Killer T cells about to destroy a cancer cell. Credit: NIH
Scientists at the University of Southampton have begun work on reprogramming natural killer cells to create pre-armed, long-lasting protection against common respiratory viruses including colds, flu and RSV. The approach differs from traditional vaccination, which uses weakened pathogen to train adaptive responses.
Professor of Hepatology Salim Khakoo from the University of Southampton said the technique could change how people protect themselves from flu, colds and RSV: “We’re working on creating a natural killer cell found in the lungs with a memory about how to fight the viruses immediately someone is infected. The idea is to arm our body naturally by enhancing these cells so that they can prevent infection from ever becoming established.”
Natural killer cells act as early responders that can destroy infected cells before a virus spreads, but they are short-lived. Co-lead Dr Andres Vallejo noted that learning to reprogram them could yield long-lasting versions resident in the airways, ready to respond on first exposure. The team received £2.5 million for the TRIUMPH-NK project under a £57 million Advanced Research + Invention Agency (ARIA) initiative. Success would aim for protection against most common respiratory viruses rather than single strains. Viruses such as flu, RSV and Covid remain major causes of illness and winter hospital admissions in the UK.
University of East Anglia researchers have found that small changes in pupil size and blink patterns can indicate mental workload during virtual reality tasks. Combining AI with eye tracking in VR may eventually support personalised treatment for chronic pain.
Lead researcher Dr Jordan Tsigarides said chronic pain affects an estimated 1.5 billion people worldwide and is a leading cause of disability. The work forms part of his PhD exploring AI and sensor technology to make VR treatments more responsive, aiming to balance challenge and comfort.
“Chronic pain affects an estimated 1.5 billion people worldwide and is one of the leading causes of disability. Virtual reality has enormous therapeutic potential – whether that’s guiding patients through a peaceful woodland, supporting relaxation exercises or engaging them with games and puzzles that help manage pain. It can help reduce chronic pain by immersing users in engaging, interactive environments that capture the brain’s attention and draw it away from pain, reduce pain-related stress and anxiety, and may even help retrain how the brain processes pain over time.
“But most virtual reality programs offer the same experience to everyone, even though people’s pain and mental effort can fluctuate from moment to moment. Our work suggests future systems could read mental effort through the eyes and adapt therapy in real time to each individual. If a headset can detect when someone is becoming mentally overloaded, it could potentially adapt the experience automatically to keep them engaged and maximise therapeutic benefit.”
In a study of 84 volunteers (42 healthy controls and 42 with chronic musculoskeletal pain such as arthritis or fibromyalgia), participants completed escalating memory (N-back) challenges while wearing a VR headset with eye tracking. As cognitive demand rose, pupils widened and blink rates increased.
AI models analysing temporal patterns distinguished low versus high mental workload with up to 88% accuracy in healthy volunteers. Tasks were well tolerated, with very low reported motion sickness or discomfort. The findings support feasibility of VR-embedded eye tracking for cognitive-load estimation; reliable individual-level inference in chronic pain will require participant-calibrated models and further validation. The researchers hope this could enable wearable systems that adapt therapy in real time.
Dr Tsigarides said: “These results suggest a future in which a headset could continuously monitor the brain’s workload through the eyes, automatically fine-tuning treatment to each individual user.
“Our earlier research showed promising pain reductions in people with fibromyalgia using therapeutic VR. Now we’re exploring how to make those experiences smarter, more responsive, and tailored to each person.
“Until now, most VR has been one-size-fits-all. Our findings could help make treatments more personalised and responsive. This could enhance future VR treatments, not just for pain but potentially for conditions like anxiety or depression.”
“In future, the same principles could be explored in education and professional training, where virtual learning experiences might adapt to the learner’s mental workload.”
However, the study also highlighted a challenge. While AI models performed strongly in healthy volunteers, accuracy was significantly lower among people living with chronic pain, suggesting that standardised approaches may not work equally well for all patients.
The researchers believe future systems may need to be individually calibrated, learning how each person’s eyes respond to mental effort before making treatment decisions.
And they say that larger studies are needed to determine whether adaptive VR therapies can improve real-world outcomes for patients.
Children whose mothers received opioid prescriptions during pregnancy have a higher rate of hospital admission in childhood than unexposed children, including unexposed siblings, according to a new study published October 13th in the open access journal PLOS Medicine by Dong Keon Yon of Kyung Hee University College of Medicine, South Korea, and colleagues.
Over recent decades, opioid prescriptions and doses have risen in clinical practice, and a considerable proportion of pregnant women are exposed to these drugs. In the US, for example, data has shown that 14-22% of women filled a prescription for opioids during pregnancy. Prenatal opioid exposure may disrupt infant development and immune system function, but prior studies have had limitations such as confounding factors, limited sample sizes, or restricted follow-up durations.
In the new study, researchers used nationwide health insurance data on mothers and children in South Korea, following a cohort of 2,928,186 children born between 2010 and 2017 for up to 14 years. Children were classified as prenatally exposed to opioids if their mothers received two or more opioid prescriptions during pregnancy, and were compared both with unexposed children and with their own siblings.
