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Archives of Medical Research

Journal Abbreviation: ARCH MED RES Journal ISSN: 0188-4409

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Human Milk: Benefits, Composition and Evolution

Breastfeeding provides all the energy that the child needs in the form of nutrients in the first months of life. The components cover the nutritional needs in all stages, including colostrum and final or mature milk. It must also be taken into account that the composition of milk varies from one woman to another, between both breasts, between feedings and in the different stages in the same mother. It can be said that variation is an active mechanism to perfectly adjust to the nutritional and immunological needs of each child. Components of breast milk can exert beneficial non-nutritional functions. Breast milk also has bioactive factors, which affect biological processes and, therefore, have an impact on health. In the nutrition of premature babies, parenteral nutrition is carried out first, which later becomes enteral through different strategies, such as early minimal enteral nutrition. Despite this, they still present postnatal growth restrictions, which is associated with adverse neurocognitive outcomes. Breast milk achieves multiple benefits in both preterm and term births. Digestion and absorption in the stomach and intestines follow circadian rhythms in mammals, and these rhythms are regulated by rhythmically expressed clock genes in the intestine, as well as by daily food intake.

Biobased Hyperbranched Poly(ester)s of Precise Structure for the Release of Therapeutics

Hyperbrached poly(ester)s derived from naturally-occurring biomonomers may serve as excellent platforms for the sustained-release of therapeutics. Those generated from glycerol are particularly attractive. Traditionally, the difference in reactivity of the hydroxyl groups of glycerol has precluded the formation of well-defined polymers at high monomer conversion without gelation. Using the Martin-Smith model to select appropriate monomer ratios (ratios of functional groups), polymerization may be carried out to high conversion while avoiding gelation and with the assurance of a single type of endgroup. Various agents may be attached via esterification, amide formation or other process. Sustained release of the active agent may be readily achieved by enzyme-catalyzed hydrolysis.

Systemic soluble Programmed Death-Ligand 1 levels in sarcoidosis subjects does not vary with disease progression

Interaction of programmed cell death 1 (PD-1) receptor and its ligand 1 (PD-L1) is well studied in the field of fibrotic lung diseases, supporting its use as a biomarker of progression of interstitial lung disease. Anti PD-L1 therapy has shown effectiveness in improvement of many malignancies and murine models of autoimmune fibrotic lung diseases. Higher PD-1 expression on T cells and PD-L1 expression on human lung fibroblasts are known to contribute towards severity in sarcoidosis and idiopathic pulmonary fibrosis (IPF), respectively. The focus of this investigation was to determine if soluble form of PD-L1 (sPD-L1) serves as predictive biomarker of disease severity in interstitial lung disease (ILD), such as scleroderma, sarcoidosis and IPF. Comparison of local environments, such as bronchoalveolar lavage, revealed significantly higher sPD-L1 levels compared to systemic environments, such as peripheral blood (p=0.001, paired two-tailed Student’s t test). Investigation of serum samples of healthy control, IPF, scleroderma and sarcoidosis patients reveal significantly higher levels in sarcoidosis and IPF patients, compared to patients with scleroderma (p=0.001; p=0.02, one-way ANOVA with Tukey’s respectively). Comparison of serum levels between sarcoidosis patients and healthy controls revealed no significant differences (p=0.09, unpaired two-tailed t test). In addition, comparison of physiologic parameters, such as percent predicated Forced Vital Capacity (FVC) and sPD-L1 levels in sarcoidosis and IPF patients revealed no correlation. These observations suggest that sPD-L1 will not serve as a biomarker of sarcoidosis disease severity. Additional investigation of sPD-L1 in local environments is warranted.

Ethics or Bioethics for the Medical Profession?

The events that have occurred as a result of the Covid-19 pandemic have brought to the fore the figure of the doctor, as a main actor, in this complex and uncertain scenario. Many of the medical actions carried out have required strength, reflection, wisdom and prudence, all of them essential virtues according to the classical philosophical tradition, and that the ETHOS of the medical profession and the doctor translate, with this it is necessary to emphasize that it is the traditional medical ethics, the basis of this undeniable commitment to humanity, and that Bioethics, born 60 years ago, has been invested with an unthinkable condition, by its creator VR Potter, who proposed that the main objective should be scientific development -Technical but with ecological responsibility, beyond its supposed guiding function of current medicine. Which are the motivations for choosing the School of Medicine? What does it mean to be a good professional? How to respond to an increasingly demanding society? In light of the development of new technologies and communication systems, which today are universally accessible. It seems that the answer to these questions lies in a higher education based on ancestral ethical principles, which have been professed by generations of doctors, in traditional clinical practice and in practicing general medicine to achieve the specific medical training process, thus achieving efficiently meet the primary health demands of society. Therefore, Bioethics must be understood as an incipient discipline whose objective is to warn about the care of ecosystems, necessary for the survival of the human being, different from medical ethics.

Coevolution study of tau and a-synuclein suggests a connection between their normal interaction in neurons and the Parkinson's disease-associated mutation A53T

Alpha-synuclein lies at the center of Parkinson’s disease etiology, and polymorphisms in the gene for the microtubule-associated protein tau are risk factors for getting the disease. Tau and a-synuclein interact in vitro, and a-synuclein can also compete with tau binding to microtubules. To test whether these interactions might be part of their natural biological functions, a correlated mutation analysis was performed between tau and a-synuclein, looking for evidence of coevolution. For comparison, analyses were also performed between tau and b- and g-synuclein. In addition, analyses were performed between tau and the synuclein proteins and the neuronal tubulin proteins. Potential correlated mutations were detected between tau and a-synuclein, one involving an a-synuclein residue known to interact with tau in vitro, Asn122, and others involving the Parkinson’s disease-associated mutation A53T. No significant correlated mutations were seen between tau and b- and g-synuclein. Tau showed potential correlated mutations with the neuron-specific bIII-tubulin protein, encoded by the TUBB3 gene. No convincing correlated mutations were seen between the synuclein and tubulin proteins, with the possible exception of b-synuclein with bIVa-tubulin, encoded by the TUBB4A gene. While the correlated mutations between tau and a-synuclein suggest the two proteins have coevolved, additional study will be needed to confirm that their interaction is part of their normal biological function in cells.

