The Burden of Cancer, Government Strategic Policies, and Challenges in Pakistan: A Comprehensive Review

Factors Influencing Breast Cancer Knowledge and Attitudes of Women in Abbottabad, Pakistan

BACKGROUND Breast cancer (BC) is a significant health issue in Pakistan, leading to higher mortality rates compared to other countries. Therefore, this questionnaire-based study aimed to assess knowledge, awareness, and beliefs about BC in 300 women in Abbottabad, Pakistan, between January and April 2019. MATERIAL AND METHODS A cross-sectional study was conducted among healthy adult female residents of Abbottabad between January and April 2019 using structured, pre-validated questionnaires. Data collection was conducted through face-to-face interviews. The questionnaire was divided into 3 sections with 17 items, including demographic information, knowledge about BC, and beliefs about BC. Data were analyzed using the SPSS version 25. A total of 300 women responded to the study invitation. RESULTS Of 300 respondents, 87.3% (n=262) were aware of BC. Among them, only 37 (14.1%) had good knowledge, 90 (34.4%) had average knowledge, and 135 (51.5%) had poor knowledge about BC. The majority of respondents exhibited positive beliefs (74%). Knowledge was significantly higher among single (6.77±2.87) and widowed (6.00±3.65) women compared to married women (p=0.001). Similarly, knowledge and beliefs about BC were higher among women with higher education (6.79±2.93; p=0.001; 6.76±2.12; p=0.025) compared to those with lower education. Women living in urban areas had greater knowledge (5.89±2.75) than those in rural areas (4.58±2.78), suggesting a significant difference. A weak positive correlation between knowledge and beliefs (r=0.336, p=0.001) was identified. CONCLUSIONS Study participants had low knowledge about BC but generally positive beliefs, highlighting the need for targeted education and awareness programs to improve knowledge about BC among women in Abbottabad.

Establishing comprehensive anesthesia services for cancer surgery at SKMCH Peshawar: Challenges, achievements, and innovations

This article details the development of new anesthesia services at Shaukat Khanum Memorial Cancer Hospital and Research Center in Peshawar, Pakistan. This involved recruiting skilled staff, who were supported by intensive training. Pre-anesthesia evaluation clinics were established to ensure patient safety and reduce surgical cancelations. Continuous professional development and innovative pain management strategies were introduced to enhance service quality, positioning SKMCH & RC as a leader in cancer-related anesthesia services in the region.

A Study of Skin Cancer Knowledge, Attitudes, and Preventive Practices Among Healthcare Professionals and the General Population in Pakistan: Insights for Healthcare Interventions and Policy Development

Background: Skin cancer is a major global health issue that can be life-threatening. The current study explores the knowledge, attitudes, and practices of healthcare professionals and the general population regarding skin cancer. Method: A cross-sectional study was conducted between January and June 2023 in Lahore, the second-largest city in Pakistan. A total of 407 respondents from the general population and 230 healthcare professionals were recruited using a convenient and snowball sampling technique, respectively. Data were collected using questionnaires and statistical analysis, including chi-square tests, and bivariate logistic regression was performed using SPSS Version 20. Result: In the overall population, 46.4% identified as male, 45.0% as female, and 8.6% chose not to disclose their gender. Significantly differing levels of skin cancer knowledge were observed between genders, with males reporting a higher knowledge (36.4%, crude odds ratio = 1.413, p < 0.001) compared to females (32.9%). In addition, females displayed a more positive attitude (crude odds ratio = 1.874, p < 0.001) and practice (crude odds ratio = 1.401, p < 0.05) toward skin cancer prevention. Furthermore, younger age groups exhibited greater knowledge, attitudes, and practices regarding skin cancer. Education and employment status also have a direct influence on skin cancer knowledge and practices. Moreover, in the current study, healthcare professionals comprised 61.3% physicians, 16.5% nurses, and 22.2% pharmacists. Among these, 37.3% of physicians, 11.3% of nurses, and 12.6% of pharmacists demonstrated the ability to identify common signs and symptoms of skin cancer in a patient (p < 0.001). Furthermore, 44% of physicians regarded regular skin cancer screenings as "very important" (p < 0.01). In addition, 27.4% of physicians and 8.7% of pharmacists exhibited a positive attitude toward regular screening of at-risk patients (p < 0.05). Conclusion: The current study highlights gender and age disparities in skin cancer knowledge and prevention among the general population, emphasizing the need for targeted public health interventions to enhance knowledge and proactive practices. In addition, among healthcare professionals, it reveals variations in knowledge levels, emphasizing the importance of tailored education initiatives to promote consistent skin cancer prevention and management practices within the healthcare community.

Implementation of a student-run initiative to facilitate multidisciplinary cancer care in Pakistan: the Tumor Board Establishment Facilitation Forum

BACKGROUND

The lack of a multidisciplinary approach to the management of cancer patients in most parts of Pakistan is a long-standing and major concern. To overcome this disparity, we started a student-run initiative to facilitate the establishment of multidisciplinary tumor boards (MTBs) in oncology, titled "Tumor Board Establishment Facilitation Forum (TEFF)". The objectives of this study were to evaluate the clinical and academic impact of TEFF on cancer care for patients and student education, respectively.