Children with prenatal opioid exposure had a 28% higher rate of hospital admission than unexposed children (adjusted incidence rate ratio 1.28, 95% CI 1.28-1.29). The association was smaller but still significant when comparing siblings (aIRR 1.08, 95% CI 1.07-1.10). The effect was also dose-dependent, with higher maternal opioid doses associated with higher admission rates (aIRR 1.19 for low-dose exposure versus 1.40 for high-dose exposure). The elevated admission rates spanned several causes, including infections and respiratory, gastrointestinal and genitourinary conditions, with the association strongest up to five years of age.
“These findings suggest the need for additional postnatal health checks for those born to mothers with opioid prescriptions during pregnancy,” the authors write. “However, these findings should be interpreted with caution, as the study relied on electronic health records, which may not reflect actual use of medication, and unmeasured factors shared within families may still partly explain the observed associations.”
Dong Keon Yon, MD, PhD (co-corresponding author) states, “In a nationwide cohort of nearly three million Korean children, those whose mothers received two or more opioid prescriptions during pregnancy had about a 28% higher rate of hospital admission, most notably for infections and respiratory illness in the first years of life. The risk rose with higher opioid doses and longer prescriptions, which points to a possible biological effect—but when we compared siblings within the same family, the association shrank considerably, so shared family factors clearly explain part of what we see.”
Jiseung Kang, PhD (co-corresponding author), adds, “Because opioids in South Korea are obtained almost entirely by prescription, our data let us examine prescribed opioid exposure in pregnancy unusually cleanly, and following nearly three million children for up to 14 years gave us the statistical power to look at dose, timing, and specific causes of admission separately. The consistency of the pattern across all of these analyses is what makes the finding hard to dismiss.”
Hyeon Jin Kim, MS (joint first author) states, “Our message is not that pregnant women should never receive opioids—for some, pain relief is essential. It is that opioids in pregnancy should be prescribed at the lowest effective dose for the shortest time, and that children born after such exposure may benefit from closer routine health checks, particularly in infancy when the risk was highest.”
Yesol Yim (joint first author) notes, “What surprised us most was how quickly the association faded as children grew older. The excess risk was clearest in the first year of life and had largely disappeared after age five. That pattern suggests a window of vulnerability in early infancy rather than a lifelong effect – and it is a window in which pediatric follow-up can make a real difference.”
Doctors and supporters of unemployed medical professionals protest outside the Natalia Building in Pietermaritzburg, calling for action on doctor unemployment. (Photo: Supplied)
By Sue Segar for Spotlight
They are qualified, ready, and willing to serve their communities. But scores of these doctors in KwaZulu-Natal, are becoming increasingly desperate because of a lack of posts in government hospitals and clinics.
Dr Tholumusa Sibiya remembers, as if it were yesterday, the day, in 2015, when a group of young doctors visited his school in Ingwavuma, KwaZulu-Natal to urge talented pupils to apply to university to study medicine and other health disciplines.
The doctors were from Mosvold Hospital where manager, Dr Andrew Ross, had started a fund to encourage local pupils to train in medicine and return to serve in their communities.
“The message from these young professionals was, ‘yeah, it’s doable. You can also study medicine. And you’re needed.’ That really inspired me,” says Sibiya, who was the top pupil in matric at Nansindlela Combined School.
He knew about Mosvold Hospital because his father worked in the mortuary, and his mother in the laundry services there. But, till then, it hadn’t occurred to him he could be a doctor there some day.
“One of the doctors said something that knocked sense into me. He said as rural kids, we need to work twice as hard to have half of what guys in other schools have,” he recalls.
Sibiya and other pupils from the area then formed a study group, to “share information and support each other”. “It helped a lot working together … especially with mathematics and physics,” he says.
Against the odds
Sibiya’s hard work paid off, and armed with an Umthombo bursary, he was accepted at the University of KwaZulu-Natal to study dental therapy. A year later, he transferred to the university’s medical school, and qualified as a doctor in 2022.
“My parents were ecstatic,” he says.
Straight after qualifying, he did two years of internship at Empangeni’s Ngwelezana Hospital, followed by community service at Manguzi Hospital in northern KwaZulu-Natal. “I rotated from one department to the next – paediatrics, maternity, the emergency unit – and learnt so much. It was the best,” he says.
He was geared up and ready to return home to serve his rural community as a doctor. His long-term dream was to work as an emergency physician in a hospital in rural KZN; maybe to specialise as an anaesthesiologist. But to specialise, you need to work in a public facility.
That was 2025. Since then, Sibiya has not been able to find a job as a doctor in the public healthcare sector. “I started applying in October last year,” he says. “But, so far, nothing.”
Many unemployed doctors
Sibiya is not alone. Spotlight has spoken to several other young doctors who are in the same boat. He reckons there are well over a hundred recently qualified doctors looking for work just in KwaZulu-Natal, others put the number at closer to 200. Even this may be an undercount since it doesn’t fully account for doctors who are still unemployed from previous years, or who have stopped looking for work. Some recent reporting suggests that the National Department of Health does not have a reliable count of how many unemployed doctors there are who are looking for work in the country.
Those who have received government bursaries, cannot fathom “why the government invests in us, then dumps us”. “Even now, they’re sending a new batch to study overseas, but where will they work?” says one doctor, who suggests that Cuban-trained doctors are prioritised for jobs because the government allegedly has a contractual obligation to give them jobs.
Currently, Sibiya and others have few alternatives but to try and do locums in private practises or in private hospitals.
