Grains in a Modern Time: A Comprehensive Review of Compositions and Understanding Their Role in Type 2 Diabetes and Cancer.

Globally, type 2 diabetes (T2D) and Cancer are the major causes of morbidity and mortality worldwide and are considered to be two of the most significant public health concerns of the 21st century. Over the next two decades, the global burden is expected to increase by approximately 60%. Several observational studies as well as clinical trials have demonstrated the health benefits of consuming whole grains to lower the risk of several chronic non-communicable diseases including T2D and cancer. Cereals grains are the primary source of energy in the human diet. The most widely consumed pseudo cereals include (quinoa, amaranth, and buckwheat) and cereals (wheat, rice, and corn). From a nutritional perspective, both pseudo cereals and cereals are recognized for their complete protein, essential amino acids, dietary fibers, and phenolic acids. The bran layer of the seed contains the majority of these components. Greater intake of whole grains rather than refined grains has been consistently linked to a lower risk of T2D and cancer. Due to their superior nutritional compositions, whole grains make them a preferred choice over refined grains. The modulatory effects of whole grains on T2D and cancer are also likely to be influenced by several mechanisms; some of these effects may be direct while others involve altering the composition of gut microbiota, increasing the abundance of beneficial bacteria, and lowering harmful bacteria, increasing insulin sensitivity, lowering solubility of free bile acids, breaking protein down into peptides and amino acids, producing short-chain fatty acids (SCFAs), and other beneficial metabolites that promote the proliferation in the colon which modulate the antidiabetic and anticancer pathway. Thus, the present review had two aims. First, it summarized the recent knowledge about the nutritional composition and bioactive acids in pseudo cereals (quinoa, amaranth, and buckwheat) and cereals (wheat, rice, and corn); the second section summarized and discussed the progress in recent human studies, such as observational (cross-sectional studies, case-control studies, and cohort studies) and intervention studies to understand their role in T2D and cancer including the potential mechanism. Overall, according to the scientific data, whole grain consumption may reduce the incidence of T2D and cancer. Future studies should carry out randomized controlled trials to validate observational results and establish causality. In addition, the current manuscript encourages researchers to investigate the specific mechanisms by which whole grains exert their beneficial effects on health by examining the effects of different types of specific protein, dietary fibers, and phenolic acids that might help to prevent or treat T2D and cancer.

Composition of Whole Grain Dietary Fiber and Phenolics and Their Impact on Markers of Inflammation.

Inflammation is an important biological response to any tissue injury. The immune system responds to any stimulus, such as irritation, damage, or infection, by releasing pro-inflammatory cytokines. The overproduction of pro-inflammatory cytokines can lead to several diseases, e.g., cardiovascular diseases, joint disorders, cancer, and allergies. Emerging science suggests that whole grains may lower the markers of inflammation. Whole grains are a significant source of dietary fiber and phenolic acids, which have an inverse association with the risk of inflammation. Both cereals and pseudo-cereals are rich in dietary fiber, e.g., arabinoxylan and ß-glucan, and phenolic acids, e.g., hydroxycinnamic acids and hydroxybenzoic acids, which are predominantly present in the bran layer. However, the biological mechanisms underlying the widely reported association between whole grain consumption and a lower risk of disease are not fully understood. The modulatory effects of whole grains on inflammation are likely to be influenced by several mechanisms including the effect of dietary fiber and phenolic acids. While some of these effects are direct, others involve the gut microbiota, which transforms important bioactive substances into more beneficial metabolites that modulate the inflammatory signaling pathways. Therefore, the purpose of this review is twofold: first, it discusses whole grain dietary fiber and phenolic acids and highlights their potential; second, it examines the health benefits of these components and their impacts on subclinical inflammation markers, including the role of the gut microbiota. Overall, while there is promising evidence for the anti-inflammatory properties of whole grains, further research is needed to understand their effects fully.

The Accuracy of MRI in the Local Staging of Endometrial Cancer: An Experience From a Tertiary Care Oncology Institute in Pakistan.

Objective Our objective is to assess the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (MRI) in identifying the depth of myometrial invasion and cervical stromal involvement in endometrial carcinoma (EC) along with nodal status and its correlation with surgical and histopathological (HP) findings. Materials and methods We performed a retrospective study on female patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Patients with endometrial carcinoma (CA) were searched from the electronic record system, and a total of 188 patients fulfilling the study criteria were selected. All the patients were evaluated using a 1.5T MRI and underwent a hysterectomy. The outcome of preoperative MRI was correlated with histopathology results, keeping pathology as the gold standard. Results A total of 188 patients were included in the study, with a mean age of 56.67 ± 12.47 years. Of the patients, 72 (38.3%) were diagnosed with stage 1a. The second common stage was 1b, seen in 43 (22.9%) patients. It was found that the staging of endometrial CA on MRI and HP were significantly correlated for myometrial invasion (stage 1a and 1b), cervical stromal involvement (stage 2b), serosal and adnexal (stage 3a), vaginal (stage 3b), and nodal (stage 3c) involvement as shown by their p-values of <0.01. However, in cases of parametrial invasion (stage 3b), bladder involvement, and rectal involvement (stage 4), MRI showed decreased sensitivity as shown by their p-values of 0.833, 0.87, and 0.9, respectively. Conclusion Preoperative MRI can predict local disease and low-risk patients accurately, thereby helping in proper surgical planning and avoiding more extensive surgery such as lymphadenectomy in these patients.