The belated implementation of a long-awaited health system in Cyprus and the role of interest groups

It is really a paradox that 60 years were required to establish a modern health system in Cyprus, despite the expressed positive attitude οf all political parties and most governments. This article investigates the planning and implementation of the National Health System (NHS) and its delay determinants, by employing qualitative research of published sources, audio material and 33 interviews with elite key informants. A major anti-reform alliance, consisting of private doctors, private hospitals and health insurance companies was identified, further supported by doctors of the “old” public system, whose benefits were threatened. Delay contributions additionally arose from media and patient groups, whilst the pharmaceutical sector imposed insignificant influence. Τhe prevailing political, economic and social environment, along with aspects of the proposed reform, fueled this anti-reform movement. However, climate in favour of the NHS implementation gradually developed, attributed to the power balance shift supportingthe Minister of Health and the government, mobilization of important actors/stakeholders, including the Federation of Patients' Organizations of Cyprus and the Media, and significant decrease in the influence of reform-resistant groups. The new dynamics created a supportive environment leading to the NHS launch on June 1st, 2019; thus Cyprus has ceased to be the last state of the European Union (EU) without a universal health coverage system. The process of introducing this new system in Cyprus is a prime example of resource and power redistribution amongst different interest groups and of the catalysts required to exit the orbit of an extremely “path-dependent” system, potentially inspiring future reformers.

History of Trypanosomosis in the One-Humped Camel and Development of its Treatment and Cure, with Special Reference to Sudan

Sudan has one of the largest populations of domestic animals in Africa. One-humped camel (Camelus dromedarius) numbers were estimated at 4.5 million in 2009. Once used extensively for military transport they are still used in the transport role by spatially mobile pastoralist households and are a major source of milk and meat for these people. Trypanosomosis, due to Trypanosoma evansi, generally known as ‘surra’ but as ‘gufar’ in Sudan was first identified in camels in the country in 1902 and is the main cause of disease although T. vivax infections have recently been discovered in parts of Sudan. This protozoan disease is the most important health problem in camels, causing high morbidity and huge production losses. The causal organism, unlike most other trypanosomes, is not transmitted cyclically with tsetse (genus Glossina) flies as the vector but mechanically by biting flies mainly family Tabanidae but also by others of the Muscidae. Identification of the parasite in camel blood was initially by simple microscopic techniques but biotechnology and molecular methods now enable infection to be diagnosed at an earlier stage and with more accuracy. Prophylactic and curative treatments of trypanosomosis are notoriously complicated and uncertain with the situation in camels being exacerbated because of its peculiar physiology. Many trypanocides have been developed over time but the parasite often develops resistance to these drugs. Some drugs are successful, for some time, as both prophylactics and cures but are often accompanied by undesirable side effects. Other drugs used on conventional domestic stock are ineffective in camels or have lower efficacy. Research on diagnosis and treatment of trypanosomosis is continuing but the disease continues to cause production losses to the detriment of national and household incomes and food security.

Time-course of adaptations for electroretinography and pupillography

Cones are primarily involved in photopic vision and light adaptation. Rods are responsible for scotopic vision and dark adaptation. The typical time-courses of light and dark adaptations have been known for century. However, information regarding the minimal adaptation time for electroretinography (ERG) and pupillography would be helpful for practical applications and clinical efficiency. Therefore, we investigated the relationship between adaptation time and the parameters of ERG and pupillography. Forty-six eyes of 23 healthy women (mean age, 21.7 years) were enrolled. ERG and pupillography were tested for right and left eyes, respectively. ERG with a skin electrode was used to determine amplitude (µV) and implicit time (msec) by the records of rod-, flash-, cone-, and flicker-responses with white light (0.01–30 cd·s/m2). Infrared pupillography was used to record the pupillary response to 1-sec stimulation of red light (100 cd/m2). Cone- and flicker- (rod-, flash-, and pupil) responses were recorded after light (dark) adaptation at 1, 5, 10, 15, and 20 min. Amplitude was significantly different between 1 min and ≥5 or ≥10 min after adaptation in b-wave of cone- or rod-response, respectively. Implicit time differed significantly between 1 min and ≥5 min after adaptation with b-wave of cone- and rod-response. There were significant differences between 1 min and ≥10 or ≥5 min after dark adaptation in parameter of minimum pupil diameter or constriction rate, respectively. Consequently, light-adapted ERGs can be recorded, even in 5 min of light adaptation time without special light condition, whereas dark-adapted ERGs and pupillary response results can be obtained in 10 min or longer of dark adaptation time in complete darkness.

A Comparison of Neuropathy Quality of Life Tools: Norfolk QOL-DN, PN-QOL-97, and NeuroQOL-28

Aims To explore the effectiveness of the Norfolk QOL-DN (QOL-DN), PN-QOL-97, and NeuroQOL-28 as tools for early detection of diabetic peripheral neuropathy in overweight, obese, and inactive (OOI), prediabetes (PD), and type 2 diabetes (T2D) individuals. Methods Thirty-four adults were divided by A1C [(10 OOI, 13 PD, and 11 T2D] and the sural nerves were tested bilaterally via NC-Stat DPN Check, conducting a sural nerve conduction study (NCS). Participants were individually timed, filling out questionnaires (QOL-DN, NeuroQOL-28, and PN-QOL-97) at a self-selected pace. Data were analyzed and compared to NCS findings to determine the best instrument for early neuropathy detection, usability in screening settings, and application for individuals with OOI, PD, and T2D. Results Abnormal NCS results were obtained from 27 individuals, of which 25 were bilateral and symmetrical. Confirmed DSPN criteria were met for 24, and 1 case met criteria for subclinical neuropathy. Normal NCS findings, reported symptoms, and reduced bilateral sensation were found in 7 cases. The QOL-DN and NeuroQOL-28 significantly predict neuropathy criteria in OOI, PD, and T2D subjects. Analyses revealed the QOL-DN as the quickest for completion (M=5.17; SD=1.83), followed by the NeuroQOL-28 (M=5.58; SD=3.56), and the PN-QOL-97 (M=13.23; SD=3.606). Conclusions The QOL-DN and NeuroQOL-28 are valid early screening measures for DPN detection. Time completion studies revealed that the QOL-DN and NeuroQOL-28 may be used as excellent short screening measures, completed in approximately 6 minutes or less, with reasonable scoring for both. The NeuroQOL-28 is a better fit for immediate feedback, time constraints, or limited staff. Future investigations should evaluate these tools for detection in DPN-prone individuals and in subclinical populations screenings.