METHODS

The formation of TEFF was based on the Theory of Change model. We conducted a needs assessment based on existing literature, physical evaluation of wards, and consultation with senior academic faculty members. The logic model was refined through multiple meetings between stakeholders. All engagements of TEFF described in this manuscript are limited to the Dow Medical College and its affiliated tertiary care hospital, Dr. Ruth K. M. Pfau Civil Hospital in Karachi, Pakistan. To gauge TEFF's impact, we used administrative data generated between October 2021 to March 2024 to evaluate predefined outcomes (number of MTBs, cases, educational interventions, and research).

RESULTS

The organizational structure comprised of 6 specialized departments: Communications, Operations, Media, Integrated Development, Research and Records, and Finance. We conducted 18 educational sessions for medical students about career guidance, research, cancer awareness; and 4 cancer awareness campaigns. TEFF facilitated the formation of 4 MTBs: breast, head and neck, gynecology, and pediatrics. Across these, 105 cases were discussed in 50 meetings. TEFF provided leadership opportunities, allowed familiarization with oncology, raised awareness of challenges associated with cancer care, allowed networking, and inculcated research-related skills and educational value through its MTBs.

CONCLUSION

Medical students can contribute significantly to clinical care at the undergraduate level. For countries/regions struggling to provide multidisciplinary cancer care, TEFF's model serves as a blueprint for a viable solution.

Knowledge, perception and utilization of breast cancer screening among women visiting primary care clinics

Context

Of all the cancers in the world, breast carcinoma claims to be the deadliest for women in the world. It is of key importance that early detection of breast cancer is made possible through awareness programs targeting the general population. However, this solution is fraught with obstacles. Noteworthy of these obstacles are lack of education.

Aims

To determine knowledge, perception, and utilization of breast cancer screening among women visiting primary care centers in Karachi, Pakistan.

Settings and Design

This cross-sectional study was conducted in community-based primary care centers at Liaquat National Hospital Karachi from September 2021 to February 2022.

Material and Methods

The data was collected by using a semi-structured questionnaire. The questions were derived from the Cancer Awareness Measure (CAM) scale, the most frequently used and validated tool to assess awareness of cancer risk factors and screening.

Statistical Analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 21.

Results

A total of 386 participants were enrolled in the study. The median age of study participants was 32 (IQR=) years. Only a few had correct knowledge regarding the breast cancer screening method (n = 118, 30.6%). However, 114 (29.5%) correctly responded that after 40 years, yearly mammography screening should be conducted (n = 114, 29.5%). The majority considered performing breast self-examination important for health (n = 273, 70.7%). 187 (48.4%) women responded that they once performed a self-examination of their breasts.

Conclusion

The study highlighted a significant gap in knowledge regarding breast cancer screening among women. There is a need to emphasize the integration of health education interventions at the primary care level keeping in mind the health literacy level of our population.

Plant and marine-derived natural products: sustainable pathways for future drug discovery and therapeutic development

Plant- and marine-derived natural products are rich sources of bioactive compounds essential for drug discovery. These compounds contain complex mixtures of metabolites, which collectively contribute to their pharmacological properties. However, challenges arise in the isolation of individual bioactive compounds, owing to their intricate chemistry and low abundance in natural extracts. Despite these limitations, numerous plant and marine-derived compounds have achieved regulatory approval, particularly for treating cancer and infectious diseases. This review explores the therapeutic potential of plant and marine sources along with innovative extraction and isolation methods that support sustainable drug development. Future perspectives will highlight the role of responsible innovation, artificial intelligence, and machine learning in advancing drug discovery, underscoring the importance of continued research to meet global health needs.

Evaluating the Carcinogenic and Non-Carcinogenic Health Risks of Heavy Metals Contamination in Drinking Water, Vegetables, and Soil from Gilgit-Baltistan, Pakistan

Environmental pollutants significantly impact health and quality of life. High levels of harmful metals in drinking water, vegetables, and soil can accumulate in the body, leading to serious health issues. In Gilgit-Baltistan, Pakistan, the prevalence of cancer is notably high, and heavy metals are considered among the possible risk factors. In this study, the distribution of heavy metals, e.g., Cd, Mn, Cu, Cr, and Ni, in the drinking water, vegetables, and soil in the Gilgit and Skardu Districts was assessed. A geo-accumulation index was combined with a deterministic technique to examine potential carcinogenic and non-carcinogenic impacts on human health. Cr and Ni levels in drinking water exceeded the permissible limits from both districts. Drinking water had a HQ > 1 for Cd, Cr, Ni, and Mn, posing significant non-carcinogenic health effects. The lifetime cancer risk (LCR) by drinking water for Cd, Cr, and Ni in Gilgit (0.0087, 0.55, and 0.0048) and Skardu (0.071, 0.21, and 0.014) indicated a considerable cancer risk (>1 × 10-4) for adults. The cancer risk for vegetable intake was observed within the safe limit, while LCR_ingetsion > LCR_dermal and LCR_inhalation for the soil samples in both regions. These findings highlight the need for regular monitoring, enhanced waste management, and advanced purification methods to reduce cancer risk, lower heavy metal contamination, and safeguard public health in the region.

