TELEMEDICINE AND VETERAN

HEALTHCARE
CRISPR-CAS9 TECHNOLOGY IN
RELATION TO SICKLE CELL DISEASE
OMEGA-3 FATTY ACIDS AND
CARDIOVASCULAR HEALTH
3D PRINTED PERSONALISED
ORTHOTICS
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BREAKING BARRIERS: TELEMEDICINE’S

ROLE IN MENTAL HEALTH CARE FOR
VETERANS
TAKEN TOGETHER, TELE-MENTAL HEALTH HAS THE POTENTIAL TO
BRING MORE EFFECTIVENESS, ENGAGEMENT, AND ACCESS TO VETERAN
COMMUNITIES.
BY LUCIANA COSTA

Telemedicine was embraced as a

transformative force in healthcare during
the first years of the COVID-19 pandemic,
with a promise to bridge the gap between
patients and providers (3). It allowed
healthcare providers to overcome
challenges and enhance accessibility,
especially within the domain of mental
health care for veterans.

Through telepsychiatry and teletherapy,

veterans are offered a lifeline of mental
health services directly to their homes. A
recent study carried out within the US
Department of Veterans Affairs (VA)
healthcare system demonstrated that
telemedicine now plays a significant role for
those who have served their country (1).

Veteran patients often face post-traumatic

stress disorder (PTSD), depression, and
substance abuse disorders. As they are
commonly anxious and avoidant, studies
also have shown it to be suited to the
treatment of those illnesses.

Fortney et al. (2015) conducted a study across 11 VA clinics comparing a telemedicine-based

collaborative model for PTSD, known as Telemedicine Outreach for PTSD (TOP), to a
standard treatment (1). The TOP model involved on-site CBOC providers and off-site
teletherapists.

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Results indicated that patients in the

telemedicine group exhibited better
overall engagement in therapies and
experienced significantly greater
improvement in PTSD and depression
severity, with higher rates of engagement
in cognitive processing therapy (CPT).
However, the intervention did not impact
medication adherence or the likelihood
of receiving PTSD medication.

Although telemedicine is completely

remote, it has been able to bring the
patient closer to the therapist in one-on-
one sessions. It makes mental health care
more accessible and convenient overall.
For instance, it eliminates the need for
in-person visits, also extensive travel for
veterans living in rural or underserved
areas.

While telemedicine holds immense

potential for PTSD and depression
treatment, many challenges must be
addressed to maximize its effectiveness
in serving veterans' mental health needs.
Senior veterans, for example, may
encounter difficulties navigating virtual
References
platforms or accessing reliable internet 1. National Academies of Sciences, Engineering, and Medicine;
connections. Health and Medicine Division; Board on Health Care Services;
Committee to Evaluate the Department of Veterans Affairs
Mental Health Services. Evaluation of the Department of
To conclude, telemedicine represents a Veterans Affairs Mental Health Services. Washington (DC):
National Academies Press (US); 2018 Jan 31. 14, Health
paradigm shift in mental health care for Technology for Mental Health Care.
veterans. By offering a scalable, patient- https://www.ncbi.nlm.nih.gov/books/NBK499492/
2. Walker DL, Nouri MS, Plouffe RA, et al. Telehealth experiences
centered approach to address the in Canadian veterans: associations, strengths and barriers to
complex challenges they face, it ensures care during the COVID-19 pandemic. BMJ Mil Health Published
Online First: 12 May 2023. doi: 10.1136/military-2022-002249
that those who have served their country https://militaryhealth.bmj.com/content/early/2023/05/11/militar
receive the support and resources they y-2022-002249
3. Ferguson, J. M., Wray, C. M., Van Campen, J., & Zulman, D.
deserve, whenever and wherever they M. (2024). A New Equilibrium for Telemedicine: Prevalence of
need it most. In-Person, Video-Based, and Telephone-Based Care in the
Veterans Health Administration, 2019-2023. Annals of internal
medicine, 177(2), 262–264. https://doi.org/10.7326/M23-2644

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ADVANCING SICKLE CELL DISEASE

TREATMENT THROUGH THE PROMISE
OF CRISPR-CAS9 GENE EDITING
BY NAIMA RAUF

What is the Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR-Cas9)

gene-editing technology? This has been one of the greatest new discoveries to
precisely edit the DNA makeup in sequences by adding, deleting, or modifying specific
genes. The CRISPR-Cas9 system uses a Cas9 enzyme, which are like the scissors to cut
the DNA and modify it. It then uses a guide RNA (gRNA), which is used to direct the
Cas9 enzyme in the DNA sequence. The CRISPR-Cas9 system has been responsible for
removing cancers, AIDS, muscular dystrophy, genetic deafness and several more
diseases from the body through modification.