A Pilot Study of At-Home Virtual Reality for Chronic Pain Patients

Chronic pain disorders are a common and expensive health problem worldwide. Available treatments for these disorders have been decreasing and new treatments are needed. Virtual reality (VR) has been used for acute and procedural pain for years but systems are only now becoming available for use with chronic pain. In this study patients with a chronic pain disorder were given the option of using either take-home virtual reality equipment for one month or take-home biofeedback equipment for one month. In the VR condition patients were oriented to the “PainCare” app but could access any free content from the internet as well. Qualitative data was gathered on 23 VR patients and 12 biofeedback patients. Pre-post measures of depression, catastrophizing and function were obtained from 17 VR patients and 8 biofeedback patients. Data found that there was a statistically significant decrease in depression and catastrophizing in the VR group but no such decrease was found in the biofeedback group. No significant increase in function was found in either group though the VR group trended in that direction. One hundred percent (100%) of the patients who tried VR reported that they thought it had helped them overall at least a little. Patient ratings of the VR equipment were more favorable than the biofeedback equipment. This non-randomized small sample study suggests that at-home VR use can be used successfully with patients to decrease the important treatment variables of depression and catastrophizing, and perhaps become a significant contribution to the treatment of chronic pain disorders.

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• v.75(2); 2021 Apr

On Occasion of the 75 th Anniversary of the "Medical Archives" Journal (1947-2021)

This year the journal "Medical Archives" celebrates 75 year of existing. "Medicinski Arhiv/Medical Archives" was founded in 1947 as official journal of the Association of Physicians (Sabor ljekara Bosne i Hercegovina) of Bosnia and Herzegovina and the first Editorial board was consisted of academicans: Vladimir Cavka (Professor of Oftalmology), Blagoje Kovacevic (Professor of Surgery), Bogdan Zimonjic (Professor of Internal medicine), and Ibro Brkić (Professor of Internal medicine). Exactly the Medical Archives journal was a key milestone that helped in education of all academic and professional staff that became the foundation of Bosnian and Herzegovinian medicine as a science and health care as a profession. Medicinski Arhiv was included in largest bimedical database Medline in 1947 and till now in that database is deposited more than 7000 papers. Also this journal has highest h-Index in Scopus database ranked by SCImago rank. In Medicinski Arhiv journal authors from more than 60 countries from whole the world published their papers, some of them with very high Scopus h-Index.

1. BACKGROUND

Medicinski Arhiv/"Medical Archives" was founded in 1947 as official journal of the Society of physicians of Bosnia and Herzegovina and the first Editorial board was consisted of Vladimir Cavka, Blagoje Kovacevic, Bogdan Zimonjic. Exactly the Medical Archives journal was a key milestone that helped in education of all academic and professional staff that became the foundation of Bosnian and Herzegovinian medicine as a science and health care as a profession ( 1 - 5 ).

The first Editoral Board, besides mentioned academicians were consisting from 1947 until 1952 by: secretary of the Editorial Board, professor Ibro Brkic, while as the Editorial Board members was very well-established Bosnian and Herzegovinian scientists: Dimitrije Dimitrijevic, Grujica Zarkovic, Slavko Djurisic, Feodor Lukac, Milos Aranicki, Teodor Ilic and Mihajlo Protic.

In the first issue published in 1947, academician Vladimir Cavka, the first Editor-in-Chief, signs the Editorial in the first issue with this line: "Our leaders, not sparing the enormous material resources, trying with all their strength that or Medical Faculty in Sarajevo as quickly as possible put on a solid foundation, expecting rightly, of all who participate in the construction of the Faculty the maximum effort. With the formation of the Medical Faculty in Sarajevo and the activation of the Association of Phisicians for Bosnia and Herzegovina there was a need of issuing a professional medical journal, in which, next to scientific papers and articles can be included also clinics and therapy of all branches of medicine, and which will, in the first place, were of interest to practicing doctors. Also the journal was publishing articles from the organization of the medical service, social medicine, as well as articles from the medical literature" ( 1 ).

Five years later (May 18, 1952), at the Annual Meeting of the Association of Phisicians in Bosnia and Herzegovina, Editorial Board Secretary Dimitrije T. Dimitrijevic, after the Assembly accepted the proposal to elect in the Editorial Board: professor Nedo Zec, professor Spiro Janovic, Teodor Ilic, MD, Isak Samokovlija, MD, S. Teofanovic, MD, professor Mihajlo Protic, professor Blagoje Kovacevic, professor Milivoje Sarvan, professor Stanislav Szabo, professor Bogdan Zimonjic, professor Feodor Lukac, and professor Milos Aranicki. As Editor-in-Chief of the journal has been elected professor Vladimir Cavka, who submited to the Assembly a report of the Editorial Board, the next states:

"The articles received for publishing was mostly from the clinics and the institutes of the Medical Faculty in Sarajevo, as well as other medical experts of our capital. But also were accepted and published articles from other medical centers, primarily in Belgrade and Zagreb, or from other places of our Republic. This increased participation of doctors from others sites which was particularly noticeable in the last year, which clearly showed how much the journal gained the reputation beyond the borders of our Republic... Editorial Board took care to gather the highest possible number of young doctors, to whose cooperation and commitment we owe the most in this considerable progress compared to the early years ... In an effort to improve the journal as much as possible and taking into account the larger influx of articles, Editorial Board has decided that during the year increase the number of volumes. As a result, it is made a shift from three-month to two-month publishing, although this required more effort and more material costs. So in the course of 1951, instead of four was published six volumes of our journal, two of which were double issues... Editorial Board will try to persist on that path. Having constantly in front them our young state of medicine as a science and the great need of medical practice, they will try by uniting and representing the demands of both, to keep despite all the difficulties this our journal in the future at the required high level. At the same time, it will try to provide to physicians, particularly those in our Republic, mainly the articles relating to the many questions of modern medicine" ( 1 ).

