“God contracts and expands.” (2:245)

The heart is a fairly small muscle that beats 100,000 times a day and produces roughly 115,000 Joules of energy, enough to boil a cup of water for some tea. Like a flowing river, deoxygenated blood travels from the right side of our body to the right side of our heart via valves and chambers until passing through our lungs, where each breath we take facilitates the oxygenation of every individual blood cell with 4 molecules of oxygen. The now oxygenated blood, continues to progress, never stopping, now through the left side of the heart, again passing through valves and chambers, eventually being pushed out to the rest of our body with the help of the left ventricle. The left ventricle is the thickest, largest, strongest, and most muscular part of the heart because it has the responsibility of pumping oxygenated blood through the aortic valve and aorta to the rest of our body. If this continual circulation is ever interrupted, it can lead to catastrophic outcomes.

There are several ways this flow can be interrupted, many of which happen before birth and require immediate surgery after delivery. Congenital heart defects (CHD) are some of the most common types of birth defects, but as medical care and treatment have advanced many of the babies that suffer from them usually end up living long and healthy lives. Treatment isn’t required while babies are in their mother’s womb, because the circulation of the heart is different before the baby takes its first breaths, and there is normally a mixing of oxygenated and deoxygenated blood. CHD can be mild, like a hole in the heart between two chambers that allows the mixing of oxygenated and deoxygenated blood. Ventricular septal defects and atrial septal defects (holes in the heart) are some of the most common forms of CHD. Sometimes these defects can be resolved on their own or may not be realized until much later in life, or they may require a “patch” repair if they are larger. VSDs and ASDs are associated with Down’s Syndrome, and maternal risk factors including diabetes, obesity, and smoking. Patent foramen ovale (a hole in the heart that fails to close) is found in up to 30% of the general population. It usually requires no treatment and isn’t discovered unless complications like a stroke occur later in life by having a blood clot form, requiring the blood to then travel through the hole, and then be shot up through the aorta into the brain. All babies are born with patent (open) ductus arteriosus – the ductus arteriosus is a fetal blood vessel that allows flow from the right heart to the aorta, necessary when the baby is in their mother’s womb, but incompatible for life after the baby is born. Within the first few days of life, this blood vessel should close and eventually transform into a ligament that helps tether the pulmonary artery and aorta to each other. If closure fails and the ductus arteriosus remains patent, a continuous machine-like murmur can be heard with a stethoscope, and treatment with indomethacin is started. Untreated, a PDA would result in cyanosis (blue/gray skin) and Eisenmenger Syndrome due to decreased oxygen delivery [1].

The heart’s responsibility is not only to provide oxygenated blood to the rest of the body but to also somehow feed itself. The heart’s muscles exhaust 11.6% of the body’s total oxygen consumption in order to maintain its own contractile activity, coming in 3rd after the liver (20.4%) and the brain (18.4%). During contraction or systole, the heart pumps at 120 mm Hg to provide blood through the aorta and arteries. During relaxation, or diastole, the heart expands and allows for blood to fill into its chambers and also flow through the coronary arteries. These coronary arteries are the arteries that will feed the heart itself. Thus, in order to feed itself the heart must relax and therefore allow its coronary arteries to expand and provide blood to itself. When the heart is contracting and providing blood to the rest of the organs it is too constricted to provide blood to itself. Since these branches are located within grooves of the heart, when the heart is systole the arteries are too constricted for blood flow due to increased tension. This is especially true regarding the arteries supplying the left ventricle since it is larger and more muscular – remember this is where the aorta will branch off, providing oxygenated blood to the rest of our body.

This balance between contraction and expansion may remind some readers of the concepts of Qabd (contraction) and Bast (expansion) in Sufism or Tzimtzum in Jewish mysticism, and how one truly feeds the other thus allowing for growth through this cycle of contraction and relaxation. Tzimtzum is used to explain the process of creation, a contraction of infinity happening to give birth to a finite universe [2]. The Sufi tradition is a personal journey described as “contraction and openness are mysterious ‘bargains’ that have been made without the will or intention of the traveler. The first one blocks his or her way; the second one gives him or her wings to fly to new heights [3].” What is perhaps most interesting is that our physical heart performs this contraction and expansion perfectly so long as we take care of it, whereas our spiritual heart can have lapses in this critical exercise. Maybe, if we understand how to take care of our physical heart, we will also find the answer to keeping our spiritual heart healthy. Prophet Muhammad, peace be upon him, emphasizes this connection as follows: “Verily, in the body is a piece of flesh which, if sound, the entire body is sound, and if corrupt, the entire body is corrupt. Truly, it is the heart.”

Some ways to take care of our physical hearts include incorporating more physical activity into our daily lives, eating less and healthy, and controlling our stress. Perhaps our spiritual health would also benefit from these and similar activities, including regular acts of worship, fasting, controlling our temper, and being kind to others. When we don’t take care of our physical heart, it begins to fail since oxygen ceases to be delivered to our heart and the electrical currents can no longer travel effectively, thus resulting in a heart attack.

Coronary artery disease is the leading cause of death worldwide, and especially in developed countries. The deadliest heart attack occurs if there is a blockage of the left anterior descending coronary artery, which is why it is tragically termed the “widow maker.” Beginning from adolescence, arteries begin to accumulate fatty streaks and progress to an atherosclerotic plaque. This plaque can lead to several disastrous complications such as follows:

• a narrowing or complete obstruction of an artery, impairing blood flow and leaving the heart thirsty for oxygen
• a stroke due to a blood clot caused by decreased movement, breaking off and flowing to the brain
• a weakening of the vessel wall leading to an aneurysm, the vessel bursting

For some patients, a heart attack becomes a wakeup call in order to make the many necessary lifestyle changes that are necessary in order to live a long and healthy life. However, 20% of patients will experience a second heart attack. As the heart gets weaker and weaker it can eventually develop cardiorenal syndrome, a complication that results from the heart being unable to pump effectively resulting in it getting backed up in the heart and the right side of the body. This increase in volume in the body is further exacerbated by the kidneys, which continue to retain fluids and thus cause the body to become overloaded. This leads to edema, or swelling, in the legs that can eventually progress to the lungs and cause congestive heart failure. As the kidneys try to ameliorate the fact that the heart is not pumping effectively, they ultimately worsen the situation leading to end-stage renal disease and stage D heart failure.

Of course, as with almost all medical conditions, these fatal results can be prevented much earlier with lifestyle changes, even before introducing medical intervention with prescription drugs or other procedures. These lifestyle modifications include moderate aerobic exercise at least 3 times a week, a diet rich in vegetables and low in fats, sugars, and carbohydrates, smoking and alcohol cessation, and weight reduction (which would come as a result of these modifications). It is also important for patients that are already dealing with hypertension, diabetes, and hyperlipidemia should keep them well-managed and controlled.

Maybe similarly, some simple lifestyle changes, such as putting aside a few minutes every day to reflect, can be the secret to keeping our spiritual heart healthy. Our heart must remain healthy to keep the rest of our body healthy. Considering the close relationship between our physical and spiritual heart, our spiritual heart must be kept healthy to keep the rest of our spiritual body healthy. Spiritually healthy individuals will further reinforce the health of our community, for Prophet Muhammad, peace be upon him, says, “The believers in their mutual kindness, compassion and sympathy are just like one body. When one of the limbs suffers, the whole body responds to it with wakefulness and fever.”

“As the whole of existence is in His grasp and at His free disposal, it is He Who directs and disposes of all things, from the heavens to the human heart… When God wills, He contracts a heart so tightly for what only He can provide that only He can satisfy it. By contrast, He expands and exhilarates it to such an extent that it needs nothing. Contraction is caused by God’s Majesty; openness is caused by His Grace. (Fethullah Gülen, Emerald Hills of the Heart).”

References

• https://www.heart.org/en/health-topics/congenital-heart-defects
• https://www.britannica.com/biography/Isaac-ben-Solomon-Luria#ref163236
• http://fgulen.com/en/fethullah-gulens-works/key-concepts-in-the-practice-of-sufism-1/qabd-and-bast-contraction-and-openness

In his Twentieth Word, Bediuzzaman Said Nursi, a 20^th century Islamic scholar and teacher, uses an interesting phrase, where he argues that the miracles of the prophets represent the highest points that scientific developments would ever attain and as such, they are set as goals which humanity should seek to accomplish. In interpreting the verse about the miracles of Jesus, upon whom be peace, in which it is said that Jesus would raise people from the dead by God’s leave, Bediuzzaman Said Nursi indicates that there is a cure to every disease which can be found through research. He also employs an interesting phrase in this section: “It is even possible to give a temporary tinge of life to death” [1]. While some suggest that with this intriguing sentence Nursi points to recent developments in medicine such as those involving organ transplantation or the use of ventilators, it appears that this phrase implies going one stage further.

