Early Studies of Human Anatomy: The Root of Modern Medicine

Introduction

Comprehensive knowledge of human anatomy is at the heart of medicine. The very first “doctors” in Ancient Egypt used only a superficial understanding of anatomy to establish medicine as a craft [1]. This interest in anatomy has endured over the years and, through extensive research, has fueled a multitude of medical discoveries and technological advancements. The vital fields of surgery and medical imaging are inherently tied to anatomical knowledge. Advancements in medicine throughout history and into the modern world can be directly tied to the emergence of anatomy as a branch of knowledge. 

The Ancient Greeks

Anatomy was first studied beyond sculptures and drawings of external structures in Ancient Greece. In the third century BCE, Herophilus of Chalcedon, driven largely by a push for evidence-based medicine, was the first to perform a human dissection [1]. Herophilus studied the position, figure, size, order, hardness, softness, smoothness, and texture of the internal organs that had previously been considered only in a speculative manner. However, these dissections were not executed without crossing several ethical lines as those being dissected were often prisoners who were breathing as they were cut into, and naturally, human dissection became highly controversial and difficult to perform [2]. Though as time has passed, they have gradually become a critical part of medical education, evident by the required dissections for medical students. Dissections have been and continue to be essential to the healthcare professional’s thorough understanding of the body as a whole. 

The Ancient Romans

As a result of the controversy regarding human dissection in Ancient Greece, the Romans were forbidden from dissecting humans. Thus, to continue studying anatomy without violating the new laws, Romans gathered anatomical information from wounded warriors and animal dissections [1]. Frequently employing these methods, Galen (129-216 AD) emerged as one of the most influential physicians of Ancient Rome. The Galenic school of thought was born out of a synthesis of Ancient Greek ideas and new information uncovered from Galen’s own anatomical studies. He suggested that blood was passed from the heart’s right ventricle to its left ventricle before being distributed by the arteries, an idea vaguely similar to the modern concept of pulmonary circulation [3]. Galen, unlike most of his peers and predecessors, understood that the movement of bodily substances occurs through tubes. Although Galen’s work seems rudimentary from a modern perspective, he was truly a trailblazer in the field of anatomy and his work faced no real opposition for another 1300 years [3]. 

The Middle Ages

In the year 1000, a revival of academic medicine was prevalent across Europe. Pressure to advance medicine to increase quality of life and lifespan for all produced a new medical curriculum in schools, and similarly, the public perception of human dissection became more positive thus allowing the field of anatomy to begin to flourish [1]. The newfound public embracement of human dissection led to the publication of the first human dissection manual in 1316 [4]. This publication set the foundation for further research and discovery through dissection for years to come. 

The Renaissance

The progression of anatomical knowledge throughout the Renaissance period can be largely attributed to the work of Andreas Vesalius in the sixteenth century. Vesalius began his medical studies by examining the work of Galen in Ancient Rome whose ideas were employed by nearly all physicians [5]. Vesalius was the first to truly challenge Galen’s work which is now known to have been filled with inaccuracy. Through the numerous dissections he performed, Vesalius was able to make detailed illustrations of many anatomical structures including the nervous system, organ systems, and muscular systems. These illustrations, he noted, were often inconsistent with Galen’s findings, and Vesalius made these inconsistencies known to the medical community in his 1543 book De humani corporis fabrica libri septem, the first anatomical book derived from first-hand human dissections [5]. Although his work was not initially well-received, it has since been proven that Vesalius was among the first physicians to accurately depict human anatomy through illustration.

Conclusion

The implications of Vesalius’ accurate illustrations of human anatomy cannot be understated. The complete speculation on anatomy that was prevalent in earlier centuries was completely eradicated, contributing to advances in overcoming the surgical obstacles of access, bleeding, infection, and pain [6]. Vesalius, however, did not work alone as he built upon discoveries, both false and true, of those before him. Thus, early work in understanding anatomy is directly tethered to modern success in surgical fields and medicine as a whole. 

Alaina Berger, Youth Medical Journal 2023

References

Habbal, Omar. “The Science of Anatomy: A historical timeline.” Sultan Qaboos University medical journal vol. 17,1 (2017): e18-e22. doi:10.18295/squmj.2016.17.01.004

Edelstein, Ludwig. “The Development of Greek Anatomy.” Bulletin of the Institute of the History of Medicine, vol. 3, no. 4, The Johns Hopkins University Press, 1935, pp. 235–48, http://www.jstor.org/stable/44437902.

West, John. “Galen and the Beginnings of Western Physiology.” The American Journal of Physiology , vol. 307, no.2, The American Physiological Society, 15 July 2014, pp. 121-128, https://doi.org/10.1152/ajplung.00123.2014.

Wilson L. “William Harvey’s Prelectiones: the performance of the body in the Renaissance theater of anatomy.” Representations (Berkeley). 1987;(17):62-95. PMID: 11618036.

Erjavic, Nicole, “Andreas Vesalius (1514–1564)”. Embryo Project Encyclopedia, 1 October 2018, http://embryo.asu.edu/handle/10776/13042.Eizenberg, Norman. “Anatomy and its impact on medicine: Will it continue?.” The Australasian medical journal vol. 8,12 373-7. 30 Dec. 2015, doi:10.4066/AMJ.2015.2550

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The Effect of Substances During Pregnancy

Pregnant women are told to not do multiple things, they are restricted from a lot of actions. Why is that, some may question? When with a baby, everything that goes into your body has the same effect on your fetus, or your unborn baby. The adage “You are what you eat” has probably been said to you before. The same idea, however, may be extended to expectant mothers because it is their unborn children who are influenced by what is consumed. Every single thing a pregnant woman consumes, drinks, or uses is somehow passed on to her unborn child. Alcohol and hard drugs are not an exception. These drugs may cross the placenta, enter a mother’s circulation, and then reach her developing child. These toxins can also be transferred to a newborn through breast milk if a mother is nursing.

What is a Placenta? 

The placenta is an organ that grows in the uterus during pregnancy. A developing newborn receives oxygen and nutrients from this structure. It also cleans the baby’s blood of waste materials. The baby’s umbilical cord grows from the placenta, which is attached to the uterus’ wall throughout pregnancy. Typically, the organ is affixed to the uterus’s front, rear, side, or top. Rarely, the placenta may connect in the uterine cavity below. This situation is known as a low-lying placenta (placenta previa).

What are Some of the Effects the Unborn Baby Goes Through?

According to recent studies, consuming illegal drugs, prescription painkillers, tobacco or marijuana during pregnancy increases the risk of stillbirth (the death or loss of a baby before or during delivery) by a factor of two to three. About 5% of pregnant women, according to estimates, use one or more addictive substances. Neonatal Abstinence Syndrome (NAS), in which the newborn experiences withdrawal, can be brought on by the regular use of particular medicines. Opioid impacts have been the subject of the majority of this field’s research (prescription pain relievers or heroin). However, research has indicated that consuming coffee, alcohol, barbiturates, and benzodiazepines while pregnant may also result in withdrawal symptoms in the newborn. The drug(s) taken, the length of time and frequency of usage, the way the birth mother’s body processed the drug(s), and whether the child was born at full term or preterm all affect the type and intensity of the infant’s withdrawal symptoms.

