcrammedtopassexaminations?It's asthoughwemedicalstudentsandevenhumans,in general, forget the essence of mental health and psychiatryinthelifeofitsvictims.

Abetterunderstandingofmentalconditions will support affected individuals and improve the qualityofcare.Inthepastfivetotenyears,therehas beenalotofawarenessregardingmentalhealthand

psychiatry. Also, given the opportunity as medical students to dive deeper, we ought to take it as seriouslyaswedowiththeotherdisciplines.Ibelieve thattheappropriateawarenessandattitudetowards mental health will go a long way in the rapid progressionofmentalhealthresearch.

Is the disconnection a coping mechanism for most students during exam time as they dedicate time to acethenotoriouslyharderexams?

With more questions flooding in, I wanted tounderstandabitmore.Eagertopicksomemore brains about this student attitude, I thought who besttospeaktothanthemedicsinPsychiatryaway fromPleven.So,Icaughtaflighthome,headedtomy localhospital'sMentalHealthDepartmentandasked forthatobservershipwiththeconsultants.

“ПристигнахмевПлевен”-echoesofthe passengers as the train pulled into Pleven. I got up and got off the train, taking a deep breath, and dashed for the bus. I smiled and Snapchatted away likeIwasatouristinmyhomeforthelastfiveyears.

“Hey—,AreyouinPleven?”Therecomesa text from my partner in crime. “Yup! Can I call ?” Thephonerings,andIanswer.“So..I’vegotabitofa migraine,mybrainisclutteredwithquestionsabout thestudents’perceptionofPsychiatryasawhole!”As theconversationwithmyfriendwasgoingon,Iasked myselfthesequestions:

Why are most students not taking Psychiatry seriously?

Coulditbefromasocietalculturalimpact?

Isitaconceptthatmakesstudentsfeeldisconnected?

“Wrong place! Go to AE and ask for Psychiatryliaisonconsultants,theylivethere.”-says the administrator at the desk. I dashed to AE, and was guided through to Majors. Here, I wondered how an internist would disregard a hypertensive patient,solelybecausehewantedthePsychiatryteam to see him? He essentially ignored the patients’ physicalsymptomswhichtomeshowsthatignorance ofmentalhealthcanalsobringapathywhichcanput patientsindanger.

Well, you are now at the end of this ideal pieceafterdaysandnightsofbrainstorming,drafting andquizzingseveralstudents.Thequestiontoyouis; how can we be better for the sake of our future patients?Themoreweholdourselvesresponsiblefor theseanswers,thebetterdoctorswebecomeforour patientsinthefuture.

Rehema NM

SmallCity, BigDreams

#pleven#studentlife#bulgaria#internationalstudent

OnOctober20th,Ireceivedmyacceptance to the Medical University of Pleven. It was an intriguingsensationasIhadpreviouslybeenentirely unfamiliar with the existence of Pleven. As an internationalstudent,I'vehadtheprivilegeofcalling Plevenhomeforthepasttwoyears,andinthisblog post,Iwanttogiveyouaglimpseintowhatlifeislike forstudentslikemeinthischarmingtown.

Exploringthecity

Upon my arrival in Pleven, my initial explorationledmetotheheartofthecity,thePleven Center,whichleftmeinawe.Foragirlexperiencing Europeforthefirsttime,especiallyinsuchan

enchanting locale, the sensation was truly unique. The Pleven Center, adorned with historical statues and monuments, piqued my curiosity about Bulgaria'srichhistory.Artistryliesconcealedinevery corner, each offering a new and unfamiliar sight to behold.

AcademicLife

Medical University Pleven welcomes studentsfromdiverseculturalbackgrounds,fostering an environment that encourages us to step beyond our comfort zones and embrace a daily journey of self-discoverythroughlearning.Thisinstitutionnot only molds us into proficient medical professionals but also cultivates qualities that extend to being compassionate individuals, friends, dedicated scholars,andemergingleaders.TheUniversitykeenly indulgesinmakinglearningimpactfulaswellasfun for students. Through interactive classes, we are encouragedtoconnectwithourpeers,whetheraslab partners or fellow group members. This feeling of oneness among students creates an element of excitementandfuninouracademicjourney.

Artistry lies concealed in every corner, each offering a new and unfamiliarsighttobehold.

St.GeorgetheConquerorChapelMausoleuminVazrazhdaneSq,Pleven SafaGousia

CulturalExperiences

OneoftheperksofstudyinginBulgariais you get to witness and also immerse yourself in Bulgarianculture.Inthisregard,culinaryenthusiasts areinforatreat,asthecuisineherehasadelightful blend of flavors, dishes like banitsa and moussaka havequicklybecomepersonalfavorites.Oneofthe traditionsIholddearfrommytimeinPlevenis'Baba Marta'. This beautiful practice involves gifting friends with red-and-white interwoven strings, symbolizingwishesforayearfilledwithhealthand happiness,whilealsoservingasadelightfulreminder thatspringisjustaroundthecorner.

StudentHangouts

Pleven has a variety of student-friendly hangout spots. The cafes around the town are a perfect escape for your me-time or for a chat with friends.Thevibesofrestaurantsgivearelaxationafter a long tiring day. The nightlife of Pleven is my favoriteaspectoftheday,thoughnotasbuzzingasin bigger

citiesbutithasitsowncharm.You’llquicklyfinda perfect spot for your late-night conversations and entertaining outings. These outings help students learnfromexperiencesofotherswhilealsoproviding inspirationfortheirownadventures.