The Holy Qur’an relates several miraculous events regarding raising the dead in the present, worldly life. In Chapter Baqara (2:67-73), the Holy Qur’an tells us of the incident upon which the chapter was named: Prophet Moses, upon whom be peace, and his people were told by God to slaughter a cow and strike a dead person with part of the slaughtered cow, afterwards the dead man was resurrected and told them who had killed him. Thus, the Qur’an reasserts that God Almighty has the power to resurrect people. Reflecting on this verse, Fethullah Gülen maintains that in addition to the miraculous nature of striking the dead body with a piece of the cow, the mention of this incident may imply that humanity is guided toward a scientific or technological goal [2]. In medicine, biological drugs used to treat certain diseases are produced from certain animals. Also, certain medications, such as insulin, can be produced making use of the ability of bacteria to produce genetically coded proteins. Perhaps, biological drugs to be obtained with the help of other living organisms may contribute to being able to give a temporary tinge of life to death. In this regard, researchers are particularly interested in stem cells and their potentials. In this method, it may be possible to use a person’s stem cells to produce organs, tissues, and replace malfunctioning organs with new ones without the risk of rejection. We have so far heard no positive results in these directions, but it was demonstrated that stem cells taken from a person and transplanted into an embryo of another living being started to grow [3]. God knows best, but this method may be part of the truth behind the act of striking the man’s corpse with a part of a cow in reference to the verse in question.

Chapter Baqarah gives two more examples concerning resurrection in worldly life. A man passed by a town that had fallen into utter ruin and asked himself in bewilderment, “How will God restore life to this town that is now dead?” God made him remain dead for a hundred years and then raised him to life, and asked him, “How long did you remain in this state?” He said: “I remained so for a day or part of a day.” God said, “No, you have rather remained thus for a hundred years. But look at your food and drink: it has not spoiled; and look at your donkey!” The verse tells us that only bones were left of the donkey (2:259).

The next verse is about Prophet Abraham, upon whom be peace, who prayed God to give him certainty in the heart about resurrection. He had to kill four birds and then put them on different hills which resulted in them being restored to life and flying back to him (2:260). While it may not be related to resurrection fully, the story of Ashab al-Kahf (“People of the Cave” or “Seven Sleepers”) is certainly intriguing and carries a similar theme. God made seven men fall sleep in a cave for roughly 300 years and then restored them to life temporarily, however they had believed that they had fallen asleep for only a very brief period. They were probably considerably skilled and well-educated young people with high positions in society, however falling asleep for three centuries caused them to lose their positions and possibly disappoint those who had invested in them at that time. Yet God Almighty’s wise purpose requires otherwise by making those people send a message to future generations, i.e., us, and giving them praiseworthy remembrance after their death. The same sura also describes the travels of Prophet Moses, upon whom be peace, accompanied by Yusha’ ibn Nun, during which the cooked fish they were carrying with them for supper was resurrected and swam into the sea (18:61-64). In a tradition of Prophet Muhammad, peace and blessings be upon him, it is recorded that he talked to a dead girl by God’s leave upon her parent’s request, but the girl refused to come back to this world as she had found something better there [the Hereafter] [4]. 

The prevention of aging, alongside the wish to attain immortality, has long been one of the greatest aspirations of human beings. Several scientists and philosophers of the previous century argued that this might become possible in the 21st century. Chapter Baqarah refers to a prototypical society with greed for life, noting that people of that society wish “if only [they] might be spared for a thousand years” (2:96). Perhaps, the ultimate goal of today’s medical research is to try to ensure human beings live forever in this world. Prophet Muhammad, peace be upon him, warns that this is a vain thought, although we should seek healing by all possible means: “O servants of God, search for remedy for your diseases. Indeed, God has created no incurable disease except one: old age (or, death, in another narration)” [5]. Nobel laureate Alexis Carrel maintained that human cells are immortal under favorable conditions but Leonard Hayflick, later, demonstrated that cell divisions are limited due to DNA damage and shortening of telomeres [6, 7]. According to the Hayflick limit, the maximum lifetime a person can get even if he or she lives under the best conditions is 125 years. Telomeres are the structures located at the end of the chromosomes that protect DNA, and during cell regeneration, the length of telomeres decreases with each cell division and the number of divisions declines after a critical limit. Scientists dream of slowing down the aging process by reactivating these telomeres, but they have not made much progress despite some positive results in experiments with rats.

Big technological corporations have recently been making considerable investments in order to find ways to further increase human lifespan. Venkatraman Ramakrishan, who won the Nobel Prize in chemistry in 2009, said, “Californian billionaires are having such a good time at the party of life that they don’t want it to stop” [8]. The investments and efforts in this field do not seem very promising because the human body is not suitable for immortality. Instead, scientists are pursuing the idea of merging human brains with machines, which would require uploading a human brain to a computer. In today’s world where research on artificial intelligence is rapidly advancing, a human being’s habits and memory are supposed to be transferred to a computer. Elon Musk, the founder of Neurolink, a company that seeks to restore memory using gadgets planted into the human brain, once said that digital intelligence and biological intelligence would converge over time with increased interaction between the two. This sounds promising for the treatment of certain diseases such as Alzheimer’s. There is, however, another lead in this research according to Josh Bocanegra: “When the time comes and all the necessary advancements are in place, we’ll be able to freeze your brain, create a new artificial body, repair any damage to your brain, and transfer it into your new body” [9]. This may be an artificial body developed using stem cells with possible aid from diverse robotic devices. Ray Kurzweil, who works on Google’s machine learning project, argues that the use of tiny robotics that connect a human brain to computers may be possible by 2029, which will in turn extend human lives considerably. Another futurist, Ian Pearson predicts that in 2050, humans will achieve virtual immortality and a person’s personality transferred to a computer will be able to communicate with people in the future [9]. A recent New York Times article suggests that brain implants could change humanity [10].

Ultimately, it is hard to predict the extent of scientific and technological developments. The idea of eliminating death reminds us of Bediuzzaman Said Nursi’s saying that it is impossible for the lake of Barla (the town he lived in at the time) to be destroyed for the time being, but people can imagine such destruction and this imagination does not change the reality. Yet even the very imagination of eliminating death may serve as a false hope for people who rationalize everything and try to forget about the idea of death, and in this way, they stick to worldly pleasures more fervently. At this point, Prophet Muhammad, peace be upon him, shows us the correct manner of thinking: “Remember death frequently as it dulls out pleasures” [11].

In the Qur’an, the most important verses concerning raising the dead are about the miracles of Jesus, upon whom be peace. It is emphasized that he would breathe into something fashioned out of clay in the shape of a bird, and it would become a bird by God’s leave, and that he would revive the dead and heal ill people (3:49). As a matter of fact, Mary becoming pregnant with Jesus and Jesus speaking when he was a baby are also medical miracles. It is interesting to note that today, just as in the time Jesus, materialistic thought dominates the scientific and medical research, which are mostly construed solely with a materialist perspective. Almost all discoveries are used as evidence for disbelief, and they reinforce the self-conceit of those who make them. Bediuzzaman predicts that as Christianity will be purified from superstitions in the End Times, and that science will have the upper hand in rule and power. If such a purification will occur, then one tends to think it is not going to be only in political and administrative fields. Possibly, the change of scientific, or more specifically, medical perspective may constitute a major stage in the purification process that could save modern medicine and science from materialism and become instruments of discovering the truth. Who knows? God Almighty may make a vulnerable and weak baby speak to send a message to a purely materialistic community as a manifestation of His divine power.

References

1. Bediuzzaman Said Nursi, 20th Word, First Station, Words.
2. Fethullah Gülen, Kurandan İdrake Yansıyanlar.
3. https://www.nytimes.com/2017/01/26/science/chimera-stemcells-organs.html
4. Bediuzzaman Said Nursi, 19th Letter, Letters.
5. Bukhari, Tib 1; Abu Dawud, Tib 1; Tirmidhi, Tib 2.
6. Carrel A, Ebeling AH. Age and multiplication of fibroblasts. J Exp Med 1921.
7. Hayflick L. The limited in vitro lifetime of human diploid cell strains. Exp Cell Res 1965.
8. https://www.livemint.com
9. https://www.entrepreneur.com/article/307675
10. https://www.nytimes.com/2020/08/28/opinion/sunday/brain-machine-artificial-intelligence.html
11. Tirmidhi Hadith No. 2307.

In 1981, scientists discovered ways to derive embryonic stem cells from early mouse embryos. Since then, they have been the subject of intense scrutiny, controversy, and advocacy.

They are unique cells, which can be derived from human embryos and can be differentiated into virtually any kind of different cells. In humans, there are about 200 different types of cells including bone, muscle, and nerve cells, and within these cells there are about 20 different types of structures or organelles. Essentially, stem cells can be derived from human embryos, and with the right enzymes, can be stimulated. For instance, bone cells can originate from osteocyte cells, or liver tissues can come from hepatocytes.

Stem cell types and research

There are three types of stem cells:

• Embryonic stem cells
• Adult stem cells
• Induced Pluripotent Stem Cells (iPSC)

Embryonic stem cells are derived from human embryos. Adult stem cells are undifferentiated cells (meaning “clean slates” with the potential to change into another cell variant) found throughout the body after development; they multiply via cell division to replenish dying cells and regenerate damaged tissues. Induced Pluripotent Stem Cells (iPSC), which were discovered in 2006, are derived from skin or blood cells that have been reprogrammed back into an embryonic-like pluripotent state that enables the development of an unlimited source of any type of human cell needed for therapeutic purposes. While these types of cells are interesting and certainly worthy of research, this article will focus on embryonic stem cells as they are consistently the most well-known and discussed type by the general public.