Risks of Stillbirth from Substance Use in Pregnancy

Tobacco use—1.8 to 2.8 times greater risk of stillbirth, with the highest risk found among the heaviest smokers

Marijuana use—2.3 times greater risk of stillbirth

Evidence of any stimulant, marijuana, or prescription pain reliever use—2.2 times greater risk of stillbirth

Passive exposure to tobacco—2.1 times greater risk of stillbirth

Source: Tobacco, drug use in pregnancy, 2013

Opioids and pregnancy 

Opioids are a group of medications that are used to treat pain, but they also carry significant hazards, such as addiction. Opioids can be obtained legally or illegally. Doctors may recommend prescription opioids to treat moderate to severe pain. A prohibited opioid is heroin. An opioid with a prescription, fentanyl can be used to relieve really bad pain. But fentanyl has also been produced illegally, and it is now more widely available. Opioid use disorder is an opioid use habit that can lead to health issues, incapacity, or the inability to fulfill important obligations at work, school, or home. Buprenorphine, methadone, and naltrexone are examples of opioid drugs that may be used in medication aided therapy (MAT), in addition to counseling and behavioral therapy, to treat opioid use disorder. In the United States, opioid use disorder in pregnant women is a serious public health issue. According to a recent CDC investigation, the proportion of pregnant women with opioid use disorder at labor and delivery more than doubled between 1999 and 2014. Preterm birth, stillbirth, maternal death, and neonatal abstinence syndrome are just a few of the major unfavorable health outcomes associated with opioid use disorder during pregnancy for both pregnant women and unborn children (NAS). When pregnant women are exposed to opioids, a collection of withdrawal symptoms known as NAS is most frequently experienced in newborns.

Aamuktha Yalamanchili, Youth Medical Journal 2023

References

https://www.floridahealth.gov/programs-and-services/prevention/substance-abuse/substance-abuse-during-pregnancy/index.html

https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

https://www.cdc.gov/drugoverdose/training/pregnancy/

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Opioid-Use-and-Opioid-Use-Disorder-in-Pregnancy

Social Media and Plastic Surgery: Hope or Hinder?

Beauty Standards

Idealized beauty standards have been plastered into society. The constant pressure to resemble those beauty standards and acclaim it as “natural beauty” is unfathomable, despite becoming a common practice nowadays 一 the cosmetic industry itself values at £340 billion. Throughout the decades, beauty has moulded into lifestyle choices, and a societal obsession, predominantly crafted by social media trends. Although, there is no universally accepted truth of beauty, many sacrifice personal happiness and satisfaction to fulfil the insatiable pressures of culture.

So, does plastic surgery provide artificial hope for those who are unsatisfied with their physical appearances, or solely engulf in societal hype implemented by social media?

Society today prioritises the concept of beauty, through implementing unrealistic and dynamic standards, that pressure primarily women to reflect and compare their physical appearances against those of others. Although, the level of complacency is substantial in determining the cause of an increase in demand for cosmetic surgery, undoubtedly social media is a contributory factor.

Snapchat and Instagram

Accounting for social media platforms, content is tailored through recent search history, based on app algorithms. Social demographic, including quantitative and qualitative data such as age, topics of interest and previous social media posts are all accounted for. A representative of a study, conducted in Saudi Arabia, focusing on the impacts of social media and undergoing cosmetic surgery, 48.5% of respondents were influenced by advertisements to undergo cosmetic treatments. Of them, two-thirds considered undergoing non-surgical procedures, and only 18.7% would consider undergoing surgical procedures due to social media influence (Arab, 2018 ).

Although the sample of the study is unrepresentative and cannot be generalised for international countries, the correlation between targeted social media advertisements and cosmetic surgery is explicit. Evidently, such advertisements are constantly promoting the targeted demographic to consider cosmetic surgery, through comparative and supposed self-improvement ideals. Although the impact of unregulated cosmetic surgery advertisements is arguable, for example emerging debates such as “Should cosmetic surgery advertisements be banned?”, cosmetic surgery advertisements may impede the self-esteem of individuals. In 2017, for example, a survey of Facial Plastic surgeons found that 55 per cent of surgeons reported seeing patients who requested to improve their appearances in selfies (Relly, 2019 ).

Filters and Lenses

Filters. As explained by Google, filters in terms of photography are “a screen, plate, or layer of substance which absorbs light or other radiation or selectively absorbs some of its components”. Notice, “selectively absorbs some of its components”, embracing this concept into the features of Snapchat and Instagram, filters have the ability to alter someone’s physical appearance, immediately, however only virtually.

Notably, Snapchat obtains the “Lenses” accessibility, where users can alter their virtual appearance, through computer vision. Computer vision uses pixelated data to conclude a specific object, identifying the person, (the same technology is applied to self-driving cars).[1]  During October 2015, Snapchat lenses were solely used for entertainment purposes, “posing as dogs with elongated tongues”, “flower crowns” and “killer bunny”. However, an aspect that progressively exerts pressure, is the “beauty element”, recently morphing into “Snapchat Dysmorphia”, referring to the psychological phenomena of patients bringing filtered selfies to their surgeons (Relly, 2019 )

Snapchat and Instagram provide filters that allow users to change their skin tone, soften fine lines and wrinkles, alter the size of their eyes, lips, and cheeks, and change various aspects of their physical appearance (Ramphul, 2018 ).The desire of cosmetic surgery patients to resemble their refined complexion strongly depicts an unrealistic expectation of themselves. Interestingly, cosmetic surgery patients are unaware about the negative impact: frequently patients desire attributes of a physically altered image, by using similar terminology and verbal descriptions. Dr Michelle Yagona, a facial plastic surgeon in New York city, noticed a distinct pattern amongst patients “I don’t ever really have somebody that comes in and says I want to look like Angelina Jolie or I want to look like a Snapchat filter of myself. But I start to notice that they talk about things that are very similar to that without using those words” (Brucculieri, 2018). Despite many other factors influencing an individual to prefer cosmetic procedures as a means of changing one’s appearance, receiving psychological support and counselling provides a wider beneficial impact.

Body Dysmorphic Disorder

A study conducted by The Department of Psychiatry and Behavioural Sciences, at University College Medical School, detailed that three patients claimed that they were not pre-occupied by their appearance prior to the surgery and that their symptoms of BDD developed only after surgery, which they believed had been done badly (Veale, 2000). The evidence, according to the study, is minuscule of the likelihood of developing Body Dysmorphic Disorder after cosmetic surgery influenced by social media. From a general perspective, it is reasonable to predict that after undergoing cosmetic surgery satisfaction rate would immediately be higher than previously; however, when patients were discontented with the post-appearance, excessive anger, guilt and frustration fuelled a spiral of undergoing subsequent procedures. Moreover, for those who already underwent multiple cosmetic procedures, after 50% of the procedures the pre-occupation transferred to another area of their body (Veale, 2000). Thus, the study concluded that nearly all patients were dissatisfied with their post-cosmetic surgery appearance and experienced adverse symptoms of Body Dysmorphic Disorder afterwards. 

Conclusion

Conclusively, centring upon the impact of social media, having an incline on opting for cosmetic surgery, it is evident that social media fuels an insatiable desire to resemble one’s virtual complexion. Frequently, such influences from Snapchat or Instagram filters are not identified at first. However afterwards when social media partakes a significant part in daily lives, detrimental influences endeavour a sense of satisfaction, both internally and externally.

Shanum Dewan, Youth Medical Journal 2023

References

Arab, K., 2018 . Influence of Social Media on the Decision to. PRS Global Open .

Brucculieri, J., 2018. ‘Snapchat Dysmorphia’ Points To A Troubling New Trend In Plastic Surgery. s.l.:Huffpost .

Ramphul, K., 2018 . Is “Snapchat Dysmorphia” a Real Issue?. s.l.:s.n.