“We’ve worked hard, done all that’s necessary to qualify and completed our internships and community service in preparation for careers in service to others, but we cannot find jobs,” says Sibiya.
Scrambling to make ends meet
We are meeting Sibiya on a Sunday at a coffee shop in Pietermaritzburg. He is currently living in Margate on the KwaZulu-Natal south coast and has come to Pietermaritzburg to do a locum shift for a private GP.
“I do shifts wherever I can find them. Primarily, I’m working in the emergency unit at the Shelly Beach (private) Hospital on the south coast. They call me whenever they need me, but I have no contract. That’s how I’ve been paying bills,” he says.
He keeps up with scores of other unemployed doctors on three different WhatsApp groups where, among others, they share job and locum opportunities, advise and support each other, and coordinate some of their interactions with the provincial health department.
“There are many people on the group(s) who aren’t able to get locum posts,” he says, “and they are really struggling. Some have depression. Sometimes it boils down to cars being repossessed, people going back home. Some people say, ‘I can’t put bread on the table, I’m selling my stuff because I can’t make ends meet’.”
“The mother of a friend of mine, also an unemployed doctor, called me recently and told me he’s drinking every day because the stress has been too much,” says Sibiya. “Some of the stories will make you cry.”
The situation is particularly tough on young doctors from poor backgrounds who do not have the funds to sustain themselves without work for extended periods.
‘I can feel I’m going into a depression’
Dr Raeesa Kathrada says she has sent her CV “to every doctor I know and to every private hospital and applied for every locum position.
“I can feel I’m going into a depression … as are my colleagues. Many people reach out to me, saying they don’t know how to survive,” she says.
Kathrada says some doctors have been waiting up to three years to find jobs.
Dr Lawrence Khoza from Osizweni, near Newcastle, is also struggling to find a position in the public sector. He started a private general practice, but he says he wants to work for the government and to see patients for free. “My passion is to help poor patients … but now I can only help those in the middle class who can afford medical aid,” he says.
Dr Nazo Nxumalo, originally from Mtubatuba, qualified in medicine at UKZN in 2022, did a two-year internship at Empangeni’s Ngwelezane Hospital and her community service at the Nseleni Community Health Centre in 2025. “After that, it was unemployment,” says Nxumalo. “It was like being dropped in the middle of the ocean.”
“I really thought that, after my community service, employment in the public health system would follow,” she says. “Basically, the department has left us stranded. We went into medicine, a very important job in society, believing we were entering a profession where our skills would always be needed.”
Understaffing in public health facilities
The unemployed doctors say that, while they are struggling to find work, the province at the same time desperately needs more doctors if it is to improve the quality and availability of healthcare services. “There is a big shortage; doctors are suffering in silence. The demand is there but the government is turning a blind eye,” says Khoza.
Several doctors who are currently employed at public sector hospitals in the province agree that they need help. One doctor, from a rural hospital speaks about “long lines of patients, late into the day” and doctors often working overtime and never taking a lunch break because “we can’t afford the 15 or 30 minutes of having no doctor on duty”. We are not naming the employed doctors quoted in this story since they could potentially suffer repercussions for speaking out.
“Whenever people leave our hospital, the posts are not filled because of budget cuts,” says another employed doctor. “Several departments here are severely short staffed.”
A recent report from South Africa’s Health Ombud paints a similarly grim picture. Following an investigation into the deaths of six healthcare workers at six public health establishments in KwaZulu-Natal, the Ombud found that while their deaths were not a result of workplace bullying, victimisation, or adverse working conditions in the hospitals under investigation, there were “significant” systemic challenges affecting healthcare professionals in the health establishments. These included “persistent staffing shortages, frozen vacant posts, rising workloads, shortages of medical equipment and supplies, inadequate employee wellness support services, infrastructure challenges, and security concerns affecting healthcare workers”.
A rough benchmark is that 1 doctor is needed for every 1 000 people, although experts stress that target ratios may differ based on factors like disease profile and population density. According to a 2025 parliamentary answer, the ratio in KwaZulu-Natal stood at around 0.38 doctors per 1 000 people – according to the District Health Barometer it was at just under 0.4 in 2024.
Though the KwaZulu-Natal Department of Health does not describe the situation as a crisis anywhere we could find, they do acknowledge shortages. Their 2025-2026 annual report largely blames a budget crunch. “The ongoing budget cuts due to implementation of austerity measures have had a significant impact on the ability of the department to fill vacant critical posts especially among clinical specialists (nurses and doctors), allied health professionals including in finance and human resource administrative posts,” the report reads.
Protests in Pietermaritzburg
On 17 June this year, a large group of unemployed doctors protested outside Natalia, which houses the KZN Department of Health and the Office of the Premier, to call on the provincial government to act urgently to create jobs for the numerous unemployed medical professionals.
With many wearing scrubs and holding placards, the doctors voiced their willingness to serve their communities. They highlighted the shortage of qualified doctors, the systemic strain in provincial hospitals and clinics, and a poor doctor-to-patient ratio in the province.
The protesters also pointed out that some doctors have been waiting for years for jobs; and that their ambitions to specialise in various medical areas were being severely hindered because of the lack of government posts.