A liposome-based assay for cancer biomarker detection: exploring the correlation between platelet-derived microvesicles and NSCLC-associated miRNAs

Advances in molecular biology have enabled the identification of numerous cancer biomarkers, offering the potential to improve the diagnosis and prognosis of cancer. In non-small cell lung cancer (NSCLC), the role of platelet-derived microvesicles (PMVs) in cancer progression has received limited attention. While previous studies have focused on the increase of extracellular vesicles in plasma and their interaction with cancer, the expression of microRNAs (miRNAs) delivered through PMVs following platelet activation has remained largely unexplored. This study fills this knowledge gap by investigating miRNA expression in PMVs isolated from healthy donors and NSCLC patients following calcium treatment, a known platelet activator. A significant correlation was found between PMV levels and the expression of specific miRNAs; specifically, miRNA-21 expression increased 7.89 ± 0.44-fold in NSCLC patients and 7.12 ± 0.49-fold in healthy donors after calcium treatment. These findings highlight the potential of PMVs and their miRNA cargo to serve as specific biomarkers for NSCLC, offering valuable insights into cancer diagnosis and prognosis. To facilitate the sensitive detection of these miRNAs, a novel carboxyfluorescein (CF)-loaded liposome-based assay was developed. This assay demonstrated enhanced sensitivity, achieving a detection limit of 1.03 pg mL-1, when combined with a calcium platelet-activation approach. This research has the potential to lead to the development of innovative diagnostic tools and therapeutic strategies, ultimately improving outcomes for patients with NSCLC and other cancers.

Cancer research in South Asian Association for Regional Cooperation (SAARC) countries

Cancer is a major global health threat, with 35 million new cases projected by 2050, predominantly in low-income and middle-income-countries. Within South Asian Association for Regional Cooperation (SAARC) countries, a notable gap in cancer research investment and output compared with high-income countries highlights the need to strengthen research capacity. The rising cancer incidence across SAARC countries is not being matched by local research, particularly in clinical trials in molecular biology, targeted therapy, immunotherapy, and cancer vaccines. This paucity of research is problematic as guidelines and therapies developed in high-income countries might not be directly applicable to low-income and middle-income countries due to distinct regional sociocultural, genetic, and environmental factors and are often impractical in these countries due to cost and implementation challenges. This Series paper examines the cancer research landscape within SAARC countries, focusing on Bangladesh, Nepal, Sri Lanka, India, Pakistan, Afghanistan, Bhutan, and Maldives. We analyse PubMed publication rates and examine available infrastructure, current research (including clinical trials), and limitations and disparities among SAARC countries in terms of cancer research. Key challenges include disparities in health-care access, cultural and economic barriers, and little funding and infrastructure. Strengthening cancer research in SAARC countries requires building collaborative networks, improving research facilities and training, focusing on local epidemiological studies, and developing affordable technologies and treatments. Effective policy and stakeholder engagement could greatly advance cancer care in the region.

Integrating MDT Tumor Board Shadowing into the Undergraduate Medical Curriculum: Perspective of Medical Students

Site-specific multidisciplinary team (MDT) tumor boards are valuable resources for medical students, enabling them to familiarize themselves with the latest evidence-based cancer management strategies and observe effective teamwork in action. In this study, we looked at the awareness and perceptions of medical students about incorporating MDT tumor boards in the medical curriculum. A cross-sectional study was conducted among medical students from year 1 to year 5 at the Aga Khan University after exemption from ethical review committee. A 20-item self-administered questionnaire was used to evaluate the awareness and perceptions of medical students regarding MDT tumor boards. A total of 285 medical students participated in this study, with their mean age (± standard deviation) being 21.91 ± 1.67 years. A majority of 183 (64.2%) had no prior knowledge of the existence of a site-specific MDT tumor board for cancer management. Of the 285 students, 252 (88.4%) demonstrated sufficient awareness of the effectiveness of MDT tumor boards; similarly, 232 (81.4%) responded positively to the idea of mandatory tumor board rotations being incorporated into the undergraduate curriculum. No significant association was found between the student's year of study (χ2 = 6.03, p = 0.20) or gender (χ2 = 35, p = 0.84) and their perceptions of the effectiveness of MDT tumor boards. However, it was found that students who had prior knowledge of their existence had a stronger association with sufficient awareness (χ2 = 4.2, p = 0.04). The results indicate that while the majority of the medical students have no prior attendance or knowledge regarding MDT tumor boards, there is an overwhelming willingness among students to incorporate them into the medical curriculum.

Identification of indole-grafted pyrazolopyrimidine and pyrazolopyridine derivatives as new anti-cancer agents: Synthesis, biological assessments, and molecular modeling insights

In the current medical era, developing new PIM-1 inhibitors stands as a significant approach to cancer management due to the pivotal role of PIM-1 kinase in promoting cell survival, proliferation, and drug resistance in various cancers. This study involved designing and synthesizing new derivatives of pyrazolo[1,5-a]pyrimidines (6a-i) and pyrazolo[3,4-b]pyridines (10a-i) as potential anti-cancer agents targeting PIM-1 kinase. The cytotoxicity was screened on three cancer cell lines: A-549 (lung), PANC-1 (pancreatic), and A-431 (skin), alongside MRC5 normal lung cells to assess selectivity. Several pyrazolo[1,5-a]pyrimidines (6b, 6c, 6g, 6h, and 6i) and pyrazolo[3,4-b]pyridine (10f) demonstrated notable anticancer properties, particularly against A-549 lung cancer cells (IC50 range: 1.28-3.52 μM), also they exhibited significantly lower toxicity towards MRC5 normal cells. Thereafter, the compounds were evaluated for their inhibitory activity against PIM-1 kinase. Notably, 10f, bearing a 4-methoxyphenyl moiety, demonstrated good inhibition of PIM-1 with an IC50 of 0.18 μM. Additionally, 10f induced apoptosis and arrested cell cycle progression in A-549 cells. Molecular docking and dynamics simulations provided insights into the binding interactions and compounds' stability with PIM-1 kinase. The results highlight these compounds, especially 10f, as promising selective anticancer agents targeting PIM-1 kinase.