From respect for a number of our scholars and researchers who over the past fifty years was engaged in publishing of the Medical Archives, in this Editorial, we will pride one summary, cursory crossection of their names and activities in journals in the past period.

The tenth anniversary volume of Medical Archives was edited by the Editorial board, consisting of: Vladimir Cavka - Editor in Chief, Dimitrije Dimitrijević - Secretary, and members of the Editorial board: Blagoje Kovacević, Bogdan Zimonjić, Grujica Zarković and Slavko Djurisić. In the period from 1957 to 1959, the post of Editor in Chief was held by professor Blagoje Kovacević, a secretary professor Jakob Gaon. In 1960 the function of Editor in Chief was given to professor Bogdan Zimonjić, and between 1961 and 1963 professor Milos Aranicki and Secretary of the Editorial Board was professor Jakob Gaon. Then, from 1964 to 1965, and the anniversary 1966 the function Editor in Chief was carried out by professor Bogdan Zimonjić and Editorial board secretary by professor Jakob Gaon. Other members of this 20th anniversary volume of Medical Archives was Ernest Grin, Seid Huković, Zivojin Jeftić, Milenko Perinović, A. Rasković and Nedo Zec. From the 1967 to 1971 Editor in Chief was professor Jakob Gaon, and the Secretary of the Editorial board professor Milenko Perinović. Since 1972, was introduced the position of deputy Editor in Chief, and from that year until 1976 jubilee function of the Chief Editor performs professor Midhat Prcić and as his deputy professor Rikica Najdanović. Also introduced was the dual functions of the secretary and in this period secretaries were Ass. professor Albert Musafija and Ass. professor Arif Smajkić.

Jubilee 1976 (volume 30) Editorial Board was consisted of: professor Midhat Prcić, Editor in Chief, professor Rikica Najdanović, Deputy Editor in Chief, Editorial Board Secretary Ass. professor Momir Macanović and Ass. professor Arif Smajkić. Members of the Editorial Board were: Mirjana Dzumhur, Izet Hadzić, Faruk Konjhodzić, Albert Musafija, Jamal Rezaković, Irfan Zulić, Izet Osmanagić, Bozidar Pokrajcić and Berislav Topić. Then, in 1977 Editor in Chief became professor Seid Huković, his deputy Chief physician Milorad Tomasević, and the Secretary of the Editorial Board professor Dubravka Potkonjak and professor Slobodan Loga. From 1981 to 1983, Editor in Chief was Chief physician Milorad Tomasević, his deputy professor Faruk Konjhodzić and Secretary of the Editorial Board Branka Kovacević. From 1984 to 1988, function of Editor in Chief Editor performs professor Irfan Zulić and of Secretary Branka Kovacević (deputy function is canceled).

Jubilee 40th volume of the Medical Archives was edited the Editorial Board with the following members: professor Irfan Zulić, Editor in Chief, Branko Kovacević, Secretary of the Editorial Board, and members: Mirjana Bokonjić, Stjepko Jadrić, Mustafa Kapidzić, Dusko Kecmanović, Mihael Sabljak, Arif Smajkić, Vera Tadić, Berislav Topić and Jovo Vranić. From 1989 to 1991 pre-war position of Editor in Chief, was held by professor Mirko Grujić, and the Secretary of the Editorial Board Antonija Kecman.

It should be noted that, in addition to numerous other difficulties that we have experienced during war 1991, 1992, and 1993 years have been suspended the continuous publishing of Medicinski Arhiv/Medical Archives journal. True, the problems of financial and technical nature have always been hampered and slowed down its regular publishing, but the circumstances of war specially underlined these difficulties, and the Medical Archives practically ceased to be published until 1994. Thanks to the exceptional dedication of certain individuals, we were able to ensure the continuity of our journal indexing. But there have been also other problems that are interfering with regular publishing of Medical Archives. In addition to those of financial and technical nature, a significant role played also the problems of quality articles authorization, the quality of peer review, while hindered communication and serious war policies were crucial to the quality of writing articles and their publication in the Medical Archives has declined significantly. War Editorial Board from 1991 to 1994 year consisted of professor Irfan Zulić as Editor, and professors Izet Masić and Halid Sulejmanagić – as his deputies and Board members: Faruk Dalagija, Zehra Dizdarević, Osman Durić, Mediha Filipović, Mirko Grujić, Sabira Hadzović, Salahudin Hodzić, Halid Hujić, Faruk Konjhodzić, Nedzad Mulabegović, Branko Nikolin, Amir Pleho, Umid Salaka, Vera Sunjic, Hamid Tahmiscija and Savo Vlaski. From 1994 the function of Editor in Chief performs professor Izet Masić.

The 50th anniversary volume was edited by the Editorial Board: professor Izet Masić, as Editor-in-Chief, Chief physician Zoran Ridjanović as his deputy and members of the Board professors and associates: Zijad Beslagić, Maida Ganibegović, Mirko Grujić, Zoran Hadziahmetović, Ljiljana Milanović, Bakir Nakas, Branko Nikolin, Besim Prnjavorac, Enver Raljević, Sead Redzepagić and Umid Salaka.

Jubilee 60th volume of the journal " Medical Archives" in 2006 was edited by the Editorial Board composed of: professor Enisa Mesić, ass. professor Belma Paralija, ass. professor Nada Koluder, professor Zakira Mornjaković professor Bećir Heljić, academician Husref Tahirović, ass. professor Haris Tanović, ass. professor Habiba Salihović, professor Izet Masić (Editor-in-Chief), ass. professor Damir Aganović and professor Osman Sinanović.