They submitted a memorandum addressed to KZN Premier, Thami Ntuli, Health MEC Nomagugu Simelane, and head of the health department, Penny Msimango. Among others, the protestors demanded that the provincial health department advertise all the vacant medical officer positions at various public healthcare institutions within 14 days and that it develops a sustainable long-term plan to provide posts annually and address doctor unemployment beyond 2026.
Not enough money
In a written response to the protestors, the department said: “A filling of vacant posts is dependent on the availability of funds to compensate employees. The department is underfunded for 2026/7 financial year, therefore not all vacant posts can be filled.” They said that, due to the budgetary constraints, they could not commit to timelines for filling posts.
Spotlight sent the KwaZulu-Natal Department of Health a detailed set of questions (which you can read here) on the afternoon of Thursday15 October. We gave them a deadline of end of business on Tuesday 20 October. While the department acknowledged that they received our questions, they did not provide responses by the deadline.
On July 6, Simelane met with representatives of the unemployed doctors and representatives from the South African Medical Association Trade Union (SAMATU) (the unemployed doctors say that SAMATU had to be present since the department does not recognise the group of unemployed doctors).
According to Sibiya, the meeting did not go well. “Their clear message was that the department has enforced austerity measures and they do not have money to fund posts. They committed to try and look for 20 posts but that was all they could promise,” he says. In his view, 20 is not nearly enough. The department later upped the number of newly released posts to 50. The unemployed doctors say that while these jobs have been advertised, there have been no further movement.
But what stung Sibiya more was the sense he got that the department had accepted the situation and given up. “What was really astonishing was that they said they are comfortable with the numbers of doctors in the province on paper,” he says. Spotlight asked the department whether this characterisation is accurate, but did not receive an answer.
“Our response is that …. if something’s declared a crisis, finances are moved to meet that crisis, be it at provincial or national level,” Sibiya says. “I’m sure the public feels the same way: the doctors on the ground by no means meet the demand. They could hire all the unemployed doctors in the province, and still the demand wouldn’t be met.”
“We are not trying to fight”
As the 2026 convenor of the KZN Unemployed Doctors group, Sibiya has been in the middle of much of these developments. The group was formed a few years back with the goal of communicating with the provincial health department to raise doctors’ concerns about unemployment. It was only after several other efforts at engaging the department had not gone anywhere that they decided to protest.
In the meeting, he says they stressed “that we’re not here to fight”. “We understand the department has financial constraints. But we’re talking about the health of the entire province resting on a few shoulders who are really tired; and people ready to work cannot be integrated into the system because of austerity measures”, he says.
“I think we must all agree it’s a crisis. Once we do this, I’m certain funds can be mobilised from somewhere,” he says. “Alternatively, we could expand the system of employing sessional medical officers, where doctors work for a certain number of hours in clinics and hospitals, and earn less.”
But, says Sibiya, “it’s almost as though they’ve given up”.
That sense that those in power are not hearing them was recently reinforced when premier Ntuli reportedly called on doctors who have left the province to return home and help strengthen the health system. More than one unemployed doctor told Spotlight that they were enraged by the comments in the context of their struggle to get jobs. “It’s ridiculous,” says Sibiya. “After all our efforts to speak to the government, and being ignored, now this.”
“Just go private!”
Meanwhile, Sibiya and scores of other young, unemployed doctors are still having to scramble to make ends meet.
Sibiya says people often say to unemployed doctors that they should go private. “Yes, that’s an option, but from the point of view of specialising, it destroys the pipeline. And if all of us go private, then in upcoming years, we will be talking about a shortage. And, in a time of NHI, why are doctors having to work in private”, he asks.
“It’s worse for us coming from Ingwavuma, funded by Umthombo, where when we signed the contract, we were told, ‘You’re going to come back and serve your community’. I was happy to do that,” he says. Umthombo is a scheme that supports young people from rural KwaZulu-Natal to study medicine and then to return to serve their communities once qualified.
Despite all the setbacks, the dream of serving his community remains alive for Sibiya. His eyes light up when he talks of his dream to work rurally, preferably at the hospital he loves, Manguzi.
But, right now, that dream seems far away. He says his main focus at the moment is just to survive.
Cold-water immersion is a popular post-workout recovery strategy, but new research suggests it may offer no greater benefit to muscle strength recovery than heat-based methods. The study, published in the Journal of Thermal Biology, investigated how different thermal recovery strategies affect muscle recovery following exercise-induced muscle damage.
Researchers led by the University of East London found that while heat-based interventions altered several physiological markers associated with cellular stress and muscle repair, neither heat nor cold resulted in superior recovery of muscle strength over a 72-hour period.
The research involved 40 healthy, physically active adults who completed an intensive exercise protocol designed to induce temporary muscle damage and delayed onset muscle soreness.
Participants were randomly assigned to one of four recovery strategies:
30 minutes of hot-water immersion at 42°C
15 minutes of cold-water immersion at 9°C
30 minutes of hot-air exposure at 30°C
Passive recovery at room temperature
Researchers then monitored changes in muscle strength, muscle soreness and a range of molecular markers associated with muscle damage and inflammation over the following 72 hours.
Immediately following exercise, muscle strength decreased by approximately 36% across all groups. Although strength gradually recovered over the monitoring period, no statistically significant differences were observed between the four recovery strategies.