Embryonic stem cells are potent and often sought after due to their abilities to proliferate without limit and contribute to any cell type. However, with great power comes great responsibility and stem cells are no exception. Poorly processed cells have been documented to mutate into cancerous tumors that can wreak havoc upon people’s bodies. Bearing this in mind, scientists also do not believe that this should derail stem cell therapies considering that there are DNA tests to check if stem cells will turn out to be problematic or not.

The stem cell project is regularly a subject of ethical debate in both the academic and public sectors. Most embryonic stem cells are derived from embryos that develop from eggs that have been fertilized in vitro—in an in vitro fertilization clinic—and then donated for research purposes with the informed consent of the donors. People willingly donate their eggs for this research, and this process does not constitute child-killing since the eggs are near their zygote phase, not a whole mature embryo. Scientists obtain those types of cells from an embryo which has not yet completed its formation to develop into a human being. Researchers then use these cells for various treatment and research purposes. It is important to stress that they are not derived from eggs fertilized in a woman’s body and that they are produced in a plastic laboratory culture via clinics in vitro.

Some examples of embryonic stem cells being used in research include the following:

1. UCLA stem cell gene therapy cures bubble baby disease

Researchers at UCLA (University of California, Los Angeles) have developed a cure for babies born with Bubble Baby Disease, a rare and life-threatening condition that can be fatal within the first year of life, by using stem cells from multiple patients and gene therapy to correct the genetic mutation of these patients.

2. Asterias biotherapeutics restores some independence to those suffering from paralysis caused by spinal cord injuries

Asterias Biotherapeutics spent much of 2016-2017 developing a stem cell therapy to restore upper body motor function to quadriplegic spinal cord injury victims. Through lengthy and rigorous testing in human clinical trials, the therapy was found to be safe for use in people with all patients treated reporting at least some improvements. Asterias is now expanding its clinical trials to include patients with sub-acute injuries.

3. UC Irvine scientists engineer stem cells to destroy cancer

In a study conducted by University of California, Irvine researchers, a stem cell-based technique was devised to find and destroy breast cancer cells that had already metastasized. The cells “feel” the stiffness of the surrounding tissues and destroy the cancer-causing cells.

Embryonic stem cells can remain undifferentiated when they are grown in a well taken care of culture that is under stable conditions. Problems primarily begin to arise if cells are allowed to clump together to form embryoid bodies in which they begin to differentiate, or change into more specific cell variants, spontaneously. Although spontaneous differentiation is a good indication that shows which cultures of embryonic stem cells are healthy, the process is uncontrolled and, therefore, an inefficient strategy to produce cultures of specific cell types.

The ability of stem cells being able to differentiate into hundreds of other types of cells continues to amaze scientists as this is no small discovery. Researchers believe that the possibilities with stem cells are near endless, especially in regard to “regenerative medicine,” the process of “replacing, engineering, or regenerating human cells, tissues, or organs to restore or establish a new function.” It is even believed that even whole organs could be synthetically grown by using them.” Additionally, stem cells have the potential to rebuild healthy tissues, help people with heart disease, diabetes, ALS, Alzheimer’s disease, liver disease, Parkinson’s disease, cancer, and many more illnesses.

In a stem cell transplant, embryonic stem cells are first specialized into the necessary adult cell type. Then, those mature cells replace tissue that is damaged by a disease or injury. This type of treatment could be used to:

• Replace neurons damaged by spinal cord injury, a stroke, Alzheimer’s disease, Parkinson’s disease, or other neurological problems.
• Produce insulin that could treat people with diabetes and heart muscle cells that could repair damage after a heart attack
• Replace virtually any tissue or organ that is injured or diseased.

Sometimes scientists use stem cells as a drug. For example, it is possible to inject a stem cell into joints to reduce swelling and pain, or in order to promote the healing processes of soft tissues. Stem cell therapy is performed by injecting the patient’s own stem cells to stimulate the body to repair and replace damaged tissue in any joint or soft tissue structures – such as knees, shoulders, hips, wrists, ankles, elbows, tendons, ligaments and non-healing bone fractures. Cellular Dynamics, a large biotechnical company, sells human heart cells called cardiomyocytes that are derived from induced pluripotent stem (IPS) cells. Pharmaceutical companies are adapting to this new and innovative trend on a day-to-day basis. Stem cells can also be used to test the quality and safety of investigational drugs by testing them on stem cells that have been transformed into tissue-specific cells. Researchers are able to monitor the side effects before exposing the drug to a patient and thus have a greater expectancy of how their body may respond to the drug. This allows us to test for cures for potentially fatal diseases in ways that would otherwise be risky or unethical.

With all of the aforementioned advantages, stem cells are a fairly new, but exceptionally promising, research area. For some people, it may seem unethical to use stem cells on the grounds that extracting stem cells damages the blastocyst, which is a structure formed in the early development of mammals, more specifically the sixth or the eighth day of the development of an embryo. In 2006, President Bush vetoed the Stem Cell Research Enhancement Act stating that the federal government should not support “the taking of innocent human life.” Although stem cells are very promising for science and can open new doors to many new treatments in the medical field, it looks like there are still differences of opinion on their ethical use. This is perhaps because there is need for more convincing evidence or people are not informed accurately on the details of this research area.

References

• https://stemcells.nih.gov/info/Regenerative_Medicine/2006Chapter1.htm
• https://www.healthline.com/health/stem-cell-research
• https://www.statnews.com/2017/04/26/stem-cells-cancer-mutations/
• https://plato.stanford.edu/entries/stem-cells/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398703/
• https://www.mayoclinic.org/documents/the-amazing-stem-cell/doc-20249792
• https://www.unmc.edu/stemcells/educational-resources/history.html
• https://www.cirm.ca.gov/patients/power-stem-cells
• https://www.nature.com/news/stem-cells-take-root-in-drug-development-1.10713
• https://hsci.harvard.edu/examining-ethics-embryonic-stem-cell-research#:~:text=Opponents%20argue%20that%20the%20research,taking%20of%20innocent%20human%20life.%E2%80%9D

“Free radicals” are a special type of atom that have been linked to many age-related diseases. They form as a result of a process called Oxidative Stress, which takes place when an oxygen molecule splits into single atoms with unpaired electrons. The nature of electrons is such that they like to be in pairs and as a result will “freely” and “radically” search throughout the body for another electron to pair with. They could almost be considered romantic if they were not so dangerous!

Their main danger comes from the damage that they cause to cells or cell membrane, proteins, and DNA. Cellular damage occurs when free radicals travel through cells and disrupt the structures of other molecules. The gradual accumulation of them, and the increased damage that builds as more and more of them collect, is what helps cause many of the aforementioned aging diseases. Our body is under constant assault from oxidative stress, and cells may function poorly or die if it occurs too frequently and without proper bodily maintenance.

Free radicals are a waste byproduct that form as a result of various chemical reactions that take place during our bodies’ normal metabolic processes. They are then “dumped,” and their eventual buildup will often harm our bodies much like how factory waste harms the environment However, they are not entirely useless; it is impossible for our bodies to turn air and food into chemical energy without a chain reaction of free radicals. Free radicals are also a critical part of the immune system, as they additionally move through our veins and can confront foreign invaders [1].

What are free radicals?

Understanding free radicals necessitates an elementary knowledge of chemistry.

Electrons orbit around atoms in levels called shells. Each shell is filled by a fixed number of electrons, and when the first shell is full then electrons will start to fill the next shell.

If there is an atom whose outer shell is not full then it may bond with another atom by using the electrons to fill its outer shell. These types of atoms are known as free radicals.

Atoms that have a full outer shell become stable, however free radicals are unstable. They are “desperate” to acquire the full number of electrons that are necessary to fill all of their shells and will therefore react quickly with other substances.

Take the example of oxygen molecules. If they split into single atoms that have unpaired electrons then they too will become unstable free radicals that seek other atoms or molecules to bond to. If this procedure continually occurs, then it will begin a process called oxidative stress.

Smoking, UV rays, air pollution, fast food, pesticides, ionizing radiation, drugs, and inflammation have all been linked to the formation of free radicals. We must be diligent when it comes to understanding how these influences can affect our bodily health, and then fight back with natural antioxidants.

Free radicals are heavily linked to aging

One of the effects of oxidative stress is that it can damage our body’s cells and thus promote many of the diseases and symptoms related to aging, such as wrinkles and gray hair. They will take electrons from other atoms in order to become more stable, a process that may cause diseases or signs of aging [2].              

In 1956, the “Free Radical Theory of Aging” was outlined as a way to understand how exactly our bodies age over time. Everybody ages, and as we age our body loses its ability to fight the effects of free radicals. Over time our bodies produce more free radicals and more oxidative stress, which increases the rate at which cells are damaged and thus can bring about degenerative processes.

Many age-related diseases such as muscular degeneration, certain cancers, atherosclerosis, cardiovascular disease, emphysema, Alzheimer’s disease, Parkinson’s disease, ulcers and all inflammatory diseases such as arthritis and lupus, and many others are linked to free radicals. Free radicals can be found in the food we eat such as fried foods, the medicines we take, the air we breathe, and the water we drink. Free radicals are also found in alcohol, tobacco smoke, pesticides, and air pollutants.