Bilateral thoracic outlet syndrome: A rare entity.

Thoracic outlet syndrome (TOS) is the constellations of symptoms produced when the neurovascular structures that traverse the thoracic outlet are compressed. The symptoms are generally due to the compression of the subclavian artery and vein, lower trunk of the brachial plexus as they pass through the thoracic outlet. Diagnosing thoracic outlet syndrome can be difficult because the symptoms and their severity can vary greatly among people. We present a case of 30 years female presenting with arm and scapular pain radiating to hand along with restricted muscle movements; subsequently diagnosed with bilateral thoracic outlet syndrome on CT angiography and confirmed on multiphasic scan.

Efficient fungal and bacterial facilitated remediation of thiencarbazone methyl in the environment.

Triazole herbicide, Thiencarbazone-methyl (TCM) applied on different crops for weedicidal activity is associated with an inherent toxicity towards bladder and urinary functionality. TCM has been first time explored for its biodegradative behavior utilizing microbes, previously isolated from soils. Simulated bio-transformation assemblies of five fungal strains; Aspergillus flavus (AF), Penicillium chrysogenum (PC), Aspergillus niger (AN), Aspergillus terrus (AT), Aspergillus fumigatus (AFu) and two bacterial strains: Xanthomonas citri (XC), Pseudomonassyringae (PS), were utilized. 10 mg/L TCM concentration was set up utilizing each microbe and analysed for 42 days. TCM bio-degradation was evaluated by UV-Visible spectrophotometery and gas chromatography mass spectroscopy. Aspergillus terrus (R2 = 0.86) and Penicillium chrysogenum (R2 = 0.88) exhibited highest capability to metabolize TCM while forming intermediate metabolites including; 2,4-dihydro-[1,2,4] triazol-3-one, semicarbazide and urea, methyl 4-isocyanatosulfonyl-5-methylthiophene-3-carboxylate. TCM degradation by all strains AF, AFu, AN, PC, AT, PS and XC was found to be 74, 74, 81, 95, 98, 90 and 95%, respectively after 42 days elucidating the effectiveness of all the utilized strains in degrading TCM. Current investigations can impact vital bioremediation approaches for pesticides mitigation from the ecological compartments. Furthermore, present research can be extended to the optimization of the bio-deteriorative assays to be employed on the practical scale for the successful management of environment through sustainable and cost effective ways.

Fungicide isopyrazam degradative response toward extrinsically added fungal and bacterial strains.

The current research is a pioneer in the evaluation of isopyrazam biodegradation, which has been performed utilizing soil-isolated microbes. Biodisintegrative assays of pure fungal strains, namely Aspergillus flavus (AF), Penicillium chrysogenum (PC), Aspergillus niger (AN), Aspergillus terreus (AT), and Aspergillus fumigatus (AFu), and bacterial strains, namely Xanthomonas axonopodis (XA) and Pseudomonas syringae (PS), were utilized. Initial isopyrazam concentration (10 mg/L) was prepared with an individual microbial suspension and monitored for 35 days. Isopyrazam biotransformation was analyzed quantitatively and qualitatively by UV-visible spectrophotometery and gas chromatography-mass spectroscopy. P. syringae (R2 = 0.90) and X. axonopodis (R2 = 0.88) displayed maximal potential to metabolize the fungicide (86% and 80%, respectively) while forming intermediate metabolites, including 3-difluoromethyl-1-methyl-1H-pyrazole-4-carboxylic acid ((S)-9-hydroxy-9-isopropyl-1,2,3,4-tetrahydro-1,4-methanonaphthalen-5-yl)-amide, 3-difluoromethyl-1H-pyrazole-4-carboxylic acid, and 3-difluoromethyl-1-methyl-1H-pyrazole-4-amide. Isopyrazam degradation by all strains, AT, PC, AFu, AN, AF, XA, and PS, was found to be 11%, 18%, 21%, 21%, 18%, 30%, 80%, and 86%, respectively, after 35 days, elucidating the effectiveness of all the utilized strains in degrading isopyrazam at varying rates. The descending order of half-lives (days) obtained is as follows: AT (56.8) > PC (44.7) > AFu (40.7) > AN (39.6) > AF (32.6) > XA (28.1) > PS (21) days. Current research can influence imperative and significant environment-friendly bioremedial strategies for xenobiotic eradication from the ecological compartments.