Jubilee 70th volume of the journal " Medical Archives" in 2016 was edited by the Editorial Board composed of very influential internationaly recognized scientists: Prof. Kenan Arnautovic (University of Tennessee, USA), Prof. Jacob Bergsland, (The Intervention Centre, Oslo University Hospital, Oslo, Norway), Prof. Marko Buksa, (Clinic for Internal diseases, Faculty of medicine, Sarajevo, BiH), Prof. Benjamin Djulbegovic, (University of Tampa, Florida, USA), Bahare Fazeli (Inflammation and Inflammatory Diseases Research Center, Medical school, Mashhad, Iran), Prof. Vjekoslav Gerc, (University of Sarajevo, BiH), Prof. Mirko Grujic, (University of Mostar and Sarajevo, BiH), Prof. Izet Hozo, (Clinic for Internal diseases, Faculty of medicine, University of Split, Croatia), Prof. Ahmad-Reza Jamshidi (Rheumatology Research Center Tehran University of Medical Sciences: Tehran, Tehran, Iran), Prof. Jasenko Karamehic, (Clinical center of University of Sarajevo, BiH), Prof. Abdulah Kucukalic, (Psychiatric clinic, Clinical center of University of Sarajevo, BiH), Prof. Asim Kurjak, (Dubrovnik International University, Dubrovnik, Croatia), Prof. Pavle Milenkovic, (Faculty of medicine, University of Belgrade, Serbia), Prof Resia Pretorius, (Faculty of Health Sciences, University of Pretoria), Prof. Zeljko Reiner, (Clinical center “Rebro”, Faculty of medicine, University of Zagreb, Croatia), Prof. Osman Sinanovic, (Neurology clinic, University clinical center Tuzla, BiH), Murat Ugurlucan (Istanbul, Turkey), Prof. Muharem Zildzic, Faculty for health sciences, University of Zenica, BiH), Editor-in-Chief was Prof. Izet Masic.

2. INFLUENCE OF "MEDICINSKI ARHIV" ON DEVELOPMENT OF MEDICAL SCIENCES IN BOSNIA AND HERZEGOVINA

Exactly the Medicinski Arhiv/Medical Archives journal was a key milestone that helped in education of all academic and professional staff of Bosnian and Herzegovinia in academic educational institutions and health care organizations ( 6 - 12 ). Medicinski Arhiv was included in MEDLINE as largest biomedical database in 1947 and till now in that database is deposited more than 7000 papers. Also this journal has highest H index in Scopus database ranked by SCImago rank. In Medicinski Arhiv journals authors from more than 60 countries from whole the world published their papers, some of them with very high peronal rank of h-Index.

"Medical Archives" grew by content, with more quality design, more international and over the past decade well known in Europe and the World, and on the library shelves of major university centers in Europe, and as on-line edition is represented in more than 30 databases. Since 2013 full articles published in Medical Archives are available in the database PubMed Central,

In 1996, on the occasion of the 50th anniversary of publishing "Medical archives" I made a detailed analysis of past events related to historical facts and figures, which are responsible for maintaining the continuity of the journal, and this text was published in the journal issue of Medical Archives, 1996; 50 ( 1 - 2 ) as it was stating this: "It is needless to point out how much and what kind of role this journal played over the past 50 years. Medical Archives became affirmed medical journal in our country, and by the exchange with the most famous libraries and journals became known in medical circles in majority of the countries of the world.

Described facts about history of "Medicinski Arhiv" were printed in special monograph published on occasion of the 60 years of Medicinski Arhiv promoted in Academy of Science and Art of Bosnia and Herzegoviba in 2006, deposited and visible on web site of the journal (www.medarch.org) and on Researchgate on-line platform ( 3 ).

True, from this distance, if we made valid scientific and professional analysis of the value of published articles in "Medical Archives", acceptable at the international level, or by the citation - indices "Impact Factor" and "Influence Factor", which are relevant for the transfer of published scientific information and their availability to the scientific world, we are not sure that these parameters were sufficiently illustrative ( 9 - 12 ).

But do not let that worry us, because according to the Garfield list, just before the aggression on Bosnia and Herzegovina, from the 1,000 most cited researchers in the world, unfortunately, there is none from the former Yugoslavia. Therefore, we need not be wrong if the citation of articles from the "Medical Archives" is relatively low, because in the same position are many esteemed journals from Bosnia and Herzegovina or other journals from former Yugoslavia ( Table 1 ).

At this point another fact must be noted - that a significant decline in the quality of published articles in the "Medicinski Arhiv" occurred after 1991. The reasons for this are well known to us all, and on them we do not need to waste words and time. One is indisputable, browsing through all the volumes of the "Medical Archives", from the first from 1947 to the last in 1995, I got the impression that the articles by, our outstanding teachers and researchers, particularly in the first and the second decade of Medical Archives publishing were of significantly higher quality. This was probably the result of a more serious approach and dealing with science and scientific research in those years.

One thing is certain, "Medical archives" has enabled us all to realize our ideas through research, to convert results of the research into practice, to convert the results of the practice into scientific facts, to join scientific facts in the base of knowledge and, finally, to convert our knowledge into specific policies and practices.

The point of all this is that the whole our research, as our strongest weapon, put in practical use, either in our own environment and internationally. A key element of this philosophy is the rapid application of existing knowledge and spreading it worldwide by modern Information and Communication techologies (ICT). Regardless that existing scientific information are underused and that the creation of new scientific and technical information is very dynamic,

"Medical Archives" by its impact, to a great extent, in many communities improve the quality of health care and was a source of current scientific and professional information in daily activities. This is especially proved valuable during the aggression on Bosnia and Herzegovina, when it was interrupted the flow of current scientific and technical information from the world, and the publication of the Medical Archives had the most significant educational role in its long history.

On this occasion, we emphasize that extraordinary role in the flow of scientific and technical information have documentation and information that open paths to the exchange of ideas, results and experiences. that is why systematic professional data collection in medical science and practice, and that is and should be one of the most important tasks of the "Medical Archives", should provide that any user of specified data and information is fully and duly informed.

The essence and size of our motives and desires to directly acquired medical scientific and technical information present through the Medical Archives to the general scientific and professional public, has its full meaning and justification. This is supported by the fact that modern ICT for transmission or transfer of scientific and technical information to the most remote corners of the world from the central hosts through influential computer online databases.

In the past period, "Medical Archives" becomes recognizable in the international scientific community, more authors published their articles in it because its recentness become significantly higher compared to other B&H journals and with highest H index included. It is important to note that to all contributed the fact that the "Medical Archives" with the full articles was made available to the wider scientific and academic community after being indexed in prestigious index database PubMed Central and in more than 30 other databases worldwide.