However, the different recovery approaches produced distinct physiological responses. Participants receiving heat-based treatments showed increased expression of heat shock protein 72 (HSP72), a cellular stress protein associated with protective and repair-related processes within muscle. In addition, concentrations of creatine kinase-MM (CK-MM), a marker commonly associated with muscle damage, returned towards baseline more rapidly in the heat-based recovery groups than in the cold-water immersion group.
These findings suggest that heat-based recovery strategies may influence some of the biological processes involved in recovery following muscle-damaging exercise. However, these physiological changes did not translate into significantly greater improvements in muscle strength or reductions in soreness during the 72-hour recovery period.
Dr Freya Bayne, Lecturer in Sport and Exercise Science at University of East London and lead author of the study, said:
Cold-water immersion remains one of the most popular recovery strategies used by athletes and recreational exercisers alike. Our findings suggest that heat-based recovery methods produce different physiological responses following strenuous exercise, particularly in relation to markers associated with cellular protection and muscle repair.
We observed increases in heat shock protein expression and a faster return towards baseline for some markers associated with muscle damage.”
Almost 3000 scans performed in five months as Bophelo First Trust and Dis-Chem Better Tomorrow Starts Here strengthen diagnostic capacity across six public hospitals
Patients at five Mpumalanga hospitals are benefiting from faster diagnosis following the launch of a point-of-care ultrasound programme by Bophelo First Trust (BFT), a South African Public Benefit Organisation (PBO), in partnership with Dis-Chem. The initiative has so far trained 14 clinicians and deployed 10 portable ultrasound machines, enabling surgical, emergency and trauma teams to scan patients at the bedside and reduce the need for referrals to other facilities.
BFT’s model strengthens existing public health systems through structure, continuity and measurable impact. It enables targeted operational support programmes that help unlock underutilised healthcare infrastructure and increase patient access to care. Through collaborative partnerships, it develops and implements scalable healthcare support initiatives focused on reducing surgical backlogs, increasing procedural throughput, expanding access to diagnostic capability, strengthening operational healthcare capacity and supporting long-term public-sector sustainability.
Uptake has been strong since the programme launched in May, says BFT CEO Dr Mark Wadley. “Targeted operational interventions have the potential to unlock additional healthcare capacity within existing public-sector infrastructure. With point-of-care ultrasound, a trained clinician can perform a focused scan beside the patient and interpret the findings in real time. This means patients can be assessed sooner and, where appropriate, avoid the need to travel elsewhere for imaging.”
The programme addresses a significant diagnostic gap in a province serving close to five million people. Since May, clinicians had performed 2,865 scans covering abdominal, vascular, trauma and musculoskeletal applications.
“Better Tomorrow Starts Here addresses pressing societal health challenges across South Africa and looks to find practical ways to improve access to quality care,” says Joshila Shiba, Dis-Chem’s Head of Health Equity and Sustainability. “This programme shows how targeted, practical interventions can unlock additional healthcare capacity within existing public-sector infrastructure and aligns with Dis-Chem’s purpose of increasing access to quality healthcare access. We want to help build, support and strengthen healthcare ecosystems across South Africa.”
“Our Better Tomorrow Starts Here initiative reflects our commitment to societal health challenges by aligning our business goals with sustainable development in South Africa and connecting our overarching “Better Health Starts Here” purpose with a broader commitment to contributing positively to the country’s future.”
Dr David Marubini, one of the 14 clinicians trained through the programme, says access to ultrasound is particularly valuable in surgical care, where delays in diagnosis can affect treatment decisions.
“Before we had ultrasound in our department, a patient arriving with severe abdominal pain or injuries from a road accident often had to wait before we could see what was happening internally. Sometimes they had to be transferred to another hospital first,” says Dr Marubini.
“Now I can scan at the bedside within minutes and answer urgent questions straight away. Is there internal bleeding? Does this patient need to go to theatre now, or can we safely manage them here? It doesn’t replace a full radiology service, but it allows us to make decisions sooner and with greater confidence.”
Dr Wadley says the initiative could provide a scalable model for strengthening diagnostic capacity in public hospitals across South Africa.
“Clinician participation is expanding and more hospitals are showing interest. The next phase will focus on improving how the clinicians’ ultrasound images and video clips are stored and uploaded to the cloud. This will support AI-assisted quality assurance and training, helping to maintain scanning standards as more clinicians are trained. In turn this will further strengthen diagnostic capacity in the province” concludes Dr Wadley.
As we approach Movember with a focus on men’s health, we talk to Dr Hein Els, a radiologist specialising in abdominal imaging at SCP Radiology and Dr Louw-Waldi Vlok, a urologist at Mediclinic Panorama, about why MRI has become such an important tool in detecting prostate cancer and guiding diagnosis.
It’s often not the man who notices something first. His partner may mention noticing he has been up three or four times a night. He’ll put it down to getting older or having a cup of tea too late in the evening. What happens next is usually a visit to your GP…
How common is prostate cancer in the first place?
“Prostate cancer is the top invasive cancer reported in men in South Africa and also one of the most treatable, when it’s caught early,” says Dr Vlok. “Knowing what to look out for and understanding how far diagnosis and treatment have come, can reduce the fear and uncertainty around the disease. Today’s imaging technology means men get answers faster, treatment only when necessary and fewer invasive procedures than they would have a decade ago.”