Relly, M., 2019 . Psychology Today. [Online]

Available at: https://www.psychologytoday.com/gb/blog/dissecting-plastic-surgery/201909/social-media-and-the-rising-trend-cosmetic-surgery

[Accessed 12 December 2022].

Veale, D., 2000. Outcome of cosmetic surgery and ‘DIY’ surgery in patients with body dysmorphic disorder. Psychiatric Bulletin.

Pills Kill.

     The pills, they kill. Drugs can have a variety of affects depending on the drug, the user, and their circumstances. Learn about the short- and long-term consequences of medications as well as how your body processes them. Drug use can have an impact on not only your physical and emotional health, but also your entire life. One tablet can be fatal.

Chemicals that have an impact on the body and brain are drugs. Drugs can have a variety of impacts. Long-lasting and permanent health problems are among some of a drug’s side effects. Even after the person has stopped using the drug, they may still go on. 

The three main methods of drug consumption are injection, inhalation, and ingestion. The way a medicine is administered affects your body differently. For instance, although ingesting a medicine has a delayed effect, injecting it directly into the bloodstream provides an immediate effect. However, the brain is impacted by all medicines that are overused. They cause the brain to experience a “high” by flooding it with a lot of dopamine, a neurotransmitter that helps control our emotions, motivation, and pleasure experiences. Drugs have the potential to alter how the way the brain functions can affect a person’s capacity for decision-making, resulting in strong cravings and compulsive drug usage. This conduct has the potential to develop into a drug addiction over time. 

Today, one in four fatalities is related to the use of illicit drugs, and more than 7 million people suffer from an illicit drug disorder. In actuality, drug misuse is more closely linked to illnesses, disabilities, and fatalities than any other illness that can be avoided. Drug and alcohol addicts are more likely to sustain unintended injuries, be involved in accidents, and experience domestic violence.

Drugs affect your life. It’s not just your physical body and heath, they also impact your mental, social health along with how you manage your finances, relationships and sometimes can even lead to how you manage your criminal record. Depending on the drug’s kind, each one has a unique bodily effect. Some will energize you and awaken your senses. Others will make you feel at ease and at peace. Some affect how you perceive things and may result in hallucinations. Others might leave you cold. Larger doses and prolonged usage have side effects that can gravely hurt your health and even result in death. These effects include the danger of infection from sharing needles, lasting brain and organ damage, and illness risks.

So how does your body process these drugs?

The human body processes drugs in 4 unique stages:

1. Absorption 

• Drugs are absorbed into your bloodstream when you take them. The way you ingested the drug will determine how quickly this happens.

2. Distribution

• Once a drug enters your bloodstream, it circulates throughout your body, reaching your brain and various organs. Depending on the drug type, the drug alters brain chemicals and receptors to produce a variety of effects.

3. Metabolism

• The drug is then metabolized by your body or broken down into smaller molecules (known as metabolites) that may be excreted more quickly. These metabolites occasionally have an impact on your body as well.

4. Excretion

• Drugs that have been metabolized pass through your digestive tract and leave your body, typically in urine or feces. 
• A drug’s elimination time in your body varies. It relies on a variety of elements, including the substance itself (the quantity, potency, etc.), as well as you personally (your metabolism, age, health, environment, etc).

The effects on the health 

There are several short- and long-term health repercussions of substance use disorders. They can differ based on the kind of medication, how much and how frequently it is used, and the patient’s overall condition. Overall, substance misuse and dependency can have significant negative impacts. They have the potential to affect practically all bodily organs. Death is one of the most serious effects of drug misuse on health. The greatest increase in deaths has been associated with heroin and synthetic opioids. 212,000 adults and children 12 and older consumed heroin for the initial time in the previous 12 months. Over 90 Americans lose their lives each day as a result of an opioid overdose.

Aaumuktha Yalamanchili, Youth Medical Journal 2023

References 

https://www.health.gov.au/topics/drugs/about-drugs/what-are-the-effects-of-taking-drugs

https://www.gatewayfoundation.org/about-gateway-foundation/faqs/effects-of-drug-abuse/

https://www.betterhealth.vic.gov.au/health/healthyliving/How-drugs-affect-your-body

https://nida.nih.gov/research-topics/commonly-used-drugs-charts

https://ojjdp.ojp.gov/sites/g/files/xyckuh176/files/pubs/coachesplaybook/effects_of_using.html

Monkey Pox: Public Health Response, Reporting and Stigma

Introduction

As of June 2022, over 2103 cases of monkeypox have been reported in 11 countries outside of areas where it is typically endemic. Prior to 2022, the UK had only ever reported 7 cases of monkeypox, but as of this month, the country has 793 confirmed cases. The strand related to the spread has been sequenced and found to be distinct from the strand typical in West Africa, which causes milder symptoms but is more infectious.

Monkeypox is a rare viral disease spread by close contact by small airborne droplets with symptoms including a fever, rash and swollen lymph nodes. The zoonotic virus earns its name from being first detected in laboratory monkeys in 1958 and is thought to transmit from wild animals to people. With a risk of death between 0-11%, there is no known cure, though the smallpox vaccine is about 85% effective against infection in close contact.

Experts believe monkeypox is unlikely to be a repetition of the devastation on the scale caused by the COVID-19 pandemic: it does not transmit from person-to-person as readily, and due to its relation to the smallpox virus there are existing treatments that can be used to combat its spread. Therefore, despite monkeypox still being a cause for concern, it is not yet a cause for widespread panic.

However, that has not prevented the public health response and discussion about monkeypox being infected with old stigmas.  

Response and Reporting

The first known case of Monkeypox in humans occurred in 1970 in the Democratic Republic of Congo. Since then, it has been primarily associated with west and central Africa, however the majority of early cases outside the region in the present outbreak occurred in gay and bisexual men.  

The causes for this are currently unknown. Presently, European authorities are investigating men’s saunas and crowded Pride festivals, such as celebrations in the Canary Islands of Spain and Belgium, as partial sources for the outbreak. The composition of the outbreak is complicated and not entirely conclusive, however, this had not stopped inaccurate health reporting from taking place. Many outlets, such as the emphasised the source of the outbreak among queer people as a ‘reason’ for the outbreak, which has been highlighted by many as being unfortunately evocative of the initial reporting of pneumocystic pneumonia in clusters of gay men with AIDs forty years ago in 1981. This is despite official health authorities such as Colin Brown, director of the clinical and emerging infections at the UK Health Security Agency, has stated that monkeypox does not spread easily nor is generally considered a sexually transmitted infection, though it can be passed in “close personal contact with an infected symptomatic person”. The World Health Organisation has also confirmed monkeypox is not a sexually transmitted infection nor exclusive to queer men.  

Irresponsible reporting in the name of accuracy can be harmful; when a disease or condition is associated with a marginalised group, people may not risk coming forward for fear of being associated or outed. This can be seen in the early days of HIV epidemic, when individuals who contracted the virus went underground and did not seek out medical care. However, the issue is complicated: while acknowledging that diseases of any kind are a wider threat that can affect anyone can reduce stigma and encourage people to come forward, it can also reduce specific resources for communities that still may genuinely need them the post. 

The LGBT community is not the only one in which misplaced reporting on the monkeypox outbreak has caused harm: racial and global economic disparities in global healthcare have also been highlighted. WHO was recently forced to change its official monkeypox pictures, after African doctors and advisors pointed out that, despite the concern being over the global outbreak, all the pictures used were of Black people.