Sickle cell disease affects

millions worldwide,
particularly those of African
descent, and is characterised
by chronic anaemia, painful
vaso-occlusive crises, and
increased susceptibility to
infections. Statistics reveal the
staggering impact of sickle cell
disease on individuals and
communities globally. In the
United States alone,
approximately 100,000
individuals are affected by
sickle cell disease, with the
majority belonging to racial
and ethnic minority groups (1).
Furthermore, sickle cell
disease is associated with
significant morbidity and
mortality, contributing to
reduced life expectancy and
impaired quality of life for
affected individuals.

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The genetic basis of sickle cell disease lies in a point mutation in the β-globin gene,
resulting in the production of abnormal haemoglobin S (HbS) molecules (2). These
abnormal haemoglobin molecules polymerize under conditions of low oxygen tension,
leading to the characteristic sickle-shaped red blood cells, impaired blood flow, and
tissue damage. Individuals with sickle cell disease experience recurrent pain crises,
acute chest syndrome, stroke, and organ damage, necessitating frequent hospitalizations
and medical interventions (3).

Despite advances in supportive care, including hydroxyurea therapy and blood

transfusions, the management of sickle cell disease remains challenging, with limited
curative options available. Hematopoietic stem cell transplantation offers a potential
cure for sickle cell disease but is limited by donor availability and the risk of graft-
versus-host disease (1). Therefore, the development of innovative therapeutic
approaches, such as CRISPR-Cas9 gene editing, holds a meaningful promise for
transforming the treatment landscape for sickle cell disease.

Preclinical studies utilising

CRISPR-Cas9 technology have
demonstrated the feasibility of
correcting the underlying genetic
mutation responsible for sickle
cell disease. By precisely targeting
and editing the β-globin gene (2),
researchers have successfully
restored normal haemoglobin
expression and ameliorated
disease manifestations in animal
models of sickle cell disease.

Although the ethical concerns

concerning the CRISPR-Cas9
systems and human germline References
editing has always been the case 1. FDA approves first gene therapies to treat patients with sickle cell disease.
with gene-editing technologies, (2023, December 8). U.S. Food and Drug Administration.
https://www.fda.gov/news-events/press-announcements/fda-approves-first-
the fear of long-term effects must gene-therapies-treat-patients-sickle-cell-disease
be taken into account. Since this 2. Frangoul, H. (2021). CRISPR-Cas9 Gene Editing for Sickle Cell Disease and β-
Thalassemia. New England Journal of Medicine.
technology is still novel, those https://www.nejm.org/doi/full/10.1056/NEJMoa2031054
effects cannot be pinpointed 3. Reardon, S. (2023, December 8). FDA approves first CRISPR gene editing
treatment for sickle cell disease. Scientific American.
regarding unintended mutations https://www.scientificamerican.com/article/fda-approves-first-crispr-gene-
over time. editing-treatment-for-sickle-cell-
disease/#:~:text=On%20December%208%20the%20U.S.,blood%20cell%20shap
e%20and%20function

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VOLUME: 2

OMEGA-3 FATTY ACIDS: NAVIGATING

THEIR IMPACT ON CARDIOVASCULAR
WELLNESS
BY KAYLA AMARO

Cardiovascular disease is the leading cause of death worldwide. Understanding what your
body needs to keep your heart healthy can be crucial but can often be overwhelming when you
may not know where to start. Omega-3 is a crucial place to start, as it has plays roles in
helping cardiovascular health with evidence from multiple studies. A systematic evaluation of
the research and recent advancements by Jia Liao, et al., explained that there may be a relation
between the consumption of Omega-3, lower blood and reduced risk of hypertension (5). Also,
in one of the studies it was concluded that after a 3.9 year check-in, Cardiovascular related
death or hospitalisation was reduced by 8%. These numbers may seem insignificant but can
mean a world of difference during an emergency.

Omega-3 is an essential fat, meaning our body cannot produce it, so we must get it from our
diet (9). It has many roles, such as making hormones that regulate blood clotting, reducing
inflammation, lowering blood pressure, lowering heart rate, and improving the function of
blood vessels. Because of these roles, they can help cardiovascular health by preventing heart
disease.

Even though Omega-3 is helpful at a

daily dose, a higher dose of omega-3,
prescribed by a doctor, can help
lower triglycerides, which play a role
in developing blood clots that can
lead to a heart attack, a stroke or a
pulmonary embolism (1).

Another factor that can lead to heart

problems is oxidative stress (7). It
needs to be in balance with
antioxidants so we can avoid damage
to your vital organs, which increase
the risk of heart disease. Omega 3
has been presented as being able to
help enhance your antioxidant
system, helping to prevent damage
to the organs caused by oxidative
stress (2).

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So now that we know how good Omega-3 can be to our heart, what foods can we get
Omega-3 from? Seafood is an excellent source of Omega-3, but if you don't eat seafood,
there are other places to get Omega-3 such as nuts, seeds, and plant oils like canola oil (10).