What are the symptoms of prostate cancer?
“It is very important to realise that in the early stages of prostate cancer the patient will often have no symptoms at all”, says Dr Vlok. “Some men may have symptoms of an enlarging prostate which can include: Needing to urinate more often, particularly at night, a weak or interrupted urine flow and even an inability to urinate and difficulty starting or stopping urination.
As the disease progress and grows beyond the prostate the symptoms will increase:
Blood in urine or semen
Pain in the pelvis or lower back
Are there any unusual or less obvious signs?
“Yes,” says Dr Vlok, “and these are the ones men are least likely to connect to the prostate.” In more advanced cases, prostate cancer can cause:
• Unexplained pain in the lower back, hips or pelvis
• New or worsening erectile difficulties
• Unexplained weight loss or persistent fatigue
• Swelling in the legs or feet
‘These signs can point to the cancer having spread beyond the prostate, most often to the bones. They can also have entirely unrelated causes, so the sensible response is to get checked rather than to worry. Catching a change early is exactly what makes modern diagnosis so effective.
These symptoms don’t automatically mean cancer. An enlarged prostate or inflammation of the prostate is common with age and usually benign, but any of these changes are worth mentioning to your doctor.
How was prostate cancer diagnosed before MRI?
For decades, the standard path was a physical examination and a PSA blood test. In many cases this is still the standard workup. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in males. If either raised concern, a biopsy followed.
This approach had/has a real drawback: Without imaging to guide it, a biopsy could miss cancer that was there or flag concern in men who didn’t actually need treatment. The biopsy itself was usually systematic. A urologist took a set number of tissue samples from across the prostate using ultrasound guidance, without being able to see whether any specific area actually looked suspicious. It worked but was something of a blind search. Some cancers were missed simply because the needle didn’t pass through them, while other men went through an invasive procedure and a period of anxious waiting, for a result that turned out to be low risk or clear. If the result was clear and symptoms carried on, only then would an MRI be ordered.
How does MRI fit into prostate cancer diagnosis now?
“This reactive approach was certainly not ideal,” says Dr Els. The international standard has fundamentally changed and the sequence is different. After a raised PSA result, the patient is usually sent to radiology for a multiparametric MRI of the prostate, before any biopsy is considered”, says Dr Els.
“This is a detailed scan that maps the prostate and identifies areas that look suspicious,’ Dr Els explains. ‘It’s non-invasive: No incisions, just a detailed set of images generated using magnetic fields rather than radiation. We review the scan and score any area of concern, so the urologist has a clear picture of where and how likely, anything significant might be. If there’s a concerning lesion, a targeted, MRI-US fusion guided biopsy is performed.”
The major advantage is that many men with a clear or low-risk MRI avoid a biopsy altogether. When an area does need sampling, the biopsy can be targeted precisely, which means fewer samples, a more accurate result and a much shorter path to an answer.
This shift is supported by the PRECISION and MRI-FIRST trials and endorsed by the European Association of Urology and the American Urological Association.
What does the MRI tell the specialist?
‘Once the prostate is imaged, we don’t just report whether something looks suspicious but we give it a score, says Dr Els. ‘This is called PI-RADS, short for Prostate Imaging Reporting and Data System and it runs from 1 to 5. The number tells your doctor how likely it is that what’s showing on the scan is aggressive cancer and whether a biopsy is worth doing at all.’
Scores 1 and 2: Usually mean no dangerous cancer is seen. Your doctor may simply monitor you over time
Score 3: The scan cannot give a clear answer either way. Doctors will look at other information, such as your PSA blood test, before deciding on a biopsy
Scores 4 and 5: Mean a high chance of cancer and a biopsy is usually recommended
This shift, from a blind search to a targeted, image-led approach, is one of the most significant improvements in prostate cancer care in the last 15 years and it’s an area in which SCP Radiology has invested heavily to get right.
Prostate cancer, when found early, has excellent outcomes. The combination of a simple blood test and non-invasive, expert-led imaging means most men now get a clear, accurate picture of their prostate health with far less uncertainty than in the past.
‘Our radiologists work closely with urologists across the circle of care, to make sure every scan is read with the depth of experience this diagnosis deserves,’ explains Dr Els.
And, if you’re reading this because you’ve noticed a change in someone else, not yourself: Raising it is worth the slightly awkward conversation. It’s often exactly what starts the process early.
FAQs
Is a prostate MRI painful or invasive?
No. It uses magnetic fields and involves no incisions.
If my PI-RADS score is low, do I still need a biopsy?
Usually not. A low score, 1 or 2, generally means your doctor will monitor you over time, rather than proceed to biopsy.
How long does the process take, from a raised PSA result to an answer?
This varies because the MRI is done before any biopsy. Many men reach a clear answer or avoid a biopsy altogether, in far fewer steps than under the older approach.
Is prostate cancer treatable if caught early?
Yes. It’s one of the most treatable cancers in men when detected early, which is why regular check-ups matter, even in the absence of symptoms.
Most workplaces run on an unspoken rule that being professional means keeping it together. You get to work, hit your deadlines, sit through meetings and deliver, regardless of what may be happening in your personal life or the challenges you might be dealing with emotionally and mentally.