Several studies and theories have been linked to oxidative stress and the buildup of free radicals including: [3]

• Genetic degenerative diseases, such as Huntington’s disease or Parkinson’s
• Age-related changes in appearance, such as loss of skin elasticity, wrinkles, graying hair, hair loss, and changes in hair texture
• Cataracts and age-related vision decline
• Diabetes
• Cancer, which is associated with chromosomal effects and oncogene activation due to the reaction of free radicals [2]
• Central nervous system diseases, such as Alzheimer’s and various forms of dementia
• Cardiovascular diseases due to clogged arteries
• Autoimmune and inflammatory disorders, such as rheumatoid arthritis and cancer

The free radical theory of aging is comparatively new; however, several studies boost its credibility. Researchers focused on cell’s mitochondria, the “powerhouse” that process nutrients to power the entire cell. Experiments on rats, for example, showed a noteworthy increase in free radicals as the rats aged. These alterations coincided with age-related declines in their health. These experiments also showed that free radicals produced in the mitochondria harm the substances that the cells need in order to work properly. This damage causes mutations that produce more free radicals, thus accelerating the process of damage to the cell. This helps explain aging since aging quickens over time. The gradual, but increasingly rapid buildup of free radicals, offers one explanation for why even healthy bodies age and depreciate over time [2].

Antioxidants can stave off free radicals

Antioxidants, molecules that prevent other molecules from oxidizing and thus undergoing oxidative stress, can help to avert the harmful effects of free radicals. They can also decrease or even nullify the effects of free radicals, as they can provide an electron to free radicals and thereby reduce their reactivity. The uniqueness of antioxidants is that they can donate an electron without becoming reactive free radicals themselves.

There is no single antioxidant that can combat the effects of every free radical. Free radicals have different effects in different areas of the body, and every antioxidant performs differently due to its chemical properties. Antioxidants such as vitamins C and E, beta-carotene, glutathione, and plant estrogens called phytoestrogens all scavenge the body and help remove free radicals. Honey can also function similar to antioxidants by removing free radicals. Additionally, selenium, a trace metal that is required for proper function of one of the body’s antioxidant enzyme systems, is sometimes included in this category. The body cannot manufacture these micronutrients so they must be supplied in the diet.

Foods that are rich in antioxidants include citrus fruits such as oranges and limes, berries, and many other fruits that are rich in vitamin C. Carrots are known for their high beta-carotene content, while the soy in soybeans, and some meat substitutes, are high in phytoestrogens. Apricots, spinach, mangoes, pumpkins, broccoli, and eggplants are all also helpful, along with a plethora of other fruits and vegetables [4].

More research needed

A 2010 study on antioxidant supplementation for the prevention of prostate cancer found no benefits. Furthermore, a 2012 study found that antioxidants did not lower the risk of lung cancer. On the other hand, the study found that people who were already at a heightened risk of cancer, such as smokers, actually had a slightly elevated risk of cancer due to antioxidants.

Some investigators have found that supplementation with antioxidants is injurious when people take more than the recommended daily allowance (RDA). A recent analysis found that high doses of beta-carotene, or vitamin E, appreciably increased the risk of dying. One study found that long-term use of beta-carotene could reasonably reduce the risk of age-related mental problems [4]. But perhaps one of the most important discoveries is that antioxidants are unable to “cure” the effects of free radicals completely [5].  

Additionally, we do not yet fully understand why free radicals form in the first place. They may result as an early sign of cells fighting diseases, or that free radical formation is simply a natural expectation that comes with aging. It is not possible to understand them completely without more conclusive research, which should be encouraged considering the significant impacts that free radicals can have upon our bodies.

References

1. https://www.rice.edu/~jenky/sports/antiox.html
2. https://www.medicalnewstoday.com/articles/318652#How-do-free-radicals-damage-the-body
3. http://www.mytruehealth.info/mytruehealth_antioxidants_freeradicals.html
4. https://www.medicalnewstoday.com/articles/318652#Antioxidants-and-free-radicals
5. https://www.medicalnewstoday.com/articles/318652#What-we-do-not-know

Most of us have taken, or at least interacted with, medicine at some point or another in our lives. This can range from more “simple” over-the-counter drugs to more complex medicines specifically designed for exact illnesses. Considering the Covid-19 era we are going through and as search for a vaccine is at the highest possible speed, it is important to have at least a general idea on how medicines are developed for our use. This article aims to explore how a complicated mix of chemical compounds in a laboratory end up as pills on a shelf in your local pharmacy. We will also explore a brief history of pharmacology, where drugs get their names, how drugs come into fruition, the various affects that drugs can have on our bodies, along with the discrepancies that exist between them in regard to when, how, and why they should be taken.

Pharmacology is the study of the interactions that occur between a living organism and the chemicals that affect normal or abnormal biochemical functions. It includes the study of how a drugs can affect our biological systems, such as individual organs or an entire part of the body, and how the body overall responds to the drug. The discipline encompasses the sources, chemical properties, biological effects and, therapeutic uses of drugs. Substances with medicinal properties are considered pharmaceuticals, whereas drugs given for therapeutic purposes are usually called medications. Drug therapy, which is also called pharmacotherapy, is the use of drugs to prevent, diagnose, and treat signs, symptoms, and disease processes. When prevention or cure is not a reasonable goal, relief of symptoms can greatly improve quality of life and the ability to function properly on a day-to-day basis. Developing an understanding of this craft can allow us to better appreciate how molecules interact to form the drugs and medicines that can change our lives, and perhaps even allow us to contemplate their complex creation and existence.

In its most simplistic definition, a medication is a substance that is ingested or placed onto the body in order to cure a disease or condition (antibiotics are given to cure an infection), treat a medical condition (anti-depressants are given to treat depression), relieve symptoms of an illness (pain relievers are given to reduce pain), given to prevent diseases (flu vaccine helps to prevent the person from complications of having the flu).

Source of drugs

Historically, drugs were mainly derived from plants, animals, and minerals. Morphine, insulin, and iron are all commonly used examples of their respective sources. Belief in the curative powers of plants and certain substances rested exclusively upon traditional knowledge. But empirical information was not subjected to critical examination. Until the end of the 19th century, medicines were made by natural organic or inorganic products including mostly dried or fresh plants and their parts. These compounds might contain substances that possess healing properties or reactions that exert a toxic effect. It is important to remember that many fruits, vegetables, and plants still possess great power despite not having a “modern” origin.

Most drugs used nowadays are synthetic chemical compounds manufactured in laboratories which are synthesized by altering the chemical structure of an existing drug. The first drug of a particular group of drugs are called prototypes. For example, morphine is the prototype of opioid analgesics, and penicillin is the prototype of antibacterial drugs. Drug classifications and prototypes are defined and most new drugs can be assigned to a group. We must be hopeful and continue to search far and wide for cures for all  diseases, whether they be organic or synthetic, since our world is full of an infinite amount of possibilities and discoveries.

Drug names

The systematic naming of pharmaceutical drugs is called “drug nomenclature.” Drugs primarily have three types of names: chemical names, generic names, and trade names. The chemical names are the scientific names that often sound complex and are based upon the molecular structure of a drug. During development, the company will apply for regulatory approval of the drug by the relevant national regulatory agency, such as the U.S. Food and Drug Administration (FDA), and will be granted a generic name for it. Generic names usually indicate, via their stems, what drug class the drug belongs to. For example, oseltamivir is an antiviral drug because its name ends in the -vir suffix.

After development, testing, and regulatory acceptance of a drug, the pharmaceutical company gives the drug a trade name, which is a standard term in the pharmaceutical industry for a brand name or trademark name. Many drugs have multiple trade names which can reflect separate marketing strategies in different countries, manufactured by different companies, or both.

Drug investigation

A new drug investigation is the beginning of the journey of a chemical compound to a drug that will be used in clinics. The testing process of a chemical compound begins with animal studies to determine potential beneficial uses and also potential toxic side effects of the candidate compound.  The results from these animal studies are reviewed, and if the results are satisfactory, the compound then undergoes clinical trials in humans that people can voluntarily sign up for. Most clinical trials use a randomized, controlled experimental design that involves selection of subjects according to established criteria, random assignment of subjects to experimental groups, and administration of the test drug to one group and a control substance to another group.

Patent protection

New drugs that are developed by pharmaceutical companies will be covered under patent protection. This means that only the pharmaceutical company that holds the patent is allowed to manufacture, market, and eventually profit from the drug. This is seen as a return on the company’s investment that it took to develop the drug, which may require years of work and millions of dollars, along with an incentive for developing other drugs. Other pharmaceutical companies cannot manufacture and market the drug during the patent period.

Usually, the drug patent is awarded for around twenty years in the United States, however the number of years varies across countries and drugs. Pharmaceutical companies apply for a patent long before the clinical trial period even begins. The effective patent period after the drug has finally received approval is often around seven to twelve years. After the patented period expires the drug can be manufactured and sold by other companies. The drug is referred to as a generic drug at this point, and they are required to be therapeutically equivalent and much less expensive than trade name drugs.