The Democratic Republic of Congo is the country that has been dealing with the world’s largest, most persistent and most deadly strain of monkeypox outbreak by far, with at least 1238 cases and 57 deaths this year and a fatality rate of 10%. Many of these deaths are preventable, but still occur due to underfunded hospitals and lack of horses. Some African doctors feel monkeypox has only become a high priority for the medical community now that individuals in the Global North are being affected by the outbreak. The Biden administrations has purchased 119 millions dollars worth of the smallpox vaccine, which has been licensed for use against monkeypox, after the first American case of monkeypox and European countries are strongly considering stockpiling antivirals. This is reminiscent of the COVID-19 outbreak, in which Canada bought enough vaccines to vaccinate its entire population 9 times over, but countries such as Uganda and Bangladesh still faced severe vaccine shortages, with only 17% of Africans fully vaccinated. The unequal distribution of healthcare resources is a long-standing issue and continues to be seen with the outbreak of monkeypox today. 

The Way Forward

Challenges lie ahead. Despite stressing that the monkeypox outbreak does not resemble the early days of the COVID-19 pandemic because it does not transmit as easily, WHO does expect more monkeypox cases.

Reporting on monkeypox being accurate and careful is not just a matter of not perpetuating stigma, but avoiding misinformation and misleading health advice. Health officials have stressed the need to communicate very clearly to the public and the health response will likely have to look beyond vaccination and focus on quarantine, isolation and community education.

Despite comparisons to the lacking and dangerous response to the HIV/AIDS epidemic, there are important differences in the health response today and that of forty years ago. For example, UNAIDs has explicitly come out and condemned the racist reporting around the recent outbreak, with deputy executive director Matthew Kavanaugh stating, “Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one. Experience shows that stigmatising rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures.” Statements released by trusted outlets such as the BBC have also explicitly stated that monkeypox is not sexually transmitted. A related discussion most also occur in relation to the global and economic inequalities of pandemic responses and distribution of medical resources, with increased investment in deprived areas of world that may need it the most. These measures are the ones that health officials emphasises will allow for the most co-ordinated, effective and informed health response to the monkeypox outbreak.

Ishika Jha, Youth Medical Journal 2022

References

[1] Isidro, J. (2022). First draft genome sequence of Monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal). [online] Virological. Available at: https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799.

[2] Petersen, Brett W.; Damon, Inger K. (2020). “348. Smallpox, monkeypox and other poxvirus infections”. In Goldman, Lee; Schafer, Andrew I. (eds.). Goldman-Cecil Medicine. Vol. 2 (26th ed.). Philadelphia: Elsevier. pp. 2180–2183

[3] Sheikh, K. (2022). How Serious Is Monkeypox? The New York Times. [online] 23 May. Available at: https://www.nytimes.com/article/monkeypox-virus-covid.html.

[4] UK Health Security Agency (2022). Monkeypox: background information. [online] GOV.UK. Available at: https://www.gov.uk/guidance/monkeypox#:~:text=Monkeypox%20was%20first%20discovered%20in

[5] Porter, J. (2022). Let’s Set the Record Straight on Monkeypox, Gay Men, and HIV. [online] The Body: HIV/AIDs Resource. Available at: https://www.thebody.com/article/monkeypox-outbreak-hiv-gay-men-media.

[6] UK Health Security Agency (2022). Monkeypox: background information. [online] GOV.UK. Available at: https://www.gov.uk/guidance/monkeypox#:~:text=Monkeypox%20was%20first%20discovered%20in

[7] World Health Organisation (2022). Monkeypox: public health advice for gay, bisexual and other men who have sex with men. [online] http://www.who.int. Available at: https://www.who.int/news/item/25-05-2022-monkeypox–public-health-advice-for-gay–bisexual-and-other-men-who-have-sex-with-men.

[8] Mills, D. (2016). How the AIDS Epidemic Actually Began. [online] Healthline. Available at: https://www.healthline.com/health-news/how-aids-epidemic-actually-began.

[9] Villarosa, L. (2017). America’s Hidden H.I.V. Epidemic. The New York Times. [online] 6 Jun. Available at: https://www.nytimes.com/2017/06/06/magazine/americas-hidden-hiv-epidemic.html.

[10] Paquette, D. and Ombuor, R. (2022). As monkeypox panic spreads, doctors in Africa see a double standard. [online] The Washington Post. Available at: https://www.washingtonpost.com/world/2022/05/24/africa-europe-monkeypox-virus-outbreak/.

[11] Zitser, J. (2022). African journalists condemn media outlets for using images of Black people in coverage of US, UK monkeypox outbreaks. [online] Insider. Available at: https://www.insider.com/monkeypox-african-journalists-condemn-media-over-images-of-black-people-2022-5

[12] Browne, E. (2022). U.S. buys millions of monkeypox vaccines as Massachusetts man infected. [online] Newsweek. Available at: https://www.newsweek.com/monkeypox-cased-uk-massachusetts-case-vaccine-ordered-us-1708075

[13] Huet, N. (2022). This monkeypox antiviral drug may soon be in high demand. [online] euronews. Available at: https://www.euronews.com/next/2022/05/20/monkeypox-outbreak-drugmaker-siga-says-eu-authorities-seeking-to-stockpile-its-smallpox-an

[14] Gill, P. (2020). Canada has enough COVID-19 vaccine doses to cover each citizen five times over while the fate of 67 poor countries remains undecided. [online] Business Insider. Available at: https://www.businessinsider.in/science/health/news/canada-has-enough-covid-19-vaccine-doses-to-cover-each-citizen-five-times-over-while-the-fate-of-67-poor-countries-remains-undecided/articleshow/79645493.cms.

[15] Li, Z., Lu, J. and Lv, J. (2021). The Inefficient and Unjust Global Distribution of COVID-19 Vaccines: From a Perspective of Critical Global Justice. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, p.004695802110609. doi:10.1177/00469580211060992.

[16] Take Action (2022). Data dive: The astoundingly unequal global COVID-19 response. [online] ONE. Available at: https://www.one.org/africa/issues/covid-19-tracker/explore-covid-response/#:~:text=17.3%25%20of%20the%20population%20of%20the%20continent%20is%20fully%20vaccinated

[17] British Broadcasting Company (2021). Covid: Vaccines running out in poorer nations, WHO says. BBC News. [online] 21 Jun. Available at: https://www.bbc.co.uk/news/world-57558401.

[18] Rigby, J. (2022). WHO expects more cases of monkeypox to emerge globally. Reuters. [online] 21 May. Available at: https://www.reuters.com/article/us-health-monkeypox-who-idCAKCN2N70D4 [Accessed 29 Jun. 2022].

[19] Kozlov, M. (2022). Monkeypox vaccination begins — can the global outbreaks be contained? Nature. [online] doi:10.1038/d41586-022-01587-1.

[20] Branswell, H. (2022). ‘Nobody wants to mess this up’: A WHO official weighs in on the challenges of responding to monkeypox. [online] STAT. Available at: https://www.statnews.com/2022/06/01/monkeypox-response-challenges-maria-van-kerkhove-who/

[21] Kampalath, V. (2022). Monkeypox is recapitulating the stigma and structural inequity of HIV, Ebola, and other diseases. [online] STAT. Available at: https://www.statnews.com/2022/06/05/monkeypox-recapitulating-stigma-structural-inequity-of-hiv-ebola-other-diseases/

[22] Al Jazeera (2022). UN denounces ‘racist’ and ‘homophobic’ coverage of monkeypox. [online] http://www.aljazeera.com. Available at: https://www.aljazeera.com/news/2022/5/23/racist-and-homophobic-coverage-of-monkeypox-un-denounces?fbclid=IwAR0XPOOULQoIuo19n1cRQ9bUsdcoHs0Mu9DDSkEA7Hy2SP5bFbwUN5YySBE&sf165152932=1

Exploring The Nervous System

The Nervous System is the body’s internal communication system. These sensory cues are interpreted by the brain to understand what is going on outside and inside the body. Without the Nervous System, we would never understand what’s going on.