As showen on Table 1 . Medical Archives has Impact Factor 0.67, H-Index, 19, Rank 16449, SJR 0.228. The impact factor shown here is equivalent to citescore and is, therefore, used as a replacement for the same. Citescore is produced by Scopus, and can be a little higher or different compared to the impact factor produced by Journal Citation Report.

Medicinski Arhiv/Medical Archives is a journal covering the technologies/fields/categories related to Medicine (miscellaneous) (Q3). SCImago Journal Rank is an indicator, which measures the scientific influence of journals. It considers the number of citations received by a journal and the importance of the journals from where these citations come. SJR acts as an alternative to the Journal Impact Factor (or an average number of citations received in last 2 years). This journal has an h-Index of 21. The best quartile for this journal is Q3.

The ISSN of Medicinski Arhiv journal is 0350199X. An International Standard Serial Number (ISSN) is a unique code of 8 digits. It is used for the recognition of journals, newspapers, periodicals, and magazines in all kind of forms, be it print-media or electronic. Medicinski Arhiv is cited by a total of 212 articles during the last 3 years (Preceding 2018). Medicinski Arhiv Impact Factor (IF) for 2018-2019 is 0.67, which is computed in 2019 as per it's definition. Medicinski Arhiv IF is increased by a factor of 0 and approximate percentage change is 0% when compared to preceding year 2017, which shows a rising trend. The impact factor (IF), also denoted as Journal impact factor (JIF), of an academic journal is a measure of the yearly average number of citations to recent articles published in that journal.

Medicinski Arhiv has an h-Index of 21. It means 21 articles of this journal have more than 21 number of citations. The h-Index is a way of measuring the productivity and citation impact of the publications. The h-Index is defined as the maximum value of h such that the given journal/author has published h papers that have each been cited at least h number of times.

Readers can visit the official website of the "Medical Archives" journal for the call for paper, submission guidelines, notification date, and submission deadlines ( 13 ).

3. CONCLUSION

The journal "Medicinski Arhiv" has been established in 1947 and published by Society of Physicians of Bosnia and Herzegovina, and since 1992 until 2008 Publisher of "Medicinski Arhiv" has been "Avicena" d.o.o., Sarajevo.

From 2009 journal changed the name to "Medical Archives" and registered in National Library Medicine Catalogue with this name and became official journal of Academy of Medical Sciences of Bosnia and Herzegovina. Coverage history of this journal is in largest biomedicine database MEDLINE as following: 1950, 1952-2014, 2016-ongoing.

Detailed facts about history of the journal are published on the occasion of 60 years anniversary and promoted at Academy of Sciences and Arts of Bosnia and Herzegovina in 2006 and as special monograph it is visible on website of Academy (www.amn.ba) and on ResearchGate platform and Academia.edu platform.

Author's contribution:

Author was involved in all steps of preparation of this article, including final proofreading.

Conflict of interest:

None declared.

Financial support and sponsorship:

Archives of Medical Research - Impact Score, Ranking, SJR, h-index, Citescore, Rating, Publisher, ISSN, and Other Important Details

Published By: Elsevier Inc.

Abbreviation: Arch. Med. Res.

Impact Score The impact Score or journal impact score (JIS) is equivalent to Impact Factor. The impact factor (IF) or journal impact factor (JIF) of an academic journal is a scientometric index calculated by Clarivate that reflects the yearly mean number of citations of articles published in the last two years in a given journal, as indexed by Clarivate's Web of Science. On the other hand, Impact Score is based on Scopus data.

Important details, about archives of medical research.

Archives of Medical Research is a journal published by Elsevier Inc. . This journal covers the area[s] related to Medicine (miscellaneous), etc . The coverage history of this journal is as follows: 1992-2022. The rank of this journal is 3785 . This journal's impact score, h-index, and SJR are 6.45, 91, and 1.066, respectively. The ISSN of this journal is/are as follows: 01884409 . The best quartile of Archives of Medical Research is Q1 . This journal has received a total of 1848 citations during the last three years (Preceding 2022).

Archives of Medical Research Impact Score 2022-2023

The impact score (IS), also denoted as the Journal impact score (JIS), of an academic journal is a measure of the yearly average number of citations to recent articles published in that journal. It is based on Scopus data.

Prediction of Archives of Medical Research Impact Score 2023

Impact Score 2022 of Archives of Medical Research is 6.45 . If a similar upward trend continues, IS may increase in 2023 as well.

Impact Score Graph

Check below the impact score trends of archives of medical research. this is based on scopus data., archives of medical research h-index.

The h-index of Archives of Medical Research is 91 . By definition of the h-index, this journal has at least 91 published articles with more than 91 citations.

What is h-index?

The h-index (also known as the Hirsch index or Hirsh index) is a scientometric parameter used to evaluate the scientific impact of the publications and journals. It is defined as the maximum value of h such that the given Journal has published at least h papers and each has at least h citations.

Archives of Medical Research ISSN

The International Standard Serial Number (ISSN) of Archives of Medical Research is/are as follows: 01884409 .

The ISSN is a unique 8-digit identifier for a specific publication like Magazine or Journal. The ISSN is used in the postal system and in the publishing world to identify the articles that are published in journals, magazines, newsletters, etc. This is the number assigned to your article by the publisher, and it is the one you will use to reference your article within the library catalogues.

ISSN code (also called as "ISSN structure" or "ISSN syntax") can be expressed as follows: NNNN-NNNC Here, N is in the set {0,1,2,3...,9}, a digit character, and C is in {0,1,2,3,...,9,X}

Archives of Medical Research Ranking and SCImago Journal Rank (SJR)

SCImago Journal Rank is an indicator, which measures the scientific influence of journals. It considers the number of citations received by a journal and the importance of the journals from where these citations come.

Archives of Medical Research Publisher

The publisher of Archives of Medical Research is Elsevier Inc. . The publishing house of this journal is located in the United States . Its coverage history is as follows: 1992-2022 .

Call For Papers (CFPs)

Please check the official website of this journal to find out the complete details and Call For Papers (CFPs).

Abbreviation

The International Organization for Standardization 4 (ISO 4) abbreviation of Archives of Medical Research is Arch. Med. Res. . ISO 4 is an international standard which defines a uniform and consistent system for the abbreviation of serial publication titles, which are published regularly. The primary use of ISO 4 is to abbreviate or shorten the names of scientific journals using the technique of List of Title Word Abbreviations (LTWA).