Is FDG-PET/CT Scan Useful in the Detection of Subcentimeter Mediastinal Lymph Node Involvement in Patients With Lung Carcinoma?

Background Early staging of lung carcinoma (CA) is pivotal in planning the treatment. Lymph node metastasis can be detected by imaging and invasive procedures. The 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is an emerging noninvasive imaging modality in detecting nodal metastasis. Objective This study aimed to determine the usefulness of the FDG-PET/CT scan in detecting subcentimeter mediastinal lymph node involvement in lung CA patients by taking histopathology as the gold standard. Materials and methods We conducted a retrospective cross-sectional study at a tertiary care cancer hospital in Pakistan over four and half years, from January 2015 to June 2019. All patients suffering from non-small cell lung CA (NSCLC) having avid subcentimeter nodes on FDG-PET/CT were included. The findings obtained on FDG-PET/CT were correlated with histopathological findings after endobronchial ultrasound (EBUS). The results were formulated using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Results Results showed that 42/380 total lung CA patients had avid subcentimeter lymph nodes obtained on FDG-PET/CT. A total of 22/42 (52.4%) lymph nodes appeared to be benign, and 20/42 (47.6%) lesions were malignant on histopathology. FDG-PET/CT sensitivity is calculated to be 95%, specificity is 68%, positive predictive value is 73%, negative predictive value is 94%, and accuracy is 80.9%. Using the receiver operating characteristic (ROC) curve, sensitivity and specificity were seen in nodes of size 7.5 mm and the maximum standardized uptake value (SUV max) of 5.5 as cutoff values as manifested by area under the curve (AUC). Conclusion FDG-PET/CT was proven to have high sensitivity and accuracy but a low specificity rate to detect nodal involvement in lung CA patients. The high false-positive rates are mainly due to increased prevalence of endemic lung infectious disease.

Improving the Cytotoxic Activity of Hinokitiol from Drug-Loaded Phytosomal Formulation Against Breast Cancer Cell Lines

Background

This study investigates the influence of various formulation parameters on the characteristics of hinokitiol-loaded phytosomes and evaluates their anticancer potential against breast cancer cells.

Materials and Methods

Phytosomal nanoparticles were prepared and characterized for size, zeta potential, and entrapment efficiency. Morphological analysis was conducted using optical microscopy and transmission electron microscopy (TEM). The solubility of hinokitiol at different pH levels was determined, and the in vitro release profile of the optimized phytosomes was assessed. Cytotoxicity assays were performed to evaluate the anticancer efficacy against breast cancer cell lines, and apoptosis induction was examined using Annexin V/propidium iodide staining. Cell cycle analysis was conducted to assess the impact on cell cycle progression.

Results

The optimized phytosomes demonstrated a size range of 138.4 ± 7.7 to 763.7 ± 15.4 nm, with zeta potentials ranging from -10.2 ± 0.28 to -53.2 ± 1.06 mV and entrapment efficiencies between 29.161 ± 1.163% and 92.77 ± 7.01%. Morphological characterization confirmed uniformity and spherical morphology. Hinokitiol solubility increased with pH, and the release from the optimized phytosomes exhibited sustained patterns. The formulated phytosomes showed superior cytotoxicity, with lower IC50 values compared to pure hinokitiol. Treatment induced significant apoptosis and cell cycle arrest at the G2/M and S phases.

Conclusion

Hinokitiol-loaded phytosomes demonstrate promising anticancer efficacy against breast cancer cells, highlighting their potential as targeted therapeutic agents for breast cancer therapy.

A Computational Predictor for Accurate Identification of Tumor Homing Peptides by Integrating Sequential and Deep BiLSTM Features

Cancer remains a severe illness, and current research indicates that tumor homing peptides (THPs) play an important part in cancer therapy. The identification of THPs can provide crucial insights for drug-discovery and pharmaceutical industries as they allow for tailored medication delivery towards cancer cells. These peptides have a high affinity enabling particular receptors present upon tumor surfaces, allowing for the creation of precision medications that reduce off-target consequences and enhance cancer patient treatment results. Wet-lab techniques are considered essential tools for studying THPs; however, they're labor-extensive and time-consuming, therefore making prediction of THPs a challenging task for the researchers. Computational-techniques, on the other hand, are considered significant tools in identifying THPs according to the sequence data. Despite many strategies have been presented to predict new THP, there is still a need to develop a robust method with higher rates of success. In this paper, we developed a novel framework, THP-DF, for accurately identifying THPs on a large-scale. Firstly, the peptide sequences are encoded through various sequential features. Secondly, each feature is passed to BiLSTM and attention layers to extract simplified deep features. Finally, an ensemble-framework is formed via integrating sequential- and deep features which are fed to a support vector machine which with 10-fold cross-validation to carry to validate the efficiency. The experimental results showed that THP-DF worked better on both [Formula: see text] and [Formula: see text] datasets by achieving accuracy of > 95% which are higher than existing predictors both datasets. This indicates that the proposed predictor could be a beneficial tool to precisely and rapidly identify THPs and will contribute to the cutting-edge cancer treatment strategies and pharmaceuticals.