MaikaBulgaria SafaGousia

Plevencenter SafaGousia

Rehema NM

ChallengesandRewards

Living abroad brings its unique set of difficulties,includinglanguagebarriersandadjusting tonewcultureandthedistancefromfamiliarsupport networks. However, these challenges are also opportunities for personal growth. The people here inspireyoutoexploreandembracenewexperiences each day. Overcoming them can be incredibly rewarding and will make your every time in Pleven even more memorable. These challenges foster the development of various qualities within an individual,suchasproblem-solvingskillsandasense ofpersonalresponsibility.

“Pleven: where every moment isaneducationinitself."

Conclusion

Life in Pleven as a student is a unique adventure filled with academic growth, cultural exploration,andunforgettableexperiences.Ifyou're consideringstudyingabroad,especiallyinBulgaria,I highlyrecommendgivingPlevenachance.Itmaynot beaswell-knownassomeEuropeantowns,butithas alottooffer,anditjustmightbecomeyoursecond home.

So, whether you're drawn to Pleven for its history, academics, weather, or the warmth of its people,knowthatthiscityhasaplaceforyou.Ihope myjourneyhasprovidedsomeinsightintowhatlife inPlevenasastudentislike,andIencourageyouto explorethishiddengemforyourself.

Kaylaka,Pleven SafaGousia

Plevencenter SafaGousia

LifeinPleven

Irememberthelongdrivefromtheairport toaplacethatIwouldsooncall'home'awayfrom home. So many questions ran through my mind as the journey progressed. I took in the scenery and thought about all my decisions that led up to this moment-tomebeinginanunfamiliarplacewhere anunfamiliarlanguagewasbeingspoken;feelingsof exclusion,lonelinessanddreadrisinginsideofme.

The coach approached a little roundabout showcasing large letters (which I later figured out after 2 Bulgarian classes) spelt out 'Pleven'. The toponymstoodoutascolourfullettersinformingme thatIhadarrivedatmydestination.AsIalighted,I acceptedthattherewasnogoingbackanditwastime toallowmynewlifetounfold.

My first year came with a few challenges, from apartment hunting to failed attempts at interactingwiththelocalswhenIneededtoaskfor directions or help at the grocery store. Living here enabled me to redefine the word 'independent'; an adjective I thought was one of my finest qualities priortolivinghere.Ihadtofigureoutawaytomerge lifeasastudentandresidentinordertoadjusttothis newcountry.Asweeksturnedtomonthsandmonths to years, I accomplished this feat and I'm more accustomedtotheenvironmentandpeople.

Pleven, as I soon discovered, is a small city providinganescapefromthehustleandbustleoflife inalargercity.Itcomeswiththeaddedbonusesof safety, affordability and accessibility. The cost of living compared to other cities brings some consolationtomypocketandIdon'thavetobreak the bank to have a good time out with friends. Everything (and everyone) is within reach and the quietnightsassureoneofagoodnight’ssleepwith

#pleven#medicalstudent#experience AmakaEdward

Rijul Sethi

zerodisturbancesfromtraffic.

ThebeautifulKaylakaParkgivesoptionsfor different outdoor activities such as jogging, hiking, kayaking, rock climbing, etc, the ponds and reservoirscanbeaccessedwithboatsandpedalosand youcanpopovertothezooifyouwish.Alongflight ofstairsleadsyouto'MotherBulgaria'leavingyouin awe as you behold one of the city's historical monuments and get a proper view of Pleven. For lovers of history, the city also offers a few other monumentsand museumsthatareworthvisiting.

I've been given an opportunity to learn a new language, try out new things, discover myself, and meet people from different parts of the world, someofwhomwerecompletestrangersatfirstbut havenowbecomeclosefriendsandlifetimemates,I hope. I've made Pleven my second home, a place I returntoatthestartofeverysemester,andaplace thatwillnowbepartofthestoriesItellalongsidemy journeyintothemedicalprofession!

It'sbeen3yearsnowandI'vegrowntolove Plevenandcherishthegemspresenthere.Ilovethe lateeveningwalksIcantakearoundthecitycentre speckled with restaurants and cafes, the water cascades and fountains that light up at dusk, the manytreesthatadornthestreets,thequietnessthat embracesthenight,thecrispeveningairandtheclear nightsky.

“…tomebeinginanunfamiliar place where an unfamiliar language was being spoken; feelings of exclusion, loneliness anddreadrisinginsideofme.”

Chalcedony Gali

Prerana Gurung

Acknowledgements

Editor-in-Chief: ElaheNaghavi

AssociateEditors: AdilNaeemandJosmyJose

Reviewers: GirayGuven SabaAli

GudithAlionye

JosnaJose

NavyaJose JasnaNaghavi

SocialMediaManager: LaibaShah

CoverPageIllustrator: RehemaNM

Photographers:

ChalcedonyGali

VysakhRatheesh

PreranaGurung

RubySri

RabeehUrRahman MaryamLateef

RehemaNM

SafaGousia

RijulSethi

ElaheNaghavi

Elahe Naghavi