As ISO 4 is an international standard, the abbreviation ('Arch. Med. Res.') can be used for citing, indexing, abstraction, and referencing purposes.

How to publish in Archives of Medical Research

If your area of research or discipline is related to Medicine (miscellaneous), etc. , please check the journal's official website to understand the complete publication process.

Acceptance Rate

• Interest/demand of researchers/scientists for publishing in a specific journal/conference.
• The complexity of the peer review process and timeline.
• Time taken from draft submission to final publication.
• Number of submissions received and acceptance slots
• And Many More.

The simplest way to find out the acceptance rate or rejection rate of a Journal/Conference is to check with the journal's/conference's editorial team through emails or through the official website.

Frequently Asked Questions (FAQ)

What is the impact score of archives of medical research.

The latest impact score of Archives of Medical Research is 6.45. It is computed in the year 2023.

What is the h-index of Archives of Medical Research?

The latest h-index of Archives of Medical Research is 91. It is evaluated in the year 2023.

What is the SCImago Journal Rank (SJR) of Archives of Medical Research?

The latest SCImago Journal Rank (SJR) of Archives of Medical Research is 1.066. It is calculated in the year 2023.

What is the ranking of Archives of Medical Research?

The latest ranking of Archives of Medical Research is 3785. This ranking is among 27955 Journals, Conferences, and Book Series. It is computed in the year 2023.

Who is the publisher of Archives of Medical Research?

Archives of Medical Research is published by Elsevier Inc.. The publication country of this journal is United States.

What is the abbreviation of Archives of Medical Research?

This standard abbreviation of Archives of Medical Research is Arch. Med. Res..

Is "Archives of Medical Research" a Journal, Conference or Book Series?

Archives of Medical Research is a journal published by Elsevier Inc..

What is the scope of Archives of Medical Research?

• Medicine (miscellaneous)

For detailed scope of Archives of Medical Research, check the official website of this journal.

What is the ISSN of Archives of Medical Research?

The International Standard Serial Number (ISSN) of Archives of Medical Research is/are as follows: 01884409.

What is the best quartile for Archives of Medical Research?

The best quartile for Archives of Medical Research is Q1.

What is the coverage history of Archives of Medical Research?

The coverage history of Archives of Medical Research is as follows 1992-2022.

Credits and Sources

• Scimago Journal & Country Rank (SJR), https://www.scimagojr.com/
• Journal Impact Factor, https://clarivate.com/
• Issn.org, https://www.issn.org/
• Scopus, https://www.scopus.com/

Note: The impact score shown here is equivalent to the average number of times documents published in a journal/conference in the past two years have been cited in the current year (i.e., Cites / Doc. (2 years)). It is based on Scopus data and can be a little higher or different compared to the impact factor (IF) produced by Journal Citation Report. Please refer to the Web of Science data source to check the exact journal impact factor ™ (Thomson Reuters) metric.

Impact Score, SJR, h-Index, and Other Important metrics of These Journals, Conferences, and Book Series

Check complete list

Archives of Medical Research Impact Score (IS) Trend

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Archives of Medical Research Impact Factor & Key Scientometrics

Archives of medical research overview, impact factor.

I. Basic Journal Info

Journal ISSN: 1884409

Publisher: elsevier bv, history: 1992-ongoing, journal hompage: link, how to get published:, research categories, scope/description:.

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II. Science Citation Report (SCR)

Archives of medical research scr impact factor, archives of medical research scr journal ranking, archives of medical research scimago sjr rank.

SCImago Journal Rank (SJR indicator) is a measure of scientific influence of scholarly journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals where such citations come from.

Archives of Medical Research Scopus 2-Year Impact Factor Trend

Archives of medical research scopus 3-year impact factor trend, archives of medical research scopus 4-year impact factor trend, archives of medical research impact factor history.

• 2022 Impact Factor 6.455 5.634 4.969
• 2021 Impact Factor 6.014 5.069 4.738
• 2020 Impact Factor 1.665 2.083 2.267
• 2019 Impact Factor 2.017 2.248 2.404
• 2018 Impact Factor 1.749 2.166 2.405
• 2017 Impact Factor 2.032 2.476 2.454
• 2016 Impact Factor 2.663 2.539 2.62
• 2015 Impact Factor 2.341 2.663 2.608
• 2014 Impact Factor 2.604 NA NA
• 2013 Impact Factor 2.416 NA NA
• 2012 Impact Factor 2.155 NA NA
• 2011 Impact Factor 1.801 NA NA
• 2010 Impact Factor 2.189 NA NA
• 2009 Impact Factor 2.027 NA NA
• 2008 Impact Factor 1.821 NA NA
• 2007 Impact Factor 2.101 NA NA
• 2006 Impact Factor 1.782 NA NA
• 2005 Impact Factor 1.643 NA NA
• 2004 Impact Factor 1.328 NA NA
• 2003 Impact Factor 1.393 NA NA
• 2002 Impact Factor 0.702 NA NA
• 2001 Impact Factor 0.515 NA NA
• 2000 Impact Factor 0.671 NA NA

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Impact factor (IF) is a scientometric factor based on the yearly average number of citations on articles published by a particular journal in the last two years. A journal impact factor is frequently used as a proxy for the relative importance of a journal within its field. Find out more: What is a good impact factor?

III. Other Science Influence Indicators

Any impact factor or scientometric indicator alone will not give you the full picture of a science journal. There are also other factors such as H-Index, Self-Citation Ratio, SJR, SNIP, etc. Researchers may also consider the practical aspect of a journal such as publication fees, acceptance rate, review speed. ( Learn More )

Archives of Medical Research H-Index

The h-index is an author-level metric that attempts to measure both the productivity and citation impact of the publications of a scientist or scholar. The index is based on the set of the scientist's most cited papers and the number of citations that they have received in other publications

Archives of Medical Research H-Index History

scijournal.org is a platform dedicated to making the search and use of impact factors of science journals easier.

Cultural Relativity and Acceptance of Embryonic Stem Cell Research

Article sidebar.

Main Article Content

There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities.