Pharmacoeconomics

Pharmacoeconomics involves all of the costs that are accrued due to drug therapy and experimentation including those related to purchasing supplies, dispensing the drug, storing it, administrative fees, laboratory and other tests that are used to monitor patient responses, and losses from expiration. The length of a patient’s illness or hospitalization is also considered. While the most important factor is the health of the patient the costs for treatment are increasingly being considered as a major factor when choosing medications, and research projects that compare costs have greatly increased in recent years. The goal is to make it easier for patients to choose the most cost-effective drugs that combine high quality treatment at an affordable price. For drugs or regimens of similar efficacy and toxicity, there is considerable pressure upon doctors and pharmacies to prescribe less costly drugs for shorter duration.

Prescription and non-prescription drugs

In many countries, consumers have two legal routes of access to therapeutic drugs. One route involves a prescription or order from a licensed health care provider, such as a physician, dentist, or nurse practitioner. The other route is by over-the-counter (OTC) purchase of drugs that do not require a prescription. Both of these routes are regulated by various drug laws that change from country to country. Acquiring and using prescription drugs for non-therapeutic purposes, by persons who are not authorized to have the drugs or for whom they are not prescribed, is illegal.

The rejection of drugs in modern society

Nowadays, there are some people who deny various kinds of treatments because of their religious beliefs. This category of people is only a minority, as the majority of religions advocate for people to be healthy and to take care of their health as much as they can. In almost all belief traditions, the human body is believed to be a trust, and in case of any disease, the most appropriate and fastest treatment methods should be used. Even substances that are not normally permitted are allowed by scholars to be used if the person’s safety is concerned. For believers, the most important goal in life is to worship God, and for this to be possible the body must be healthy.

One day, people asked Prophet Muhammad, peace be upon him:

“Should we make use of medical treatment?”

He replied: “Make use of medical treatment, for God has not made a disease without appointing a remedy for it, with the exception of one disease, namely old age.”

People are encouraged to seek out those remedies and to use them with skill and kindness. Let us also remember that Jesus, peace be upon him, too, was very active in his ministry of healing. He showed by God’s permission miracles like curing the blind and the deaf, and bringing the dead back to life. Thus, religions do not refuse treatment with any available methods, and they even strongly encourage treatment and prevention of diseases.

Religions are also well known to treat stress, which wreaks havoc on the mind and body. It is still not known exactly how stress harms our health, but researchers have found that chronic psychological stress is associated with body’s losing its ability to regulate the inflammatory response. It has been shown that the effects of psychological stress on the body’s ability to regulate inflammation can promote the development and progression of disease. We know that religions and beliefs give people hope and significantly decrease the stress.

Human beings are the most precious creation, and health is necessary for us to achieve the purpose of our existence. Using scientific medicine together with faith and religion can help people to protect their health. Being the science of drugs and by investigating new drug therapies, pharmacology helps us exactly with that.

History of Pharmacology

Claudius Galen (129–200 A.D.) was the first person who attempted to consider the theoretical background of pharmacology.

Ali al-Tabari (838 A.D.) Medieval Islamic physicians used natural substances such as Papaver somniferum Linnaeus, poppy, and Cannabis sativa Linnaeus, hemp as a source of medicinal drugs. Although poppy had medicinal benefits, Ali al-Tabari explained that the extract of poppy leaves was lethal, and the extracts and opium should be considered poisons (4).

Theophrastus von Hohenheim (1493–1541), also known as “Paracelsus”, began to question doctrines from antiquity. He prescribed chemically defined substances with such success that professional enemies had him prosecuted as a poisoner. Against such accusations, he defended himself with the thesis that has become an axiom of pharmacology:

“If you want to explain any poison properly, what then isn‘t a poison? All things are poison, nothing is without poison; the dose alone causes a thing not to be poison.”

Johann Jakob Wepfer (1620–1695) was the first to use animal experimentation for pharmacological or toxicological actions.

Rudolf Buchheim (1820–1879) founded the first institute of pharmacology at the University of Dorpat (Tartu, Estonia) in 1847, which firstly made pharmacology as an independent scientific discipline. In addition to a description of effects, he strove to explain the chemical properties of drugs.

Oswald Schmiedeberg (1838–1921), together with his many disciples, helped to establish the high  reputation of pharmacology. He partnered with pathologist Bernhard Naunyn (1839–1925) to found the first journal of pharmacology, which has since been published without interruption.

After 1920, the pharmacological industry had their own pharmacology laboratories outside established university institutes. After 1960, departments of clinical pharmacology were set up at many universities and in industry.

References

1. Clinical Drug Therapy: Rationales for Nursing Practice – Seventh 7th Edition, Lippincott Williams &Wilkins.
2. Basic&Clinical Pharmacology, 12^th Edition, McGrawHill Lange.
3. Modern Pharmacology with Clinical Applications, Sixth Edition, Charles R. Craig and Robert E. Stitzel, Lippincott Williams &Wilkins.

Cancer is a prevalent disease among humans and animals, affecting millions of lives across the globe. It can be caused in a variety of ways and can affect virtually every part of our bodies, ranging from skin cancer caused by prolonged exposure to the sun’s harmful UV rays to lung cancer that results from carcinogenic substances smokers inhale. However, plants do not die of cancer despite sometimes being exposed to the sun for over a thousand years – and they do not use any sunscreens!

Humans and animals who live to a certain age are very likely to get cancer one day. We see this situation mostly in our pets which have been specially bred and protected from predators and diseases. Cancer has become part of our lives and remains a top world health priority. The probability of prostate cancer is roughly 80% in 80-year-olds, 90% in 90-year-olds, and 100% in 100-year-olds. However, these statistics yet again do not apply to trees.

What is cancer?

Cancer is a disease caused by the uncontrolled growth of cells that have become abnormal in a part of the body. These abnormal cells are not foreign invaders that have entered our bodies from outside but are instead our own cells. However, in time, various factors such as radiation, viruses, and chemical substances that they are exposed to cause the accumulation of errors, or mutations, in the genetic codes of cells. Some of them then acquire very different characteristics and become alien to their own body.

With old age, errors arise in the genetic code in an increased rate when our cells divide by copying their own DNA. External factors, such as “free radicals” and various radiations that affect our DNA, play a role in these errors. For young people, when there are too many errors in a cell’s genome, a process called “apoptosis” takes place after which faulty cells die before they can multiply in a potentially cancerous manner and forming a tumor. However, sometimes these accumulated errors cause the cell’s growth process to become stuck in the “on” position, and the cell begins to grow and divide continuously. Cells that emerge with out-of-control divisions ignore the commands coming from the healthy cells of the body, continue to grow and reproduce according to the erroneous commands from the cell’s disrupted genome. This situation lasts until death.

What is a tumor?

Cell growths that result from defective genome proliferation will eventually form a mass called a tumor. Some cells grow very slowly and stop at a certain size after a while and do not spread anymore and are called benign tumors. Masses formed by fast-growing, defective (cancerous) cells are known as malignant tumors. Cells that detach from malignant tumors and grow rapidly can attach to another organ where they will begin to grow again when they enter the bloodstream. The process by which cancerous cells start from a tumor and spread all over the body to different organs is known as metastasis.

Why does this process not happen in plants?

One of the most destructive features of cancer when it enters metastasis is the mobility of malignant cells to varying degrees according to their type. Blood vessels, i.e. the transportation pathways of the circulatory system, act like a highway for cancer cells. As the blood vessels surround the entire body, a single cancerous cell can travel to and settle almost anywhere in the body, from the toes to the head.

Plant cells have a vital feature that is different from human and animal cells. In plants, cells do not change their locations because their cells are surrounded by a very rigid, strong, and impenetrable wall outside of normal plasma membranes. Cell walls are made of cellulose, which constitutes the main substance of plants, and form the wooden structures that ensure the plants stand upright and harden while at the same time locking each cell in place and preventing it from migrating within the organism.

Another important difference that is unique to plants is that they do not have blood circulation in which cells are carried; they have a circulatory system in which only water and food are carried. This system is often used to pump water from the roots to the leaves and to transport organic products such as sugar, which is a product of photosynthesis, from the leaves down. Therefore, there are no blood cells or immune system cells in these carrier channels, which are known as wood and roe tubes (xylem and phloem), in plants.

In addition, animal cells are specifically employed in tissues and organs such as muscle, bone, liver, and skin during embryonic development. Thus, when they divide only new cells of the same type are created. Tumors that occur in animal tissues can metastasize into different tissues and disrupt different organs. We can think of animal and human biology as a very complex system in which each cell, tissue, and organ has a task and purpose. In such a system, all elements work in cooperation for the continuation of life. This system is of a kind of irreducible complexity. A human being cannot live without organs like brain, heart, or lungs, while plants, on the other hand, have fewer simpler internal structures which are not as vital. When plant cells divide, they retain their ability to form new cells of any type. This is called totipotency.

In plants, every necessary structure can be recreated from the few tissues they have. For this reason, a gardener can grow new plants from the roots, branches, or leaf parts of a plant.