Introduction

Your nervous system serves as the command center for your body. It is controlled by your brain and governs your emotions, thoughts, and automatic responses to the environment around you. Almost all of what you think, feel, say, and do is controlled by your nervous system. It manages complex functions like memory, cognition, and movement. Furthermore, it is crucial for bodily functions like breathing, blushing, and blinking that occur automatically. It regulates other bodily functions and systems, including digestion, breathing, and sexual development (puberty). Your nervous system can be harmed by diseases, accidents, pollutants, and the natural aging process. The nervous system is split into two parts. Each component comprises billions of neurons, also known as nerve cells. These unique cells communicate with your body by sending and receiving electrical impulses. The main divisions of the Nervous System are the Central Nervous System (CNS), and the Peripheral nervous system, which then is further organized into other systems. (1)

What does the Nervous System do?

A nerve cell, or neuron, is the basic unit of the neurological system. The human brain has about 100 billion neurons. A neuron has a cell body, which contains the nucleus, as well as unique extensions known as axons (pronounced AK-sonz) and dendrites (pronounced DEN-drahytz). Nerves are bundles of axons found throughout the body. Neurons can interact across extended distances thanks to axons and dendrites. (2). When a neuron transmits a message to another neuron, it sends an electrical signal down the length of its axon. At the end of the axon, the electrical signal changes into a chemical signal. The chemical signal is then released by the axon via chemical messengers known as neurotransmitters (pronounced noor-oh-TRANS-mit-erz) into the synapse (pronounced SIN-aps)—the gap between the end of an axon and the tip of a dendrite from another neuron. The neurotransmitters carry the signal across the synapse to the adjoining dendrite, where it is converted back into an electrical signal. The electrical signal is subsequently transmitted across the neuron and through the same conversion steps as it travels to neighboring neurons.  

The nervous system also consists of glia, or non-neurons, cells (pronounced GLEE-uh). Glial cells provide a variety of critical activities that keep the nervous system running smoothly. To send impulses or messages throughout your body, the nervous system employs neurons. These electrical signals go through your body, connecting your brain, skin, organs, glands, and muscles. The messages assist you in moving your limbs and sensing sensations such as discomfort. Your eyes, hearing, tongue, nose, and nerves throughout your body gather information about your surroundings. The data is then transmitted to and from your brain via nerves. Neurons of various types send out messages in various ways. 

Image 1: Sciencefacts

The Different Parts of the Nervous System

The Nervous System is divided into two main parts. The Central Nervous System, which comprises the brain and the spinal cord, and the Peripheral Nervous System, which is made up of all the body’s parts that are connected by nerves that emerge from the spinal cord. The Peripheral Nervous System is then divided into Sensory Division and the Motor Division. The Motor Division is then organized into the Somatic and Autonomic Nervous System. The Autonomic Nervous system is then finally composed of the Sympathetic and Parasympathetic Divisions. 

Central Nervous System (CNS)

The brain and spinal cord contain the central nervous system (CNS). The central nervous system is the processing center of the body. The brain is in charge of the majority of the body’s operations, including awareness, movement, thinking, speaking, and the five senses of seeing, hearing, feeling, taste, and smelling. 

The spinal cord is a brain addition. Through the network of peripheral nerves that link to it, it transmits and receives messages to and from the brain. (3)

Peripheral Nervous System (PNS)

Your peripheral nervous system is everything else, and it includes nerves that flow from your spinal cord and brain to feed your face and the rest of your body. The term “peripheral” is derived from the Greek phrase for “around or outside the center.”

The peripheral nervous system (PNS) is the part of your nervous system that is not directly connected to your brain or spinal cord. It is responsible for both transmitting information from various sections of your body back to your brain and carrying out commands from your brain to various parts of your body. Some of these signals are automatic, such as those to your heart and gut. Others, such as those that control locomotion, are under your command. (4) 

Image 2: Cleveland Clinic

Sensory Division

The afferent division, also known as the sensory division, transfers impulses from peripheral organs to the CNS.

Motor Division

The efferent or motor division sends impulses from the CNS to the peripheral organs in order to produce an effect or action.

Somatic Nervous System (SNS)

The peripheral nervous system includes the SNS, which is connected with the voluntary control of body movements through the use of skeletal muscles. (6). The somatic nervous system’s primary roles are to transport sensory information from nerves to the central nervous system and to transport motor information from the central nervous system to muscles via motor neural pathways to govern their activity. The sensory-somatic nervous system is made up of cranial and spinal nerves, whereas the autonomic nervous system is made up of sensory and motor neurons that connect the CNS to the internal organs.

  Autonomic Nervous System (ANS)

The autonomic nervous system is the part of your nervous system that controls automatic actions such as heartbeat and blood vessel widening or narrowing. When something goes wrong in this system, it can lead to major complications, such as high blood pressure. (5)

Sympathetic Nervous System (SNS)

Your autonomic nervous system is made up your sympathetic nervous system. It could be referred to as your “automatic” nervous system because it controls numerous functions that you do not have to think about. This includes, among other things, controlling your heart rate, blood pressure, digestion, urination, and sweating. Your sympathetic nervous system is most known for its role in responding to risky or stressful conditions. In certain conditions, your sympathetic nervous system acts to increase your heart rate, provide more blood to places of your body that require more oxygen, or perform other actions to assist you in escaping danger. 

The majority of the impulses sent by your sympathetic nervous system originate in your spinal cord. The signals exit the spinal cord and trigger structures known as ganglia. Your sympathetic ganglia then sends the required signals to various sections of your body. Your heart, lungs, arteries, sweat glands, and digestive system could all be affected.

Your “fight-or-flight” response is controlled by your sympathetic nervous system. Danger or stress triggers your sympathetic nervous system, which can result in a variety of physiological reactions. In response to a threat or stress. These impacts assist you in situations where you must think or act swiftly. They enhance your vision, reflexes, endurance, and strength. Your sympathetic nervous system also activates when your body is under stress, such as when you exercise or are unwell. 

Your sympathetic nervous system activity influences your immune system and the repair processes in your body. If you get harmed, these impacts can assist your body start healing faster. To communicate, your sympathetic nervous system employs molecules known as neurotransmitters. These substances are norepinephrine, epinephrine, and acetylcholine. (7)

Parasympathetic Nervous System (PNS)

The parasympathetic nervous system balances your sympathetic nervous system. While your sympathetic nervous system is in charge of your body’s “fight or flight” response, your parasympathetic nervous system is in charge of your body’s response when you are at rest. The primary function of the parasympathetic nervous system is to calm down or lessen your body’s activity. Because of the signals it sends, the rhyming phrases “rest and digest” or “feed and breed” are simple ways to recall what your parasympathetic nervous system performs.

Your parasympathetic nervous system is one of two parts of your autonomic nervous system. Your autonomic nervous system is a subsystem of your peripheral nervous system, which is all the nervous tissue in your body excluding your brain and spinal cord.

Your parasympathetic nervous system uses four of your 12 cranial nerves. These are nerves that connect directly to your brain. (8)

Image 3: Merck Manuals.

In the end, all these subsystems make up our Nervous System.