For a while, many people manage. But the 2025 Profmed Stress Index suggests that for a lot of South African professionals, that is no longer working. Nearly a third of respondents said stress was affecting their sleep and their ability to exercise, while just under 30% reported changes to their eating habits. Another 44.05% still felt overwhelmed despite using coping strategies such as exercise, mindfulness and therapy, and almost half were concerned about the long-term impact of stress on their mental health.
As Mental Health Awareness Month gets under way, those numbers raise an uncomfortable point. Many professionals are already doing what they have been told to do about stress, and yet, it’s still not enough.
How stress has changed
According to Justine Lacy, Clinical Executive at Profmed, the nature of professional stress has shifted over the past decade. Before COVID-19, it mostly came from the ordinary challenges of life. During the pandemic, it was driven by fear: lost income, health worries and the rising cost of living. Since then, the main source has been work itself, through heavy workloads, toxic workplaces and poor work-life balance.
Justine Lacy, Clinical Executive at Profmed
These pressures no longer arrive one at a time. They overlap and feed each other, which makes stress more persistent and harder to manage. It also builds slowly. Constant tiredness that rest doesn’t fix, a shorter temper than usual, trouble concentrating or small mistakes that aren’t like you are easy to put down to a busy month. Pressure becomes a mental health concern when it stops being temporary, when rest doesn’t help, and when it starts to affect someone’s health, relationships or ability to function.
The person who still looks fine
Many people assume that someone who is struggling will eventually show it in their work. Justine says that often isn’t the case. Plenty of professionals keep meeting deadlines while dealing with serious distress, and sometimes their output stays strong because they are working harder to make up for it, at considerable personal cost.
“We often look for a drop in performance as the warning sign, but by then we may have missed months of struggle,” she says. The earlier signs are usually changes in energy, behaviour, engagement and wellbeing.
The expectation to stay composed makes this harder. People known as dependable may worry about looking incapable or letting colleagues down, so they put off asking for help. Over time, that delay can lead to burnout, poorer decisions and a growing sense of isolation.
Why self-care has limits
Exercise, mindfulness and therapy all help. But they work on the person, and the problem often sits in the job. “You can’t self-care your way out of a situation that’s continually creating stress,” Justine says. Exercise won’t shorten someone’s working week, and mindfulness won’t fix unrealistic expectations or a toxic team.
The World Health Organization lists excessive workloads, lack of control, job insecurity, poor organisational culture and lack of support as workplace mental health risks. None of those can be solved by an individual. As Justine puts it: “Individuals need healthy coping mechanisms, but organisations also need to create environments where people can thrive, not just survive.”
What employers can do
A wellness day or an employee assistance programme has value, but Justine says real support starts with the causes of stress. She points to three things:
Supportive leadership. Managers check in regularly, encourage open conversations and model healthy behaviour themselves.
Healthy work design. Workloads are reasonable, deadlines are realistic and boundaries outside working hours are respected.
Psychological safety. Employees can ask for help or admit they are struggling without fearing the consequences.
Check-ins also need to happen more often than the annual survey. “Burnout rarely happens overnight,” Justine notes, and employers who watch for absenteeism, withdrawal, irritability or persistent fatigue can step in early. The question to ask, she says, is “How do we create a workplace where fewer people reach that point in the first place?”
The cost of waiting
Justine calls cost one of the biggest barriers to getting help early. Many people hold off on seeing a psychologist or psychiatrist until they are in significant distress, and by then the problem is usually harder to treat.
She believes medical schemes and healthcare providers are well placed to move mental healthcare from a crisis response to early intervention, so people can get support when stress first becomes a concern and not only once it becomes a diagnosis.
Success shouldn’t cost your health
Justine’s message to professionals is simple. Mental health matters as much as physical health, and seeking support early is a sign of strength, not weakness. You don’t need to wait until you are burnt out or in crisis. Pay attention to the early signs and check in with yourself and the people around you.
“Being resilient doesn’t mean carrying every burden alone,” she concludes.
New research from scientists at King’s College London, the University of Toronto, the Sloan Kettering Institute and the Francis Crick Institute advances understanding of the genetics of autism spectrum disorder (ASD).
In a study published in Nature, researchers identified hundreds of new microexons – short gene segments that appear to play a key role in ASD and other neurological conditions – and developed a machine-learning approach to predict the impact of ASD-associated genetic variants on the regulation of these segments.
Autism is characterised by multifactorial genetics. Hundreds of genomic variants have been associated with autism, and these deliver a genetic diagnosis in 15 per cent of people with autism diagnoses.
Dr Benjamin Blencowe, King’s College London and University of Toronto
That means that for 85 per cent of people with an ASD diagnosis, a genetic link is unknown. Dr Benjamin Blencowe, the study’s co-senior author, believes that many contributing genetic factors may have remained undetected because they occur in regions of the genome that do not have a known function.
The genomic regions surrounding microexons are one such example. Through alternative splicing, these very short snippets of DNA – which range from three to 27 DNA “letters” long – can be included or excluded from the messenger RNA instructions used to make proteins. The resulting proteins vary slightly in composition yet contribute to a greater diversity of critical protein functions.
In the newly published study, Dr Guillermo Parada, the study’s co-lead author and a postdoctoral fellow at King’s College London and the Francis Crick Institute, used a computational tool he developed called MicroExonator to analyse over 100 terabytes – enough storage for 25 million smartphone photos – of publicly available RNA sequencing data. He identified more than 1500 new microexons, of which nearly 300 appeared to be specifically spliced in the brain.