Intracranial Extra-axial Undifferentiated Pleomorphic Sarcoma; a Case Report.

Introduction: Head-and-neck sarcomas result in high mortality rates. A lot of new cases of sarcomas are diagnosed every year constituting about 1 % of all head-and-neck malignancies. Undifferentiated pleomorphic sarcomas (UPSs) are high-grade soft-tissue malignant tumours which occur primarily in limbs and retroperitoneal cavities. These tumours can often metastasize to the central nervous system. However, in rare instances, soft-tissue sarcomas may develop as a primary lesion within the intracranial compartments. Case Description: A young male presented to the clinic with occipital headache and blurring of vision. Initial workup included brain contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). The CECT suggested that there was an extra-axial mass present which was pressing against the adjacent left frontal lobe. Overlying frontal bone of the left side showed remodelling effect and associated mild periosteal reaction. MRI scan showed intracranial extra-axial lobulated mass with T1 intermediate to low-signal intensity and intermediate to high signals on T2 sequences. Heterogeneous enhancement on post-contrast sequences was also seen. The lesion had a broad-based attachment with dura mater and was closely applied to the orbital roof without orbital invasion. Staging positron emission tomography-CT scan showed a solitary site of disease in an intracranial location. Final diagnosis was confirmed by histopathology following excision of mass as UPS. Post-surgery MRI brain showed satisfactory post-operative appearance without any residual disease. The patient remained asymptomatic for 2 years and 6 months following the resection of the tumour. Practical Implications: Most of the extra-axial intracranial soft-tissue tumours arise from the meninges with meningiomas making the substantial bulk; however, possibility of other relatively rare tumours of meningeal origin must not be ignored. Intracranial soft-tissue sarcomas mostly arise from meninges thus require a good understanding of clinical presentation as well as acquaintance with morphological features on radiological imaging to differentiate from other tumours. These can be treated with excision and radiotherapy along with sequential follow-ups to look for recurrence. Tissue sampling is mandatory followed by complete staging scan in case of sarcomas to rule out possible primary or secondary disease.

Breast cancer knowledge and perception among healthcare professionals and senior medical students at Bolan Medical Complex Hospital Quetta, Pakistan.

OBJECTIVE: To assess knowledge and perception about different aspects of Breast Cancer among health care professionals at Bolan Medical Complex Hospital Quetta, Pakistan. METHODS: This cross-sectional study was carried out at Bolan Medical Complex Hospital Quetta from October to December 2017. A total of 312 health care workers including consultants (42), residents (85), medical officers (52), interns (45), nurses (48) and final year medical students (40) took part in the study. The study tool was a self-designed questionnaire with separate sections to assess the knowledge about risk factors, signs and symptoms, screening tools, breast self-examination (BSE), treatment and barriers in seeking medical advice. RESULTS: Participants had satisfactory knowledge about risk factors and signs of breast cancer but poor knowledge about association of breast cancer with menarche status, oral contraceptive pills and smoking. Majority was aware of mammography benefits and believed that breast cancer is curable with therapy. All perceived that cultural and socioeconomic barriers are the cause of late stage presentation. The nurses particularly were having misconceptions in knowledge about breast cancer risk factors and screening tools. CONCLUSIONS: The current study demonstrated that knowledge related to breast cancer was average and highlighted the need for provision of continuing medical education programmes to improve health practitioners' practice on cancer screening tools. Knowledge was particularly deficient regarding screening modalities and BSE method and timing. Special emphasis is needed to train nurses, so they could play an expanded role in breast cancer care.

Subserosal Leiomyoma with Intravenous Leiomyomatosis Extending into Inferior Vena Cava and Right-sided Cardiac Chambers.

Leiomyoma (fibroid) is the most common benign tumour of the uterus in reproductive age. Its treatment is easy and employs a surgical resection, usually without complications. However, it may show an atypical behaviour and result in intravenous leiomyomatosis (IVL) extending into the regional and systemic veins, thus reaching the heart; and may extend into the pulmonary arteries. The symptoms of IVL are non-specific, resulting in underdiagnosis and misdiagnosis of the disease entity and so the condition is underreported. Cross sectional imaging plays an important role in correct diagnosis of the condition, resulting in reduced morbidity and mortality of the patient and saving surgeons from unwanted complications. It typically originates from the uterus and may involve ovarian/uterine veins. We report a 45-year female who presented with right hypochondial pain for which she was diagnosed as cholelithiasis. She was also diagnosed with a left adnexal mass on ultrasonography (USG) for which she underwent a CECT abdomen and pelvis and was diagnosed as a case of subserosal fibroid with IVL extending into left gonadal vein, and inferior vena cava (IVC). Intracardiac extension was confirmed on 2-D echocardiography. This is first reported case of IVL from Balochistan, Pakistan.