ABSTRACT
As one of the key tools on the precision medicine workbench, high-throughput genetic testing has enormous promise for improving healthcare outcomes. Tunisia has made tremendous progress in acquiring and implementing the technology in the clinical context. However, current utilization does not ensure the whole range of benefits that high-throughput genomic testing provides which impedes the country's ability to move forward into the new era of precision medicine. This issue is primarily related to the current state of Tunisia's healthcare ecosystem and the sociological attributes of its population, creating numerous challenges that must be addressed. In the current review, we aimed to identify and highlight these challenges that may be prevalent in other low and middle-income countries. Essentially, they fall into three main categories that include the socio-economic landscape in Tunisia, which prevents citizens from engaging in precision medicine activities; the current settings of the healthcare system that lack or miss key components for the successful implementation of precision medicine practices; and the inability of the current infrastructure and resources to handle the various challenges related to genomic data and metadata. We also propose five pillar solutions as a framework for addressing all of these challenges, which could strengthen Tunisia's capability for effective precision medicine implementation in today's clinical environment.
ABSTRACT
BACKGROUND: Children with Down syndrome (DS) offer a compelling context within the fieldof human biology for examining potential lunar influences. While the exact mechanisms governing lunar effects are still under investigation, a growing body of scientific inquiry suggests possible connections between lunar phases and physiological, physical, and cognitive parameters. This investigation holds promise for uncovering the intricate interplay between lunar cycles (LCs) and the unique biology of children with DS. This study investigated the potential influence of the LC on physiological, physical, and cognitive parameters in children with DS, focusing on sleep patterns, physical performance, and cognitive abilities. MATERIALS AND METHODS: Seventeen children with DS participated in this study. Sleep data, physical performance metrics, and cognitive test results were collected throughout the LC, including the new moon (NM), first quarter, full moon (FM), and third quarter. Statistical analyses were conducted to assess the differences in these parameters across lunar phases. RESULTS: Significant differences were observed in sleep patterns, with reduced total sleep time (P < 0.01) and sleep efficiency (P < 0.001) during the FM phase. Heart rates (HRs) before (P < 0.001) and after (P < 0.01) exercise also displayed pronounced changes during LC. Additionally, the reaction time (RT) exhibited a significant difference (P < 0.01) across the lunar phases. However, physical performance metrics, including squat jump (SJ), sprint, and 6-minute walk distance (6MWD), did not show significant variations. CONCLUSION: This study suggests that LC may have a moderating effect on sleep patterns, HR, and cognitive performance in children with DS. These findings have practical implications for caregivers and educators and highlight the importance of considering lunar-associated variations in planning schedules and interventions for children with DS.