Akshaya Ganji, Youth Medical Journal 2022

References

1. Cleveland Clinic: “Nervous System”- https://my.clevelandclinic.org/health/articles/21202-nervous-system 
2. NIH: “What are the parts of the nervous system?” – https://www.nichd.nih.gov/health/topics/neuro/conditioninfo/parts 
3. Healthdirect: “Central nervous system (CNS)- https://www.healthdirect.gov.au/central-nervous-system 
4. Cleveland Clinic: “Peripheral Nervous System (PNS)- https://my.clevelandclinic.org/health/body/23123-peripheral-nervous-system-pns 
5. MedicinePlus: Autonomic Nervous System Disorders- https://medlineplus.gov/autonomicnervoussystemdisorders.html 
6. National Library of Medicine: Neuroanatomy, Somatic Nervous System- https://www.ncbi.nlm.nih.gov/books/NBK556027/ 
7. Cleveland Clinic: Sympathetic Nervous System (SNS)- https://my.clevelandclinic.org/health/body/23262-sympathetic-nervous-system-sns-fight-or-flight 
8. Cleveland Clinic: Parasympathetic Nervous System (PSNS)- https://my.clevelandclinic.org/health/body/23266-parasympathetic-nervous-system-psns 

Music and Medicine

You might have heard of the term music therapy but do you know what it is? Do you know how it works and who it treats?

History of Music Therapy

Music therapy is as old as the old writings of Aristotle and Plato. It is a therapeutic technique used to provide support and care to people who have been injured or ill, as well as assist them with their emotional and communication needs. The first mention of music therapy appeared in an unsigned piece in 1789 in a Columbian magazine with an article entitled “Music Physically Considered”. More than 60 years after that, the Nordoff-Robbins approach to music therapy came to prominence. It was officially introduced in the 1950s and 1960s by Paul Nordoff and Clive Robbins. This approach stated that everyone is sensitive to music and has the ability to use it for personal growth. 

How

Music therapy can be used to help people of all ages communicate. Some illnesses that can be addressed through music therapy include post-traumatic stress disorder (PTSD), learning impairments, autism spectrum disorders, and neurological disabilities. Music establishes people’s relationship with the world through engagement with a music therapist. Music lets patients express themselves by allowing them to develop their own musical language.

Patients normally have one-on-one music therapy sessions, but can also request group sessions if they’d like. These sessions begin with a discussion of the patient’s life goals, as well as their expectations for the course’s result. Then songs from various genres will be performed; some will be instrumental only, while others will include lyrics. They can even range from being uplifting to depressing. Some patients are even instructed to write their own songs, with the goal of allowing them to express themselves via music. For example, if their song has dissonances or has loud and quick beats, it may indicate that the patient is angry. This allows patients who are unable to talk to express their feelings rather than suppressing them and suffering alone. The music therapist will then play songs that are the opposite of how the patient is feeling, in this case, soft beats and pleasant sounds. The patients may be instructed to sway, sing, or dance to the music. Although there are no set locations for therapy, it is crucial to ensure that the environment is welcoming and private, as, in more public areas, the patient may be embarrassed and hesitant to speak up. 

There are various types of music therapy. As stated in the introduction, some patients use the Nordoff-Robbins technique, a technique where it is thought that everyone is sensitive to music. Analytical music therapy is another type of music therapy. It allows patients to improvise and express themselves by singing or playing an instrument to convey their deepest thoughts, which are then analysed by a therapist. Benenzon music therapy seeks to match the patient’s sentiments to the closest melodic song, while vocal psychotherapy aims to connect the patient with themselves through singing. The Bonny Method of Guided Imaging and Music (GIM) is an intriguing sort of music therapy which allows patients to listen to classical music while being guided to imagination. This helps patients express their emotions, recall prior memories, and predict future scenarios based on what they expect to experience and how they feel at the time. In addition, cognitive behavioural music therapy (CBMT) combines music with cognitive behavioural therapy (CBT). The goal of cognitive behavioural therapy is to improve depression and anxiety symptoms by improving some behaviours and changing others. These are not the only types of music therapy that can aid patients. There are many more that can help them before, during, and after their recovery.

Support

Some people believe that music therapy is exclusively beneficial to patients with mental illnesses; however, this is not the case. Alzheimer’s disease, traumatic brain injury (TBI), and schizophrenia are just a few of the conditions that music therapy may help with. It can also aid in the recovery from an accident, as well as issues associated with childbirth. Music therapy can assist youngsters in establishing their individuality and ambitions and help them improve their communication skills with others.

With the help of the British Association for Music Therapy (BAMT), which was founded in 2011, music therapy is starting to gain popularity in the United Kingdom. The organization’s goal is to get more individuals involved in music therapy by providing courses and events for professionals. Furthermore, a music therapist is considered a healthcare practitioner and someone who can collaborate with other healthcare experts as part of a multidisciplinary team (MDT). Music can always be viewed as a form of therapy, and some doctors may send you to a music therapist following treatment in order to help you avoid post-traumatic stress disorder (PTSD). Apart from that, Levitin noted in his book, This Is Your Brain on Music that “We’ve found compelling evidence that musical interventions can play a health-care role in settings ranging from operating rooms to family clinics”. This demonstrates how music can have an impact on everyone, including healthcare workers, by reducing stress. Furthermore, it is important to listen to music, especially in certain situations, such as the  Covid-19 outbreak. Listening to music eliminates stress and allows for a cheerful attitude. Second, it is proven that immunoglobulin, a natural killer cell that strengthens the immune system, can be produced more effectively by playing and listening to music.

Music therapy is commonly employed in religious studies all over the world. Sacred music therapy, for example, is used in North India. Indians consider diseases to be spiritual rather than microbiological. As a result, ailments are linked to demons, and they are treated by village healers who specialise in anything related to spirits. These village healers attempted to employ “sound cures” on human minds and physiology.

Finally, Music therapy, which helps improve sleep quality is beneficial to everyone regardless of whether they are sick, and should be widely encouraged.  It aids in the development of both physical and psychological states, and also lowers heart rate, blood pressure and breathing rate.

Mary Ho Yan Mak, Youth Medical Journal 2022

Is Communication Important in the NHS?

The concept of communication is not contemporary, instead its longevity diverges before the 7th century, according to Claude Simmon, who had developed the Communication Theory, “Information is the resolution of uncertainty”. However, when applying simplified theories, upon diverse sectors especially healthcare, the significance of communication may sometimes be blurred or perhaps become obscured. Frequently, the concept of communication is blurred into organisation structures, that the absence of communication leads to detrimental repercussions, regardless of the setting or situation. 

Throughout the development of the NHS, since 1948, paramount structural alterations have proceeded, due to the absence of a the utmost important element: communication. Both the clinical and moral failures, of the NHS was outlined first through the Ely report. The Ely report, followed the complaint of a nursing assistant employed at the Ely hospital, describing the “inhumane and threatening behaviour by six staff members towards four patients”, alongside the lack of care and indifference on the part of the senior staff to complaints (The Health Foundation). An inquiry committee had been established, after consideration upon the request of the Secretary of Social Services, to investigate the “ill-treatment of patients and of pilfering by staff” (UK Parliament). It is explicitly foreshadowed that, the rationale into filing the complaint, involved substantial lack of a combination of verbal and non-verbal communication between the staffing structures consisted with the NHS; further highlighting, the notorious consequences of underfunding inflicting upon the quality of care. The following allegations, were also implemented into the complaint:

• Cruel ill-treatment of four particular patients by six named members of the staff;
• Generally inhumane and threatening behaviour towards patients by one of the staff members already referred to ;
• Pilfering of food, clothing and other items belonging to the hospital or the patients;
• Indifference on the part of the Chief Male Nurse to complaints that were made to him;
• Lack of care by the Physician Superintendent and other member of the medical staff.