The complex yet fascinating role of Omega-3 fatty acids in our cardiovascular health is
excellent at reducing blood pressure, the chance of blood clots and balancing out oxidative
stress, all things that can negatively impact our heart. Omega-3 that we can get from our
daily diet is excellent, but your doctor can also prescribe a higher dose during the correct
circumstances if you are at a higher risk of damage to your heart health.

References
1. Cardiovascular diseases. (2019, June 11). ​
https://www.who.int/health-topics/cardiovascular-
diseases#tab=tab_1
2. Dix, M. (n.d.). Oxidative stress: Definition, effects on the
body, and prevention. Healthline.
https://www.healthline.com/health/oxidative-stress#effects
3. Dubois-Deruy, E. (2020). Oxidative Stress in Cardiovascular
Diseases. PubMed.
https://pubmed.ncbi.nlm.nih.gov/32937950/#:~:text=At%20ca
rdiovascular%20levels%2C%20oxidative%20stress,%2Freperf
usion%2C%20or%20heart%20failure
4. The effect of omega-3 supplements on antioxidant capacity
in patients with type 2 diabetes. (n.d.). PubMed Central
(PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678224/
5. The effects of fish oil on cardiovascular diseases:
Systematical evaluation and recent advance. (n.d.). PubMed
Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767101/#:~:
text=After%20a%20mean%20follow%2Dup,%3D%200.009)%2
0(119)
6. Jain, A. (2015). Omega-3 fatty acids and cardiovascular
disease. PubMed.
https://pubmed.ncbi.nlm.nih.gov/25720716/#:~:text=Omega%
2D3%20fatty%20acids%20have,to%20treat%20hyperlipidemia
%20and%20hypertension
7. Omega-3 fatty acid supplement use and oxidative stress
levels in pregnancy. (n.d.). PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584173/#:~:t
ext=adverse%20birth%20outcomes.-,Omega%2D3%20fatty%2
0acid%20(n%2D3%20FA)%20supplementation,3%20FA%20in%
20cell%20membranes
8. Omega-3 fatty acids. (2023, October 16).
https://ods.od.nih.gov/factsheets/Omega3FattyAcids-
Consumer/
9. Omega-3 fatty acids: An essential contribution. (2023,
September 14). The Nutrition Source.
https://www.hsph.harvard.edu/nutritionsource/what-
should-you-eat/fats-and-cholesterol/types-of-fat/omega-3-
fats/
10. Omega-3 supplements: In depth. (n.d.). NCCIH.
https://www.nccih.nih.gov/health/omega3-supplements-in-
depth#:~:text=Several%20products%20containing%20omega
%2D3s,triglyceride%20levels%20are%20very%20high

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 VOLUME: 2

STEPPING INTO THE FUTURE:

PERSONALIZED ORTHOTICS THROUGH 3D
PRINTING
BY DIANA CHENG

Orthotic devices have long been

essential tools for individuals
seeking improved support and
mobility. The advent of 3D printing
technology has revolutionized
orthotics by enabling the creation
of customized devices. Let's delve
into how 3D printing is shaping the
world of orthotics for better
comfort, function, and quality of
life.

Orthotic needs vary greatly among

individuals. The National Center
for Biotechnology Information
highlights that orthotic devices
must be meticulously tailored to
an individual's anatomy for
optimal effectiveness.

3D printing technology enables precise customization. A study

published in the Journal of Prosthetics and Orthotics demonstrated
that 3D-printed orthotics significantly improved comfort, fit, and
overall satisfaction compared to traditional off-the-shelf options.

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Mobility is essential
to an individual's
well-being.
According to the
World Health
Organization, over
75 million people
worldwide require
a wheelchair for
mobility assistance.

3D-printed orthotics address these needs. A case study published in

the Journal of NeuroEngineering and Rehabilitation showcased how a
customized 3D-printed ankle-foot orthosis dramatically improved a
patient's gait pattern and mobility, enhancing their independence.

Traditional orthotics can be costly and time-consuming to produce.

However, 3D printing offers cost-effective solutions by reducing
material waste and production time.

A study in the Journal of Additive Manufacturing found that 3D-

printed orthotics are not only affordable but also readily accessible.
This technology democratizes orthotic care by making personalized
devices available to a broader range of individuals.

The era of personalized orthotics has arrived, thanks to 3D printing

technology. The evidence underscores the transformational impact of
customized orthotics in enhancing comfort, mobility, and quality of
life. By embracing the precision and accessibility of 3D-printed
orthotics, we are stepping into a future of improved well-being.

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 THIS LETTER WAS APPROVED BY CO-FOUNDERS
KAMRAN SHUKOOR AND IBRAHIM TARIQ

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