The researchers also observed that many of the newly discovered microexons are concentrated in genes associated with critical brain-specific processes, further supporting the idea that these tiny DNA fragments contribute to neurological function.
The researchers then asked whether DNA variants found in the genome of people with autism might preferentially impact the expanded repertoire of microexons.
To answer that question, Dr Parada and study co-lead author and postdoctoral fellow Dr Hannes Bretschneider teamed up with Dr Quaid Morris, a faculty member at Memorial Sloan Kettering Cancer Center and Vector Institute and co-senior author on the study, to build and apply a machine-learning model that identifies the key regulatory features governing whether a microexon is spliced in or out of messenger RNAs. This so-called regulatory code encompasses specific sequences of DNA letters flanking microexons.
What surprised me was that the sequences the model identified as important closely matched those conserved throughout vertebrate evolution.
Dr Guillermo Parada, King’s College London and the Francis Crick Institute
DNA sequences that are highly conserved, or the same, between species generally have critical functions.
Through a collaboration with Dr Stephen Scherer and Brett Trost, both scientists at The Hospital for Sick Children and professors of molecular genetics at Temerty Medicine, the researchers applied their model to whole-genome sequence data from thousands of people with autism and neurotypical sibling pairs, and analysed the predicted impact of ASD-associated genetic variants on the microexon regulatory code.
Using our model, we were able to show that rare genetic variants generally have the largest predicted effects on the splicing of neuronal microexons.
Dr Benjamin Blencowe
The model further pinpointed a subset of rare variants predicted to alter microexon splicing that are associated with autism. The research team also found that the variants predicted to affect microexons are predominantly detected among the 85 per cent of people with an autism diagnosis previously lacking a genetic link to autism.
These new findings build on over a decade of research from the Blencowe lab to uncover the role of microexons in ASD, including earlier work showing that microexons are frequently misregulated in the brains of people with autism and that mice lacking microexon splicing display multiple ASD-like behaviours.
“In terms of future work, it will be important to understand how disrupted microexons affect interactions between proteins that are important for nervous system development and function,” says Dr Blencowe. One of the research programmes in his lab is also exploring new therapeutic approaches to target microexon dysregulation.
Dr Blencowe says that beyond helping to define some of the missing genetics of ASD, their study provides a valuable resource to advance research in the field.
The researchers believe that the machine-learning model they developed can be used to characterise newly discovered genetic variants and their effects in other neurological conditions, like schizophrenia and epilepsy, where microexons are believed to play a role.
Neurons in the brain of an Alzheimer’s patient, with plaques caused by tau proteins. Credit: NIH
Research led by King’s College London suggests diabetes may mask biological changes linked to Alzheimer’s disease, raising the possibility that the underlying biology of Alzheimer’s differs between people with and without diabetes.
Diabetes is a major risk factor for Alzheimer’s disease, and the two conditions share several biological processes, including mitochondrial dysfunction, inflammation, oxidative stress and impaired insulin signalling. This suggests that diabetes may contribute to the progression of changes in the brain associated with Alzheimer’s disease.
The team found that Alzheimer’s disease and diabetes were associated with opposing changes in mitochondrial DNA. Alzheimer’s was associated with lower mtDNA-CN, while diabetes was associated with higher levels across all three brain regions.
When people with diabetes were removed from the analysis, mtDNA-CN was 19 to 30 per cent lower in people with Alzheimer’s compared with cognitive controls. In contrast, among people with Alzheimer’s, those with diabetes had significantly higher mtDNA-CN than those without diabetes. Levels were 41 per cent higher in the hippocampus, 52 per cent higher in the amygdala and 64 per cent higher in the cerebellum. Surprisingly, all diabetes cases, including those with and without dementia, had higher mtDNA in these three regions than non-diabetic controls.
These opposing effects suggest that including people with diabetes in Alzheimer’s studies could reduce or mask differences associated with Alzheimer’s itself.
The findings suggest that diabetes may change the way Alzheimer’s disease is associated with mitochondrial changes, rather than simply being a background health condition. This could mean that the relationship between Alzheimer’s and mitochondrial DNA may be different in people with diabetes compared with those without diabetes.
“The key finding of our study in relation to Alzheimer’s disease is that grouping both diabetic and non-diabetic data for mtDNA-CN together can result in loss of real changes which may be important in disease mechanisms. Our research supports the growing view that Alzheimer’s disease can affect people in different ways at a biological level, and that conditions such as diabetes may contribute to these differences.”
Senior author Dr Afshan Malik
“We were surprised to find that mtDNA-CN was higher in the brains of people with diabetes. We don’t yet know whether this represents a response to cellular stress, a compensatory mechanism, or something else and what this means for the brain function. Our next step is to use multi-omics approaches to understand the biological consequences of this change and how it may affect brain function.”
First author Dr Aakruti Kaikini
The study provides a possible explanation for why previous studies of mitochondrial dysfunction in Alzheimer’s disease have produced conflicting results, potentially making it more difficult to diagnose patients.
In the future the researchers hope the results could be important for developing better ways to identify and understand Alzheimer’s disease, tailoring treatments to individual patients and designing future dementia clinical trials.