INTRODUCTION

Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve.

Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes. [1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research. [2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.” [3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops. [4]  Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture.

I.     Global Cultural Perspective of Embryonic Stem Cells

Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense, [5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research. [6] Consequently, global engagement in ESC research depends on social-cultural acceptability.

a.     US and Rights-Based Cultures

In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism, [7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.” [8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed. [9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field. [10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture. [11]

b.     Ubuntu and Collective Cultures

African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama , which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,” [12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth. [13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole . Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value. [14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society.

Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.” [15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail.

Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable. [16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus. [17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines. [18]

Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim. [19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research. [20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF.  Their use is conditioned on consent, and available only to married couples. [21] The community's receptiveness to stem cell research depends on including communitarian African ethics.

c.     Asia

Some Asian countries also have a collective model of ethics and decision making. [22] In China, the ethics model promotes a sincere respect for life or human dignity, [23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life. [25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research. [26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions. [27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency. [28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021. [29] However, issues still need to be addressed in implementing effective IRB review and approval procedures.

The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy, [30] research ethics should also adapt to ensure respect for the values of its represented peoples.

Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies. [31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells. [32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval, [33] and in another instance, the oocyte source was unclear and possibly violated ethical standards. [34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust.

d.     Middle East

Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells, [35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research. [36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors. [37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so. [38]

Jordan has a positive research ethics culture. [39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial. [40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation. [41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.” [42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes.

e.     Europe

In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected. [43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44]

For example, in Germany, Lebenzusammenhang , or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.” [45]  Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount. [46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007. [47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization. [48] Spain’s approach differs still, with a comprehensive regulatory framework. [49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility. [50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices. [51]

II.     Religious Perspectives on ESC

Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives.

The Qur'an states:

“And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.” [52]

Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception. [53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible. [54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research. [55]

In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided. [56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden. [57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all. [58] Acceptance varies on applied beliefs and interpretations.

Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero, [59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all. [60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime. [61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit. [62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets. [63]

Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life. [64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception: [65]

“If she is found pregnant, until the fortieth day it is mere fluid,” [66]

Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation. [67] Stem cell research is accepted due to application of these religious laws.

We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory , which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions. [68] We only wish to show that the interaction with morality varies between cultures and countries.

III.     A Flexible Ethical Approach

The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities.

While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe. [69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation.

For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent. [70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context, [71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders.  This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research.

Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values. [72]

An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions. [73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion.

IV.     Concerns

Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values. [74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions.

Other concerns include medical tourism, which may promote health inequities. [75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments. [76]

For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.” [77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices. [78]

The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.” [79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds. [80]

While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research.

For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society.

This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model.

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[5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources:

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[7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics . Oxford University Press.

[8] Sherley v. Sebelius , 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf

[9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109 th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text ; Bush, G. W. (2006, July 19). Message to the House of Representatives . National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html

[10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells . National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells

[11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells.  Social Research ,  73 (3), 819–834. http://www.jstor.org/stable/40971854

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[13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics , 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight , 49 (4).

[14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics , 22 (2), 112–122. https://doi.org/10.1111/dewb.12324

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[18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80 , see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

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[21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries.  Middle East Fertil Soc J   24 , 8 (2020). https://doi.org/10.1186/s43043-019-0011-0 ; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics , 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247

[23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

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[30] Chen, H., Wei, T., Wang, H.  et al.  Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017.  BMC Public Health   22 , 434 (2022). https://doi.org/10.1186/s12889-022-12839-0

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[35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

[36] Association for the Advancement of Blood and Biotherapies.  https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia

[37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia.  BMC medical ethics ,  21 (1), 35. https://doi.org/10.1186/s12910-020-00482-6

[38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics , 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics , 23 (3), 260–268. https://doi.org/10.1111/dewb.12355 ; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know . Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know

[39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

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[43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France.  Biotechnology Law Report ,  32 (6), 349–356. https://doi.org/10.1089/blr.2013.9865

[45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

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[47] Regulation of Stem Cell Research in Germany . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany

[48] Regulation of Stem Cell Research in Finland . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland

[49] Regulation of Stem Cell Research in Spain . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain

[50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered:

Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110.

Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ...  Revista do Colegio Brasileiro de Cirurgioes ,  41 (5), 374–377. https://doi.org/10.1590/0100-69912014005013

Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India . Routledge.

For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe   

[51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights.  Cultura (Iasi, Romania) ,  14 (2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent?  Research Ethics ,  13 (1), 23-41.  https://doi.org/10.1177/1747016116650235

[52] The Qur'an  (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23

[53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life . Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/

[54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics , 31: 399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386

[55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association , 12 (4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf.

[56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52.  https://doi.org/10.5372/1905-7415.0801.260

[57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation.  Journal of Religion and Health ,  30 (1), 35–41. http://www.jstor.org/stable/27510629 ; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva . A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm

[59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. (( King James Bible . (1999). Oxford University Press. (original work published 1769))

Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…”

In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David.

Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…”

These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth.

[60] It should be noted that abortion is not supported as well.

[61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day . Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

[62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells . Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html ; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology . Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf.

[63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed . Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/

[64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society , (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law).  Journal of assisted reproduction and genetics ,  25 (6), 271–276. https://doi.org/10.1007/s10815-008-9221-6

[66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet) . Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en

[67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979).  The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services.  https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes.  Journal of assisted reproduction and genetics ,  35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

[71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA.  Reproductive biomedicine online ,  18 (5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8

[72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa.  Clinical trials (London, England) ,  3 (3), 306–313. https://doi.org/10.1191/1740774506cn150oa

[73] Veatch, Robert M.  Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

[74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity.  Research Ethics ,  14 (3), 1-17.  https://doi.org/10.1177/1747016117739939

[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry.  Voices in Bioethics ,  8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis.  Voices in Bioethics ,  3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation,  New Genetics and Society , 30:2, 141-153, DOI:  10.1080/14636778.2011.574375

[78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[79] International Society for Stem Cell Research. (2024). Standards in stem cell research . International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

MS Bioethics Columbia University (Disclosure: affiliated with Voices in Bioethics)

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