Plants are equipped with very powerful antioxidants to protect them from the sun’s harmful rays and mutations that may be caused by radiation. Therefore, tumors can develop only due to bacteria, viruses, fungi, parasites, and insects. For example, in a situation that we can call “information confusion” that occurs when Agrobacterium Tumefaciens bacteria insert some of its DNA into the plant’s DNA, an anomaly occurs in the plant’s genome. Cells that go through a rapid growth process and form tumors are not normally classified as cancer, since they simply remain in that area and cannot be transported elsewhere. Since the tumors cannot spread to the whole plant, they may cause only minor distress at most in a specific area rather than a fatal disease such as cancer. Just as the plant continues to grow around a rock that it encounters, it grows around the tumor as well. The tumor can continue to grow for years, but does not spread to the rest of the plant, meaning there is no metastasis.

In summary, plants can also be cancerous, but a cancerous tumor is not a deadly threat to a plant, as its cells are immobile and do not have vital and complex organs like humans and animals. Thanks to the cellulose walls gifted to the them, plants continue their role in the ecosystem by continuing to grow with healthy cells around the tumor as if nothing had happened.

References

• Luis Villazon. “Can a plant die of cancer?” www.sciencefocus.com/nature/can-a-plant-die-of-cancer
• Sam Westreich. “Do Plants Get Cancer?” medium.com/@westwise/do-plants-get-cancer-60eb435c6d1a
• Stuart Thompson. “Plants couldn’t run away from Chernobyl—but that’s what saved them. Why plants don’t get cancer.” www.popsci.com/chernobyl-plants-radiation-cancer

The foot is a limb that is not given much importance when compared to other vital organs such as the brain or heart. However, the foot is a very complex mechanical structure that is made of 26 bones, 33 joints, and more than 100 muscles and ligaments. About a quarter of the bones in the human body and about a fifth of the joints are found in our two feet. That is why Leonardo da Vinci described the human foot as an engineering and artistic masterpiece.

A healthy person takes about 5,000 steps a day. Given a life of eighty years, a person takes about 150 million steps throughout their life. Assuming that each step is 75 cm, a person walks about 110,000 kilometers throughout his life. This corresponds to walking around the equator about 3 times. Apart from that, a typical person stands for around 2-4 hours a day. During all these activities, the human foot carries the entire body’s weight. In standing position, body weight is supported by two feet while activities such as walking and running are done by only one foot for a certain period of time. While standing, the feet carry 100% of their body weight, while walking, this rate rises up to 150%. While walking, the foot that needs to be lifted from the ground approaches the ground again with an acceleration in the same direction as gravity. Therefore, the impact force at the moment the foot touches the ground corresponds to 150% of a person’s body weight. In cases of severe effects such as running and jumping, this force easily increases up to 5 times the body weight and up to 10 times in some people. For a person weighing 70 kilograms, this force can be 105 kg (or about 1050 Newton) in walking, and easily 350 kg (or about 3500 Newton) in running or jumping. Assuming that a person walking for an hour takes 5,000 steps, the foot pulls a total of about 500 tons of load (5,000 steps x 105 kg). In running, this figure will increase approximately three times.

The foot has been created with a wonderful mechanical and construction design that is able to consistently sustain such high loads. The bones and muscles of the foot add two different belt designs to it. One of them, the structure called the longitudinal belt starts from the heel bone (calcaneus) and ends with its metatarsal bones (Figure 1). Some researchers claim that the long arch is divided into two parts as the inner (medial arch) and the outer arch (lateral arch). However, both structures resemble bridges built in arches. The second arch on the foot is called the transverse arch. This belt is perpendicular to the long belt from the right side of the foot to the left side and is shorter in length (Figure 2).

Therefore, the foot is a marvelous structure consisting of roughly two arches. This structure of the foot can be compared to arch bridges or a dam. The arch structure is known as the strongest structure against steep loads in construction areas due to the robustness of the designs against compression forces in cases of vertical loading. Therefore, hydroelectric dams are constructed in the form of arches or arcs in order to make the most resistant model against hydrostatic pressure.

The arch structure of the foot is very flexible and can also move up and down like a car suspension and acts as a shock absorption. If there was no such structure on the foot, the impact forces during walking and running activities would be higher and cause chronic foot pain. The flatfoot complication is a result of a damage in the arch structure in the foot which comes from birth or develops afterwards. Flatfoot patients are often unable to perform long-term activities and experience foot pain as well as complications in other organs of the body.

Our feet’s arch structure is not the only factor involved in shock absorption that is designed against mechanical forces. The layer of fat on the bottom of the foot also contributes to this process. In a healthy person, this fat layer, which has a height of 2.5 cm under the heel, drops to 5-7 mm in the front part of the foot. It also helps to distribute the vertical and horizontal forces caused by standing or walking evenly on the sole of the foot. At the same time, it serves as a source of heat insulation and helps protect our feet from hot or cold surfaces. In some diseases such as diabetes, in which this fat layer melts or decreases, wounds called foot ulcers can develop because the shock absorption and load distribution get damaged. Mechanical pressure is calculated by dividing the amount of mechanical force by the surface area on which it is applied, meaning that smaller surfaces areas are subjected to more pressure. This is why very tiny needles, despite weighing almost nothing, can pierce our skin and cause pain. Similarly, damage to the fat layer under the foot causes the forces applied under the foot to act on a limited surface area. For example, the reduction of fat in the area just below the heads of the metatarsal bones reduces the “cushioning” effect in this area and causes a pressure in high values. This extra pressure can cause tissue damage along with the aforementioned foot ulcers.

Such a situation that will cause pain in a normal person cannot be felt by many diabetics. If diabetes is not well controlled, neuropathy or a “lack of feeling” may occur as a complication. Dead nerve cells become unable to feel pain which can result in people not knowing about harm that is being done to their body. Diabetic patients who develop neuropathy would not feel fatty layer damage and accompanying high pressure values whereas a typical person normally would. Untreated foot ulcers can become infected and can turn into gangrene. Since the gangrenous foot has to be cut, diabetes unfortunately causes a large number of amputations. Such amputations are sadly quite frequent throughout the world due to diabetic neuropathy. Dr. Paul Brand, who studied diabetic foot ulcers, defined pain as a gift from God that no one wanted. Sometimes, what we do not like might be better for us (Qur’an 2:216); likewise, pain can cause a lot of trouble to people but it can also alert us of dangers and harm to our bodies.

Thus, foot care is very important in diabetics. The following three actions are recommended to patients; daily inspection of the foot; daily washing; and control of the inside of the shoes. The pest, pebble, or similar hard object in the shoe that can be very harmful for diabetics with loss of sensation would be removed this way. On the other hand, when such a hard object remains in the shoes, patients may step on them repeatedly without feeling it which will likely lead to an ulcer case.

With its pain that works like a health alarm, extraordinary mechanical loads it carries, heat insulation and shock absorbing features, the human foot is a wonder of art that calls for contemplation.

Washing our hands has become one major way to protect ourselves from Covid-19. However, ablutions have always had a central place in the practices and beliefs of many religious traditions. Christians perform baptism with water, in amounts varying from small sprinkles to larger vessels, to bring about purification, cleanliness, revival, and rebirth. Jesus’ washing the feet of his disciples as narrated in the Gospel makes the washing of feet an important practice in Christianity to promote cleanliness and is still carried out to this day. The Jewish tradition also has many instances of ablution where water is specifically used to promote cleanliness, including washing hands to reclaim or preserve purity and mikveh in which the feet or whole body is immersed in water.

The Islamic ablution, also known as “wudhu,” contains 24 washing movements to be carried out several times a day for the five daily prayers. If performed for all five prayers, it would consist of about 120 repeated actions as Muslims washed parts of their body.

A lover must undertake the required preparation to cleanse and beautify oneself before meeting with their Beloved. Likewise, a believer is required to wash specified parts of their body to stand before God in supplication, as instructed in Chapter Maidah of the Qur’an, verse 6: “O believers, when you stand for prayer, wash your faces, and your hands up to the elbows, and wipe your heads, and wash your feet up to the ankles. If you are unclean, bathe and purify your bodies fully. But if you are ill or in the middle of travelling or … you cannot find water, then take wholesome dust and wipe your faces and hands with that. For God does not wish to burden you, rather He desires to purify you and to complete His blessing and favor upon you so that, perhaps, you may be grateful” [5:6].

The spiritual cleansing that the act of wudhu provides is highlighted by the Prophet Muhammad (pbuh) in numerous hadiths, or prophetic sayings, which has been collected under The Book of Purification. While water literally cleans the face and limbs, with every pure intention to do wudhu, the water droplets that meet the body also wash away the minor sins that were committed by the hands, mouth, face, ears, and feet. The famous hadith that “cleanliness is half of faith” [Sahih Muslim, 223] can be interpreted as applying primarily to doing wudhu in one translation [Wudhu: Fiqh, Rules, Purification and Blessings, Qadri]. Therefore, to perfect the faith, to be cleansed of our mistakes continuously, God has given us a simple mechanism through which to be purified and recalibrated countless times in a day.