Implementation of a clinical breast exam and referral program in a rural district of Pakistan

BACKGROUND

The role of clinical breast examination (CBE) for early detection of breast cancer is extremely important in lower-middle-income countries (LMICs) where access to breast imaging is limited. Our study aimed to describe the outcomes of a community outreach breast education, home CBE and referral program for early recognition of breast abnormalities and improvement of breast cancer awareness in a rural district of Pakistan.

METHODS

Eight health care workers (HCW) and a gynecologist were educated on basic breast cancer knowledge and trained to create breast cancer awareness and conduct CBE in the community. They were then deployed in the Dadu district of Pakistan where they carried out home visits to perform CBE in the community. Breast cancer awareness was assessed in the community using a standardized questionnaire and standard educational intervention was performed. Clinically detectable breast lesions were identified during home CBE and women were referred to the study gynecologist to confirm the presence of clinical abnormalities. Those confirmed to have clinical abnormalities were referred for imaging. Follow-up home visits were carried out to assess reasons for non-compliance in patients who did not follow-through with the gynecologist appointment or prescribed imaging and re-enforce the need for follow-up.

RESULTS

Basic breast cancer knowledge of HCWs and study gynecologist improved post-intervention. HCWs conducted home CBE in 8757 women. Of these, 149 were warranted a CBE by a physician (to avoid missing an abnormality), while 20 were found to have a definitive lump by HCWs, all were referred to the study gynecologist (CBE checkpoint). Only 50% (10/20) of those with a suspected lump complied with the referral to the gynecologist, where 90% concordance was found between their CBEs. Follow-up home visits were conducted in 119/169 non-compliant patients. Major reasons for non-compliance were a lack of understanding of the risks and financial constraints. A significant improvement was observed in the community's breast cancer knowledge at the follow-up visits using the standardized post-test.

CONCLUSIONS

Basic and focused education of HCWs can increase their knowledge and dispel myths. Hand-on structured training can enable HCWs to perform CBE. Community awareness is essential for patient compliance and for early-detection, diagnosis, and treatment.

Lipid-based nanoparticles as drug delivery carriers for cancer therapy

Cancer is a severe disease that results in death in all countries of the world. A nano-based drug delivery approach is the best alternative, directly targeting cancer tumor cells with improved drug cellular uptake. Different types of nanoparticle-based drug carriers are advanced for the treatment of cancer, and to increase the therapeutic effectiveness and safety of cancer therapy, many substances have been looked into as drug carriers. Lipid-based nanoparticles (LBNPs) have significantly attracted interest recently. These natural biomolecules that alternate to other polymers are frequently recycled in medicine due to their amphipathic properties. Lipid nanoparticles typically provide a variety of benefits, including biocompatibility and biodegradability. This review covers different classes of LBNPs, including their characterization and different synthesis technologies. This review discusses the most significant advancements in lipid nanoparticle technology and their use in medicine administration. Moreover, the review also emphasized the applications of lipid nanoparticles that are used in different cancer treatment types.

Thorough examination of the potential biological implications of the cuproptosis-related gene LIPT2 in the prognosis and immunotherapy in pan-cancer

OBJECTIVES

To elucidate the expression levels and prognostic value of the Lipoyltransferase 2 (LIPT2) gene in a pan-cancer view.

METHODOLOGY

Our study comprehensively investigated the role of LIPT2 in pan-cancer, combining bioinformatics analyses with experimental validations.

RESULTS

Analysis of LIPT2 mRNA expression across various cancers revealed a significant up-regulation in 18 tumor types and down-regulation in 8 types, indicating its diverse involvement. Prognostic assessment demonstrated a correlation between elevated LIPT2 expression and poorer outcomes in Overall Survival (OS) and Disease-Free Survival (DFS), particularly in Glioblastoma Multiforme (GBM), Liver Hepatocellular Carcinoma (LIHC), and Pheochromocytoma and Paraganglioma (PCPG). Protein expression analysis in GBM, LIHC, and PCPG affirmed a consistent increase in LIPT2 levels compared to normal tissues. Examining the methylation status in GBM, LIHC, and PCPG, we found reduced promoter methylation levels in tumor samples, suggesting a potential influence on LIPT2 function. Genetic mutation analysis using cBioPortal indicated a low mutation frequency (< 2%) in LIPT2 across GBM, LIHC, and PCPG. Immune correlation analysis unveiled a positive association between LIPT2 expression and infiltration levels of immune cells in GBM, LIHC, and PCPG. Single-cell analysis illustrated LIPT2's positive correlation with functional states, including angiogenesis and inflammation. Enrichment analysis identified LIPT2-associated processes and pathways, providing insights into its potential molecular mechanisms. Drug sensitivity analysis demonstrated that elevated LIPT2 expression conferred resistance to multiple compounds, while lower expression increased sensitivity. Finally, RT-qPCR validation in HCC cell lines confirmed the heightened expression of LIPT2 compared to a control cell line, reinforcing the bioinformatics findings.