(Socialist Health Association)

Principally focusing upon the allegation of “indifference on the part of the Chief Male Nurse to complaints that were made to him”, (Socialist Health Association) emphasises the culture of segregated communication due to the varying levels of responsibilities between members of the NHS. The mentioning of the term “indifference”, constructs the ignorance between members of the NHS, diverging due to a lack of communication and awareness of the importance of multi-disciplinary teams in any healthcare setting. In this case, effective communication between various roles within the disciplinary was essential to build a positive relationship between other NHS members and the patients, for better health outcomes from the perspective of the patients. Consequently, in this case due to consistent lacking of a combination of verbal communication skills, non-verbal communication skills, and listening, members of staff were unable to raise awareness of the issues encountered, instead they were dismissed as there was no framework to debrief situations, which may have significantly impacted staff, or a staff welfare trust. Having said, the failures of the Chief Male Nurse to address issues, primarily due to inadequate funding, further leading to failures in committing to the individual’s responsibilities, and being enforced to condemn the issues encountered by NHS subsidiary members.

Consequently, the predominant problem alerted centred around staff welfare, especially concerning “professional isolation” (UK Parliament) as there was a significant imbalance between “the skilled and devoted service given by the staff in long stay hospital, who have all too often been working for many years under heartbreaking difficulties” (UK Parliament), therefore upon the recommendations of Beatrice Serota, “a new system of regular visiting and inspection is needed” (UK Parliament) Beatrice Serota’s recommendation centred around effective communication, as regular visiting and inspection had significantly increased the wellbeing of staff members across the four departments investigated. Furthermore, regular visits allowed the four departments of the Ely Hospital to be constantly under the assistance of the government; therefore constantly developing plans to coherently improve the communication between staff members, to establish an attributional relationship between each other’s welfare.

On the other hand, some people may believe that throughout developing clinical skills, communication is sub-consciously and simultaneously developed, therefore there is no necessity into investing upon staff welfare and communication inspections by the government, instead they should be directly invested into allocating clinical equipments; specially in departments, where there is a significant shortage. According to Baroness Hylton-Foster, during a Parliamentary conference, supposedly the issue arisen is not professional isolation, instead “even with special training it needs superhuman patience to cope with some of the patients with whom they have to deal”. (UK Parliament) However some may question, in order to elaborate upon the patience to deal with complicated situations, in any healthcare setting, definitely communication is required in order to explicitly and assuringly address situations. 

In conclusion, communication whether it be in healthcare or any other professional or daily setting, is significant to continuously develop through organisation schemes, and avoid severe moral and legal failures. As portrayed through the case of Ely Hospital’s failings, in which professional isolation was deeply ingrained within the culture of Ely Hospital, members of staff had compensated the quality of healthcare through a paramount lack of motivation and inability to cope with mental and physical pressures. 

Sheza Dewan, Youth Medical Journal 2022

References

The Health Foundation. “Inquiry into Ely Hospital.” The Health Foundation, 1969, https://navigator.health.org.uk/theme/inquiry-ely-hospita. Accessed 27 June 2022.

Socialist Health Association. “Report on Ely Hospital.” Socialist Health Association, 1969, https://www.sochealth.co.uk/national-health-service/democracy-involvement-and-accountability-in-health/complaints-regulation-and-enquries/report-of-the-committee-of-inquiry-into-allegations-of-ill-treatment-of-patients-and-other-irregularities-at-the-ely-h. Accessed 28 June 2022.

UK Parliament. “Ely Hospital, Cardiff: Inquiry Findings.” UK Parliament, 1969, https://api.parliament.uk/historic-hansard/lords/1969/mar/27/ely-hospital-cardiff-inquiry-findings. Accessed 27 June 2020.

ADHD: Over Diagnosed or Loosely Defined?

Introduction

Attention deficit hyperactivity disorder (ADHD) is generally manifested through difficulty focusing. The disorder’s diagnostic criteria, as described in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), includes a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, the presence of several inattentive or hyperactive-impulsive symptoms prior to the age of twelve and in two or more settings, clear evidence the symptoms interfere with social, academic, or occupational functioning, and the precedent that the symptoms cannot be explained by another mental disorder. The DSM-5 also provides examples of behaviors that may be indicative of ADHD, including frequent fidgeting, excessive talking, difficulty waiting for a turn, an inability to play quietly, and frequent interruption of others [1]. Many remark that these symptoms are merely traits of being a child and are not signs of a disorder. Accusations of ADHD’s overdiagnosis have been on a rise in recent years, as have diagnosed cases of ADHD. In 1997, the parent-reported percent of children with an ADHD diagnosis in a National Health Institute survey was just under 6%. Ten years later, this figure had risen to 10% [2]. Similar results have fueled a growing debate as to whether these diagnoses are the result of a widening definition of the disorder or a true increase in those afflicted. 

Identifying Over Diagnosis

The commonly-held notion that ADHD is loosely and  inaccurately diagnosed stems from an assumption that many diagnoses are falsely positive. For ADHD to be justifiably labeled as overdiagnosed, there must be evidence that the total number of false positive diagnoses significantly outweighs the number of falsely negative diagnoses [3]. Such evidence has not yet been discovered, thereby establishing the ability to recognize the factors at play in a potential false positive ADHD diagnosis as vital in gaining insight to the overdiagnosis assumption. 

Potential Components of Misdiagnosis

The relative age of schoolchildren is a common explanation for ADHD misdiagnosis. Numerous studies have found that children who are relatively younger than their classmates are at an increased risk of ADHD diagnosis. In a study conducted within a school whose school-age cutoff is December 31, results revealed that boys born in December were 30% more likely to be diagnosed and 41% more likely to be treated for ADHD than their January-born peers. Girls born in December were 70% more likely to be diagnosed and 77% more likely to be treated for ADHD than those born in January [4]. These findings suggest that diagnostic measures have failed to account for the relative developmental immaturity of young children, leaving unnecessary room for subjectivity in diagnosis. 

Early diagnosis provides another point of concern in the misdiagnosis of ADHD, given that most ADHD research has been conducted on older, school-age children, rather than younger preschoolers [4]. Research as to the manifestations of ADHD at such a young age has been limited. Current diagnostic measures are geared toward older children and may lead to false positive diagnoses, especially considering the prevalence of inattention, impulsivity, and hyperactivity at that developmental age [5]. 

The argument of diagnostic inaccuracy has been substantiated in a number of studies, such as a 1993 study that evaluated 92 children previously referred to a specialized ADHD clinic. Of the referrals, only 22% received a primary diagnosis of ADHD and only 37% were given a secondary diagnosis [3]. Variability in assessment among providers may be to blame for these diagnostic inaccuracies that may contribute to an increase in false positive diagnoses. 

Potential gender differences in the manifestations of ADHD may be at blame for deflated diagnoses in girls. It has been hypothesized that boys tend to exhibit the prototypical characteristics of ADHD through disruptive and hyperactive behaviors. Girls, however, may exhibit less externalized and disruptive behavior that had become characteristic of ADHD and increased intellectual impairment [4]. A potential inability to distinguish between different manifestations of the disorder suggests further inaccuracy in the diagnostic criteria. 

Conclusion

It appears to be overwhelmingly evident that ADHD is often misdiagnosed. Fallacies in the diagnostic criteria may be to blame for an inflated number of diagnoses in preschool-age children and developmentally immature children, as well as a deflated number of diagnoses in girls. Although such diagnostic concerns have been supported by a number of studies, sufficient evidence for systematic overdiagnosis remains lacking. Due to the variability in assessment techniques by provider, prevalence rates of ADHD are unreliable and cannot be used to prove that the number of false positive diagnoses drastically outweigh the number of false positive diagnoses. Despite this, the popular idea that ADHD is widely misdiagnosed remains intact, and likely will remain as such. It is important to remember that such claims are generally based on unreliable data and should be deemed untrustworthy by association. 