Many of us perform this pattern of washing with little thought. It has become a routine that we seldom consider a medical protection that we apply to our body. Besides its effects on the soul, washing also has wonderful effects on the body. Over fourteen hundred years ago, the Prophet (pbuh) advised ablution before going to bed. Interestingly, yoga experts in recent years have also started to encourage the washing of the legs, hands, arms, eyes, and the mouth before sleep with cool water for a deeper undisturbed sleep. This is not surprising considering the relief that comes with the touch of water on a busy day.

Three of our principal systems benefit from wudhu; the circulatory system, the immune system, and the electrostatic balance of the body. In this way, the health benefits from the ritual of washing are threefold…

Circulatory system

The circulatory system is a magnificent circuit of blood vessels between the heart and the tissues that make up every other system of the body. The systemic circulatory system circulates oxygenated blood from the heart to the tissues around the body and back to the heart, whilst the pulmonary circulatory system transports deoxygenated blood to the lungs for detoxification and returns clean blood to the heart. The correct functioning of the blood vessels, which act as wires that connect our major organs, are essential to the efficiency of this circuit. These vessels divide into thinner branches called arterioles which in turn split into smaller capillaries which surround the cells of the body. The vascular resistance generated by blood vessels is overcome by the blood pressure generated by the heart to enable blood flow. Over time (due to ageing, or a diet high in fat), our blood vessels often harden and become constricted meaning that the heart has to work harder to overcome increased vascular resistance to maintain steady blood flow. The vessels in the limbs are the most peripheral to the heart and thus the most vulnerable to the process of hardening and narrowing over a long period.

The application of water in our daily routine “exercises” these blood vessels by alternately contracting and dilating them. Water can act as an agent of temperature gradients, thereby affecting the thermoregulatory response of the cutaneous circulation. When hot, water ensures that vessels in the limbs dilate, and when cold, that they contract. In this way, water ensures the flexibility of vessels distant from the heart, forcing nutrients deposited in tissues as a result of poor circulation back into the bloodstream through a temperature gradient.

Lymphatic system

The lymphatic system, on the other hand, is probably not the first to come to mind when we think of the body’s organ systems. Yet without this quietly working system our cardiovascular system would collapse and our immune system would be impaired. Our lymphatic vessels transport “leaked” blood fluids into our capillaries to prevent the accumulation of fluid in the interstitial spaces and eventual tissue damage. The vessels of the lymphatic system are much thinner than those of the cardiovascular system, ensuring the circulation of white blood cells which have an essential role in protecting the body against invaders and resisting disease. It is this fluid that we see oozing out when we have a cut or wound.

The optimal functioning of this system and its thin vessels, like those of the circulatory system, can be said to be closely linked with the effect of washing. The phagocytes and lymphocytes, which make up the immune system are housed by our lymphoid tissues and organs, are supported by the act of wudhu. The nasopharyngeal region behind the nose leads to the tonsils, which are small masses of lymphoid tissue that trap and remove pathogens that are entering the throat. Washing the mouth and nose three times with every wudhu therefore helps to remove the bacteria that builds up in the region of the body most exposed to the external environment. Moreover, the act of washing both sides of the neck during wudhu stimulates our cervical lymph nodes – a specialized mass of tissue which houses lymphocytes and particularly helps to protect the body by removing bacteria and tumor cells from lymphatic circulation. Our lymphocytes are arguably the most important component of our immune system, patrolling every point of the body many times a day and destroying cancer cells and pathogens along the way. Considering that the act of wudhu enhances the filtration effect of our lymphoid circulation, one can see the blessings that come with the divine command to “wash…and purify your bodies fully….”

Electrostatic balance

Our physiology is also closely related to the electrostatic balance of the body. While many psychosomatic diseases result from electrostatic imbalance, the most pronounced effect of static electricity is exerted on the subcutaneous muscles located under the skin, mitigating their function and inducing the onset of wrinkles which often start in the face. Maintaining the regular habit of washing the skin – particularly the face which is most frequently exposed to ultraviolet radiation – protects the surface and internal layer of our skin cells by constantly dampening the skin surface with clean water. It is a much simpler alternative to spending hundreds and hundreds of dollars on expensive skin care and makeup products to maintain a healthy complexion.

In regards to how wudhu can benefit our electrostatic balance, the part of the verse which sheds light to tayammum, “if you cannot find water, then take wholesome dust and wipe your faces and hands with that” highlights that the water substitute for wudhu significantly reduces static electricity, like water. This is why when wudhu is performed calmly with care, it often leaves one feeling refreshed and discharged.

The Quran is a grand source containing many prescriptions for good health. While every civilized person may wash their face and hands throughout the day, wudhu ensures that cleanliness and a sense of well-being is sustained by virtue of its association with worship. The worth and significance of wudhu is not limited to the medical benefits discussed here. However, for anyone else wondering why taking a pause on a busy day with wudhu feels so rejuvenating, I hope this humble article sheds some light to a grand prescription from among the many medicines revealed in the Qur’an.

Sometimes, your back itches slightly and scratching it at that perfect spot fills you with an odd sense of happiness. Other times, you notice a biting itch on your arm and a chickpea-like redness shows up there. Oh, those mosquitoes! It is rarely likely to catch a mosquito in the act, and sometimes it even feels as if their bites just appear out of thin air. As you scratch the blister to soothe the itchiness, your eyes scan the room to locate its infamous proboscis. You see it on a wall, plump with the blood it sucked from you. You cannot help thinking: Why do their bites always leave so much itching? Or even, what is the purpose of itching at all?

Itching is an unpleasant feeling we perceive by our skin and mucous membranes, and an occasionally uncomfortable and sometimes very excruciating feeling.

Itching, just like pain, is a sensation intrinsic to our body to protect itself [1].  It is the way our skin “talks” to us. Indeed animals, even fish, itch too. When itched, our skin instinctively and in its own tongue tells us, “There is something that bothers me and I want you to push it away from me immediately!” If it was not for itching, we would not notice a spider walking on our arm. We would not be disturbed by lice and scabies mites or even fungi that settled on our skin, and we would not try to protect ourselves from these pests either.

An ordinary scabies patient has an average number of about 15-20 adult scabies mites on their skin. In the case of Norwegian or crusted scabies, which is most commonly observed among the elderly, the bedridden, people with seriously weakened immune systems, or those who are unable to itch themselves sufficiently, there are thousands of parasites under the thick crusts of the skin [2]. Itching accelerates the blood circulation on the itched parts, and tissues virtually prepare to fight infection by the rushing blood cells and substances [3]. Yet, millions of people also suffer from chronic itching and scratch their itches much more than usual. To understand this, we need to set on a journey from our skin to our brain.

Human skin consists of three layers: epidermis, dermis and subcutis (also known as hypodermis). The dermis layer in the middle makes glove-like protrusions upward into the epidermis. At the top of these protrusions are mechanoreceptors and nerve endings that allow our skin to sense stimulus (such as temperature, sharpness, pressure, vibration, pain, or itching) [3]. With these receptors, our skin functions as one of our five sensory organs and more like an “alarm system” of our body against changing conditions outside. This alarm system has been created so perfectly that each component knows exactly what stimulus to detect.

Previously, it was thought that pain and itching were sensed by the same receptors (nociceptors) and that mild stimuli were responsible for itching while strong stimuli were responsible for pain [4]. Yet, a contradiction existed because while pain triggered an avoidance reflex, itching activated the scratching reflex. In recent years, it was discovered that the receptors (pruriceptors) that perceive the itching sensation on the skin are the free boundary terminations of C-fibers with myelin-free, slow conduction velocity extending in the form of tree branches toward the upper layer of the skin. Furthermore, it was found that the skin cells themselves behave like itch receptors [3, 4]. When we receive a stimulus that induces itching, such as a mosquito bite which leaves anticoagulant substances on our skin, the mast cells in the skin tissue spring to defense against those alien substances. This ensues the secretion of the bodily defense system called mediators, substances that are produced and stored by mast cells as precursor for emergency conditions. Histamine is the most known of these substances and is the most important mediator in itching conditions [5]. Histamine binds to receptors found for itself in myelin-free C fibers that are tasked for detecting itching on the skin. If we consider histamine as a key, the lock that it fits into is on the nerve that senses itching. Thus, the itching nerve is stimulated by histamine.

The nerves receiving this stimulus connect to the spinal cord at their respective levels and transfer the message to another nerve. Each of these transfer processes is mediated neurotransmitters. The last message transmitted to the brain through these nerves is assessed by the brain and labeled as “itching” [6]. The brain determines the coordinates of the itching location and orders the scratching action to the related muscle system. A new journey that conveys messages from the brain to the arm muscles ends with scratching. Considering the swift rubbing action when we feel an ant walking on our face and scratch to push it away, we may value how fast and perfect our brain and transmission system work.