CONCLUSION

Overall, our study highlights LIPT2 as a versatile player in cancer, influencing diverse aspects from molecular processes to clinical outcomes across different cancer types.

Awareness regarding breast cancer amongst women in Pakistan: A systematic review and meta-analysis

BACKGROUND

Breast cancer (BCa) is the most common cause of cancer death in Pakistan. In 2019, Pakistan saw the highest global BCa-associated death rate. But do Pakistani women know about the various aspects of BCa? And how prevalent are BCa screening methods amongst Pakistani females? These questions formed the basis for our study.

METHODS

We conducted this review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. On September 1, 2023, we searched PubMed, Embase, Scopus, and Google Scholar, and performed a citation search to search for eligible studies published in 2010 or after, using the following terms: "breast cancer" and "Pakistan". Observational studies that evaluated BCa awareness and/or practice amongst Pakistani females who were not associated with medicine were eligible. We used the National Institutes of Health quality assessment tool to assess the risk of bias. We conducted a proportion meta-analysis to calculate pooled prevalences for variables.

RESULTS

Responses from 9766 Pakistani women across 18 included studies showed alarmingly low levels of BCa knowledge: risk factors, 42.7% (95% CI: 34.1%-51.4%); symptoms, 41.8% (95% CI: 26.2%-57.5%); diagnostic modalities, 36.3% (95% CI: 23.1%-49.4%); treatments, 46.6% (95% CI: 13.5%-79.8%). Prevalence of breast self-examination (BSE) and ever having undergone a clinical breast exam (CBE) was 28.7% (95% CI: 17.9%-39.6%) and 15.3% (95 CI: 11.2%-19.4%), respectively. BCa knowledge was significantly associated with better educational status, age, and socioeconomic status.

CONCLUSION

On average, only two in five Pakistani women are aware of one or more risk factors, symptoms, or diagnostic modalities. Approximately one in two women know about possible BCa treatment. Less than one in three women practice regular BSE, and less than one in five women have ever undergone a CBE.

Oral health related quality of life in head and neck cancer survivors within the first year following treatment: a cross-sectional study in Karachi, Pakistan

After completing treatment for head and neck cancer (HNC), patients often face oral complications like oral pain, limited mouth opening and dry mouth which significantly reduce their oral health related quality of life (OHRQoL). These issues impact their overall well-being, social activities and long-term survival. The primary objective of this study was to evaluate OHRQoL and its association with sociodemographic characteristics, oral hygiene practices and oral clinical parameters such as oral hygiene status and oral mucositis grade in patients who have completed treatment for head and neck cancer. This cross-sectional study involved 79 HNC-treated patients within first year after completion of cancer treatment attending ENT and dental clinics at outpatient department (OPD) setting in Karachi. Data was collected electronically using structured questionnaire comprising of EORTC QLQ H&N - 35 to measure OHRQoL, patients were also examined for oral hygiene status using oral hygiene index- simplified (OHI-s) and oral mucositis grade using WHO oral mucositis scale. Multiple linear regression was used to test OHRQoL associations with the sociodemographic and different clinical factors. The result showed an overall mean score for oral health related quality of life (OHRQoL) of 25.02 ± 15.86 (95% CI 21.46-28.57), with difficulty in mouth opening 53.16 ± 18.88 and dry mouth 45.14 ± 24.48 being predominant concerns for decline in the OHRQoL in the population. Male predilection was observed among participants n = 60 (75.9%), majority of the participants n = 41 (51.9%) were below 52 years of age. n = 63 (80%) participants received radiotherapy alongside surgery and chemotherapy. Most of participants n = 66 (83.5%) experienced moderate to severe oral mucositis with poor oral hygiene status n = 56 (71%). Significant associations were found between OHRQoL and BMI, OH status, marital status, monthly income, gender and fluoride toothpaste (p < 0.05). These findings suggest that Quality of Life (QoL) among HNC treated patients is negatively impacted by their poor oral health, post cancer treatment. Therefore, it is important to evaluate and modify the current treatment modalities and involve multidisciplinary teams, to improve their OHRQoL thereby enhancing overall QoL.

Multi-biological activity assessment and phytochemical characterization of an aqueous extract of the Cymbopogon citratus grown in Palestine

BACKGROUND

Plants have historically been a rich source of medicinal compounds, with many modern pharmaceuticals derived from botanical origins. In contemporary healthcare, there is a resurgence in utilizing botanical substances as recognized medicinal agents. This study delved into understanding the phytochemical makeup and the multifaceted biological activities of an aqueous extract from Cymbopogon citratus (C. citratus). The investigated activities were its effect on AMPA receptors, antioxidant capacity, anti-lipase, anti-α-amylase actions, cytotoxicity, and antimicrobial properties.

METHODS

The extract of C. citratus received a comprehensive investigation, which included the study of its phytochemical composition, assessment of its antioxidant and anti-lipase properties, evaluation of its capacity to inhibit α-amylase, analysis of its impact on cell viability, and assessment of its antimicrobial activity. The approaches are used to clarify the complex physiological and biochemical characteristics.