Alaina Buerger, Youth Medical Journal 2022

References

[1] Reynolds, Cecil and Kamphus, Randy. “Attention-Deficit/Hyperactivity Disorder (ADHD).” DSM-5 Diagnostic Criteria, Pearson, 2013, http://images.pear sonclinical.com/images /assets/basc -3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf

[2] “Attention-Deficit/Hyperactivity Disorder (ADHD).” Centers for Disease Control and Prevention, 23 September 2021, https://www.cdc.gov/ncbddd/adhd/timeline.html

[3] Scuitto, Mark. “Evaluating the Evidence For and Against the Overdiagnosis of ADHD.” Journal of Attention Disorders, Sage Publications, September 2007, pp. 106-113, https://t heunbrokenwindow.com/wp-content/uploads/2017/10/ADHD-Overdiagnoses.pdf

[4] Ford-Jones, Polly Christine. “Misdiagnosis of attention deficit hyperactivity disorder: ‘Normal behaviour’ and relative maturity.” Paediatrics & child health vol. 20,4 (2015): 200-2. doi:10.1093/pch/20.4.200

[5] Tandon, Mini et al. “Attention-deficit/hyperactivity disorder in preschool children: an investigation of validation based on visual attention performance.” Journal of child and adolescent psychopharmacology vol. 19,2 (2009): 137-46. doi:10.1089/cap.2008.048 

CRISPR Gene Editing: From novel treatment to reality

Originally released in the year 2000, the Marvel blockbuster film series features a team of six genetically enhanced beings called the X-Men. It appears that every time a new X-Men movie is released on the big screens, the world looks to science to answer the age-old question: “Is the creation of such mutants a possibility?”. 

With the endless developments in genetic engineering and the discovery of CRISPR-Cas9 gene editing in 2020, it is difficult not to wonder if the creation of such mutants in our reality is possible. Yet, much sooner than we expected, these so-called “superhumans” are already walking amongst us, with a range of unbelievable powers including super-strength, super-speed, and mind-blowingly high brain power that increasingly mirror superhuman powers seen on the big movie screens.

To understand the science behind these superhumans, we must first understand the basis of gene editing, which forms the foundation and function of CRISPR-Cas9.

What is CRISPR-Cas9?

CRISPR-Cas9 is a new and unique form of gene editing that allows medical scientists to edit parts of the genome by removing, adding, or altering sections of the DNA sequence [1]. Discovered back in 2021, it has been one of the frontiers of genomic research and a common hot topic within the medical community due to its simplicity, versatility, and precise method of genetic manipulation. The cheap price associated with CRISPR has ultimately made it more desirable than previous methods of DNA editing available on the market including transcription activator-like effector nucleases (TALENs) and zinc-finger nucleases (ZFNs), which are much less cost-effective and accessible [2].

So why is CRISPR-Cas9 gene editing relevant to us right now?

The answer lies in the enormous potential of CRISPR gene editing for treating a wide range of life-threatening medical conditions that have a genetic basis and foundation such as cancer, hepatitis B, and high cholesterol. For example, the excess fatty deposits in major blood vessels causing high cholesterol can be resolved through genetic engineering techniques that “turn off” the genes that regulate cholesterol levels in our body [6]. A new study conducted by Nature 2021 revealed that knocking out the protein PCSK9 with CRISPR significantly reduced LDL cholesterol in monkeys by around 60% for at least 8 months [3]. Although it is likely to be many years before any testing for CRISPR technology can be carried out on humans, this kind of breakthrough within our own genus is impressive. As much current research is focused specifically on ex-vivo or animal models, the intention is to use the technology to routinely treat diseases in humans that can’t be addressed through routine drugs and medications.

How does this form of gene editing work?

The foundation of CRISPR-Cas9 is formed from two key molecules that introduce a mutation into the targeted DNA: the Cas9 enzyme and guide RNA (gRNA). The guide RNA has RNA bases that are complementary to the target DNA sequence in the original genome, and this helps the gRNA bind to the correct region within DNA. The Cas9 enzyme follows the gRNA and essentially acts as small scissors that make incisions within both strands of the DNA, allowing for sections of DNA to be added or removed [1][4]. 

At this point, the cell recognises the damage within the DNA and works to repair it, allowing scientists to use external machinery to introduce one or more new genes to the genome. This causes the genetic makeup to differ from the “normal” human genome, causing mutations and noticeable changes in the phenotype to occur such as the “super-variants” including super-sprinter variant (ACTN3), super-sleeper mutation (hDEC2), and the super-taster variant (TAS2R38) [5][7].

There is also extensive research being put into eliminating the “off-target” effects of CRISPR, where the Cas9 enzyme makes cuts at a site other than the intended one, introducing a mutation in the wrong region. Whilst some of these changes are inconsequential to the overall phenotype, they may affect the structure and function of another part of the genome. It is suggested that the use of Cas9 enzymes that only cut a single strand of target DNA as opposed to the double-strand may be the solution to eliminate this problem [4].

The next generation of enhanced individuals?

Though the alteration of the human genome is very much already a reality, the creation of ‘mutant’ individuals with more fantastical powers such as Wolverine’s special healing and animal keen senses, and the Scarlet Witch’s telekinesis and matter manipulation remains purely fictional. As of right now, the use of CRISPR in medicine is solely therapeutic, used for repairing or altering innate mutations, as opposed to creating them. Yet, it can be argued that these genetic changes allow the patient to have better DNA than the one they were born with, making them the first generation of genetically modified humans to walk the earth – mutants indeed.

In the X-Men franchise, all mutants carry an ‘X-gene’ which bestows upon them their aforementioned abilities. Unfortunately, no such gene exists – our phenotype arises from a much more complicated relationship between genes and presenting characteristics, and the effects of current gene editing pale in comparison to what is shown in blockbuster movies. That said, hope is not lost: extensive research and development within this field continually offer the possibility of giving individuals similar ‘powers’ to those of the X-Men and Professor X on an increasingly real scale. 

Below, are some examples of X-Men’s superpowers against their real-world human genetic mutation counterparts [5][7]:

X-Men ability	Existing human genetic variation
Animal-keen senses	hDEC2 (super-sleeper mutation)
Super-speed	ACTN3 (super-sprinter variant)
Super-strength	LRP5 (unbreakable bone mutation)
Enhanced senses	TAS2R38 (super-taster variant)

Do scientists think it is possible for some of these powers to be attributed to genetic mutation? The simple answer is yes. But unsurprisingly, the uncertainty and unpredictable nature surrounding new treatments will always generate some degree of ethical controversy in the scientific community, and CRISPR is no different. The use of CRISPR technology in medicine will undoubtedly become more mainstream in the near future, and once the door is open for genetic modifications to embryos, babies, and adults alike, there is no going back. As with many medical technologies in the past, human health and safety may fail to be at the forefront of CRISPR’s use, leading to all kinds of unnecessary complications. The impact that CRISPR-Cas9 will have on the medical field, now and in the next generation, is undeniable – whether it’s curing a rare form of cancer or creating the first generation of real-life X-Men [8].

There are many unanswered questions surrounding this topic, and this is unlikely to change. But as the research continues and our questions go on, I would like to leave you with only one… What would your superpower be?

——

Works Cited

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