It is also rather odd how soothing itching can be despite its initially uncomfortable feeling, almost as if our body is rewarding us for saving it from a threat. There are several reasons for this contradiction. Scratching causes a low-intensity pain on the skin. Pain and itch are positioned on the skin alternately. The transmission of the sensation of pain is prioritized while the transmission of itching is prevented [7]. Consequently, our brain senses the pain and, in response, secretes the hormone called serotonin to soothe the body. Although this makes us feel relaxed for a short time, the brain continues to transmit virtual sense of itching by connecting to the receptors that are located on the spinal cord along the same nerve path with the receptors for serotonin [8]. This condition, which may be termed as a vicious cycle of itching-scratching, unsurprisingly infuriates patients. Scratching the same area on the skin continuously causes the production of new mediators and oversensitivity of itching nerves, which can thus turn itching into a chronic distress. Chronic itching can often result as a complication from skin diseases such as scabies, lice, eczema, fungal diseases, or drug allergies. It can also result from a systemic disease such as chronic renal failure, cholestatic liver diseases, thyroid problems, iron deficiency anemia, blood diseases and, rarely, cancers [7]. Itching in systemic diseases can be triggered by mediators on the skin but also by neurotransmitters in the intermediate pathway. This kind of itching cannot be controlled by drugs called antihistamines which block the histamine pathway. Sometimes the brain will receive false itching alarms due to post-shingles contraindications or nerve damage in the vertebrae. Such episodes of itching need to be addressed to prevent adverse outcomes. At times, the reason an itch can occur can even be psychological when there seems to be no need for an itch. According to research, scratching activates the brain’s reward center which triggers the addiction mechanism. Patients in that case are thrilled as they itch constantly [9].

As doors in this mysterious journey of science are opened one after another, we discover that nothing has been created without a purpose, including apparently discomforting sensations such as itching, which, it turns out, is how our skin communicates with us!

References

1. Arıcan O. Kasintinin patofizyolojisi, klinigi ve tedavisi Turkderm 2005;39(2):88-97
2. Jonston G, Sladden M. 2005 Scabies: diagnosis and treatment BMJ;17;331(7517):619-22
3. Guyton AC, Hall JE. Tıbbi Fizyoloji 10. Baski 2001.p815-42
4. Schmelz M. Itch and pain. Neurosci Biobehav Rev 2010;34(2):171-6
5. Arck P, Raus R. From the Brain-skin connection. Neuroimmunomodulation 2006;13(5-6)347-56
6. Metz M, Stander S. Chronic pruritus pathogenesis clinical aspects and treatment. J Eur Acad Dermatol Veneral 2010;24(11)1249-60
7. Metz M, Grundman S, Stander S. Pruritus: an overview of current concepts. Vet Dermatol 2011;22(2):121-31
8. Chen ZF et all. Descending control of itching transmission by Serotonergic System via 5-HT1A-facilitated GRP-GRPR signaling. Neuron Vol.84(4) Nov.19-2014

9. Chan YH et all. Brain’s Reward Circuits Mediate Itch Relief. A functional MRI Study of Active Scratching. Dec. 2013

Robots continue to advance and develop every year, and these consistent improvements continue to amaze us with how much they physically resemble humans. Even though these robots lack spiritual qualities and function way below the human brain, we still admire these developments, for they lead to even more discoveries and help us understand the miraculous human body even more.

Notwithstanding our medical knowledge that continues to build upon nearly 3,000 years of shared human experience and research, new discoveries about the human body, the magnificent work of God Almighty, continue to increase our admiration.

The discovery of the “Interstitium” and the “Subcapsular Proliferative Foci” in 2018 allow us to develop an even greater appreciation for the complexity of our bodies. They are called the “macro organ” and “micro organ” according to the amount of space that they occupy in our bodies, along with the nicknames “buffer organ” and “control center organ” according to their function. These newly discovered biological structures did not attract much attention earlier because, in accordance with our current understanding, organs are more easily visible structures such as the hands, arms, eyes, nose, kidneys, and lungs that have a certain shape and a set of clearly-defined functions. It is interesting that although these complex structures are so widespread in our bodies, they were not known until recently; they are now considered as organs [1].

The Macro Organ: Interstitium

According to an article published in Scientific Reports on March 27, 2018, the “interstitium” was discovered rather serendipitously by David Corr-Loce and Petros Benias of Mount Sinai Beth Medical Center along with Neil Theise, a pathologist from New York University. The discovery came when these physicians were analyzing a cancer patient’s bile duct. Although they had been conducting the same routine over the years, it was the first time they had the sight of slots between examined tissues. They realized that the interstitium was unnoticed earlier due to the disappearance of interstitial fluid after they had examined the tissue with their usual histological methods. Subsequently, the researchers found that this structure was found not only in the bile duct but also in many other organs.

Specifically located under our skin, these micro-compartments were also found in almost all organ membranes except the intestines, lungs, veins, and muscles in order to form a network around the organs with malleable but sturdy proteins. The interstitium, the entirety of the intercellular spaces filled with liquid, has been defined as the largest organ in the body. Actually, examining cells and tissues has been the subject of histology and cytology science for the last 150 years, and the fluid that fills the tissues and forms a basis for supporting these cells was not new to the medical world. However, its definition as a new organ was a first.

The researchers froze the biopsy tissues obtained from the bile ducts of 12 patients in order to preserve and examine the anatomy of the discovered structure. One of the reasons that this organ exists is because it protects the surrounding organs by acting as a shock-absorber and has an effect similar to that of a car’s bumper. Damage to tissues and internal organs remains minimal when one falls, hits something or is impacted Using a micro-endoscopic camera, the volume of this whole organ was revealed to be about ten liters in an adult human [2].

It was later discovered that the interstitium is also present in the structure of lymph nodes, the most important part of the body’s immune system, and that cancer cells enter the lymphatic system through the interstitium. In this case, the interstitium play a significant role as a passageway, or conduction interface, for spreading cancer cells across the body. In an analogy, this organ is akin to the water in which fish swim, the air that surrounds us, and the soil that borders the roots of trees. In this liquid that rotates the cells and spans on the base where they are positioned, any exchange of substances of body biochemistry is regulated within the required amount and size to provide a good setting to the cells, and the hard mechanical effects that may impact the cells are alleviated and absorbed by this liquid pad.

Each discovery of the interstitium’s features, including its significant contributions in the fight against cancer, reveals more and more about how this great organ aids in intercellular communication.

The Micro Organ: Subcapsular Proliferative Foci

One of the most important features of the immune system is that it has its own “memory.” The cells of the immune system can remember the infections a person has contracted before, and can fight infections before they spread. How quickly the immune system reacts based on memory may vary, for instance depending on the type of infection, but is usually quite rapid. Considering how many bacteria multiply in a matter of seconds, a quick response must be launched to prevent infections from spreading across the body.

Professor Tri Phan of the Garvan Medical Research Institute led the team of researchers that discovered the subcapsular proliferative foci (SPF), a “micro-organ” that appeared in the lymph nodes during an infection. Lymph nodes and lymphoid organs such as tonsils, thymus, and spleen are surrounded by a protective capsule made of connective tissue. This capsule was considered to serve the purpose of a mechanical support only to enclose and protect the lymph nodes. However, recent research has shown that in some areas under this capsule, cells that had been alerted to previous encounters with harmful invasive organisms are gathered. These main subcapsular cells are memory B cells that carry information on how to counter the invasive organisms. Memory B cells also proliferate into plasma cells, which are highly important for producing antibodies. Therefore, when an infection reoccurs in our body the subcapsular proliferative foci act quickly to form the first defensive front to prevent the possible spread of infection.

The purpose of vaccines is to activate the attenuated form of a harmful organism to be stored in the body’s memory as an immune response. If the body comes back into contact with similar bacteria in the future, the immune system will remember how to fight it. The discovery of the sub-capsule foci also revealed that these centers are the home for the memory B cells. If they can unveil the development and training processes of the memory B cells in these slots, scientists can produce vaccines that enhance the memory of the immune system even more quickly and efficiently.

The reason why these structures have not been noticed earlier is due to their emaciation, brief emergence, and disappearance. The sub-capsule proliferation centers presented in the article “Memory B Cells Are Reactivated in Subcapsular Proliferative Foci of Lymph Nodes” published in Nature Communications on August 22, 2018 are defined by some authoritative scientists as the “micro-organ.” According to the findings about this new organ, if our infection-fighting immune system would have activated longer than it currently does, we would easily die. Every minute is very crucial in this struggle. These excellent centers that produce memory cells under the lymph node [3] capsules fight bacteria which can replicate in multitudes every 20–30 minutes during an infection.

Although the world of science has been working with the microscope for about 400 years, these centers that have been embedded in our body since its creation could only be noticed today when the microscope design has reached its technological peak.

There are trillions of bacteria living in the intestinal cavity, skin, and orifices of our body. Some of these are already protective and beneficial, yet others are pathogenic. But they do not make us sick because of B cell production centers. When our immune system is weakened for any reason (such as stress, insomnia, or malnutrition) these bacteria can cause illnesses and meet little resistance. These sub-capsular micro-organisms surrounding the lymph nodes were placed in the most strategic places across the human body to fight infections in the fastest way, while the lymph nodes were placed at locations that are most vulnerable to microbial attack.

Consequently, these discoveries increase our admiration for the palace and magnificent realm called our body. It is likely in the light of this information that the anatomy and histology books may be rewritten and the definitions of organs and tissues may be redefined.

References

• Claire Maldarelli, “Scientists found a new organ, but it might not be what you’re expecting,” Popular Science, 3 April 2018.
• iflscience.com/health-and-medicine/newly-discovered-microorgan-helps-explain-how-vaccine.
• nature.com/articles/s41598-018-23062-6