RESULTS

The results were compelling; receptor kinetics had a marked impact, notably on the GluA2 subunit. Regarding its medicinal potential, the extract demonstrated potent antioxidant and anti-diabetic activities with IC50 values of 15.13 and 101.14 µg/mL, respectively. Additionally, it displayed significant inhibitory effects on the lipase enzyme and showed cytotoxicity against the Hep3B cancer cell line, with IC50 values of 144.35 and 148.37 µg/mL. In contrast, its effects on the normal LX-2 cell line were minimal, indicating selectivity.

CONCLUSION

The aqueous extract of C. citratus shows promising therapeutic properties. The findings advocate for further research into its compounds for potential isolation, purification, and in-depth pharmacological studies, especially in areas like nervous system disorders, diabetes, obesity, and combating oxidative stress.

Knowledge, Attitude and Practice Related to Chemotherapy Among Cancer Patients

Cancer is a leading cause of death, with a rapidly increasing global burden. Chemotherapy is the most effective cancer treatment, and with its benefits, there exist potential problems. The present study assesses cancer patients' knowledge, attitude, and practice toward chemotherapy use. A descriptive cross-sectional study was conducted in the oncology wards of various tertiary care hospitals and cancer care centers in Lahore, Pakistan. Patients were included in the study based on convenient sampling. A structured questionnaire with 25 (close-ended) questions and a demographic profile was used to collect data. Descriptive statistics was used to analyze frequencies and percentages. Independent sample t-test and ANOVA were used to calculate the mean and standard deviation. Most patients were females (54%) and married (52.6%), with an unemployment rate of 39%. Patients with higher education depicted significantly higher scores in knowledge (9.61 ± 2.65), attitude (19.37 ± 2.70), and practice (3.89 ± 1.03) domains. Surprisingly, throughout the whole KAP domain, the patient's attitude (18.42 ± 3.31) toward chemotherapy use, showed higher values, as compared to their knowledge (7.78 ± 3.26) and practice (3.66 ± 1.08) scores. The majority of the study participants had a positive attitude toward chemotherapy use, with limited knowledge, and practice.

Deciphering the Epigenetic Symphony of Cancer: Insights and Epigenetic Therapies Implications

Epigenetic machinery is a cornerstone in normal cell development, orchestrating tissue-specific gene expression in mammalian cells. Aberrations in this intricate landscape drive substantial changes in gene function, emerging as a linchpin in cancer etiology and progression. While cancer was conventionally perceived as solely a genetic disorder, its contemporary definition encompasses genetic alterations intertwined with disruptive epigenetic abnormalities. This review explores the profound impact of DNA methylation, histone modifications, and noncoding RNAs on fundamental cellular processes. When these pivotal epigenetic mechanisms undergo disruption, they intricately guide the acquisition of the 6 hallmark characteristics of cancer within seemingly normal cells. Leveraging the latest advancements in decoding these epigenetic intricacies holds immense promise, heralding a new era in developing targeted and more efficacious treatment modalities against cancers driven by aberrant epigenetic modifications.

Biooriented Synthesis of Ibuprofen-Clubbed Novel Bis-Schiff Base Derivatives as Potential Hits for Malignant Glioma: In Vitro Anticancer Activity and In Silico Approach

This research work is based on the synthesis of bis-Schiff base derivatives of the commercially available ibuprofen drug in outstanding yields through multistep reactions. Structures of the synthesized compounds were confirmed by the help of modern spectroscopic techniques including high-resolution electrospray ionization mass spectrometry (HR-ESI-MS), 1H NMR, and 13C NMR. The synthesized compounds were evaluated for their anticancer activity using a normal human embryonic kidney HEK293 cell and U87-malignant glioma (ATCC-HTB-14) as a cancer cell line. All of the synthesized compounds among the series exhibited excellent to less antiproliferative activity having IC50 values ranging from 5.75 ± 0.43 to 150.45 ± 0.20 μM. Among them, compound 5e (IC50 = 5.75 ± 0.43 μM) was found as the most potent antiprolifarative agent, while 5f, 5b, 5a, 5n, 5r, 5s, 5g, 5q, 5i, and 5j exhibited good activity with IC50 values from 24.17 ± 0.46 to 43.71 ± 0.07 μM. These findings suggest that these cells (HEK293) are less cytotoxic to the activities of compounds and increase the cancer cell death in brain, while the lower cytotoxicity of the potent compounds in noncancerous cells suggests that these derivatives will provide promising treatment for patients suffering from brain cancer. The results of the docking study exposed a promising affinity of the active compounds toward casein kinase-2 enzyme, which shows green signal for cancer treatment.

m6A-modified circNFIX promotes ovarian cancer progression and immune escape via activating IL-6R/JAK1/STAT3 signaling by sponging miR-647

BACKGROUND

Ovarian cancer (OC) is one of the most common gynecological malignant cancers. Our previous work confirmed that circNFIX acted as an oncogene in OC, which could promote malignant proliferation, metastasis and angiogenesis. However, the role and mechanism of circNFIX in OC immune escape remain unclear.

METHODS

The RNA and protein levels were determined by qRT-PCR and western blot assays. The malignant phenotypes were tested by cell count kit-8, EdU staining, flow cytometry and transwell assays. The immune cytokines levels were measured by ELISA analysis. Molecular interactions were verified employing RNA immunoprecipitation, meRIP and dual luciferase methods. In vivo validation was performed by xenograft tumor and lung metastasis model. Hematoxylin & eosin and immunohistochemistry staining were used to observe the pathological changes.

RESULTS

The levels of circNFIX, PD-L1, and IL-6R were upregulated in OC tissues and cell lines, while miR-647 was downregulated. Functional assays showed that loss of circNFIX suppressed the growth, metastasis and immune escape of OC cells both in vitro and in vivo. On the molecular level, the m6A modification of circNFIX was elevated in OC cells, and its expression was positively correlated to m6A modification and depended on IGF2BP1 ∼ 3 recognition. Moreover, circNFIX acted as a competing endogenous RNA for miR-647 to upregulate IL-6R expression, thereby activating JAK/STAT3 signaling and elevating PD-L1 expression. Rescue assays revealed that co-silencing of miR-647 reversed the antitumor effects of circNFIX knockdown on cell proliferation, metastasis and immune escape of OC cells.

CONCLUSION

This study provided a comprehensive understanding of the molecular mechanism about circNFIX in OC, demonstrating m6A activated-circNFIX accelerated OC development and immune escape via regulating miR-647/IL-6R/PD-L1 pathway.

A comprehensive review of summer savory (Satureja hortensis L.): promising ingredient for production of functional foods

This review aims to measure the different aspects of summer savory including biological activity, medicinal properties, nutritional value, food application, prospective health benefits, and its use as an additive in broiler feed. Furthermore, toxicity related to this is also overviewed. Summer savory leaves are abundant in total phenolic compounds (rosmarinic acid and flavonoids) that have a powerful antioxidant impact. Rosmarinic (α-O-caffeoyl-3,4-dihydroxy-phenyl lactic) acid has been identified in summer savory as a main component. According to phytochemical investigations, tannins, volatile oils, sterols, acids, gums, pyrocatechol, phenolic compounds, mucilage, and pyrocatechol are the primary compounds of Satureja species. Summer savory extract shows considerable biological potential in antioxidant, cytotoxic, and antibacterial assays. Regarding antioxidant activity, summer savory extract displays an inhibitory effect on lipid peroxidation. Summer savory also has Fe (III) reductive and free radical scavenging properties and contains minerals and vitamins. Summer savory has important biological properties, including antimicrobial activity and antioxidant activity, and protective effects against Jurkat T Cells, Alzheimer's disease, cancer, infection, cardiovascular diseases, diabetes, and cholesterol. The leaves and stems of this plant are employed in the food, feed, and pharmacological industries due to their antioxidant properties and substantial nutritional content. Conclusively, summer savory is widely considered beneficial for human health due to its versatile properties and medicinal use.

Standard Hypercaloric, Hyperproteic vs. Leucine-Enriched Oral Supplements in Patients with Cancer-Induced Sarcopenia, a Randomized Clinical Trial

(1) Background: Malnutrition frequently affects patients with cancer, and it negatively impacts treatment tolerance, clinical outcomes and survival. Thus, appropriate nutritional screening and early nutrition support are extremely recommended. Currently, a significant number of oral supplements (OS) are commercially available; despite this, there is a lack of evidence for recommending specific OS, including leucine-enriched OS, for nutritional support in patients with cancer. (2) Aim: To compare the clinical evolution of patients with cancer (undergoing systemic treatment) that received standard hypercaloric, whey protein-based hyperproteic oral supplements vs. hypercaloric, hyperproteic leucine-enriched OS using a novel morphofunctional nutritional evaluation. (3) Patients and methods: This paper details an open-label, controlled clinical study in which patients were randomly assigned to receive nutritional treatment with whey protein-based hyperproteic oral supplements (control group) vs. hypercaloric, hyperproteic leucine-enriched OS (intervention group) during a twelve-week period. Forty-six patients were included; epidemiological, clinical, anthropometric, ultrasound (muscle echography of the rectus femoris muscle of the quadriceps and abdominal adipose tissue) and biochemical evaluation were performed. All patients received additional supplementation with vitamin D. (4) Results: Nutritional parameters (including bioimpedance, anthropometric, ultrasound and biochemical variables) of all included patients remained stable after the nutritional intervention. Extracellular mass tended to increase in the patients that received the leucine-enriched formula. Functionality (evaluated through the stand-up test) improved in both groups (p < 0.001). Prealbumin, transferrin levels and superficial adipose tissue increased in the control group (p < 0.05), while self-reported quality of life improved in all the evaluated patients (p < 0.001). (5) Conclusions: Nutritional support with hypercaloric, hyperproteic (with whey protein) OS and vitamin D supplementation were associated with the maintenance of body composition and improvements in functionality and in quality of life in the patients with cancer undergoing systemic treatment. No significant benefits were observed when a leucine-enriched formula was used.

Role of Confocal Laser Endomicroscopy in Early Detection of Upper Gastrointestinal Malignancy in High Risk Patients

BACKGROUND

Upper gastrointestinal malignancies are a major global health burden. Early diagnosis of upper gastrointestinal premalignant and malignant lesions is crucial for improving prognosis and reducing morbidity and mortality. The purpose of this study was to investigate the diagnostic accuracy of confocal laser endomicroscopy (CLE) in detecting upper gastrointestinal premalignant and early malignant lesions in high-risk patients, as well as diagnosing patients with inconclusive white light endoscopy (WLE) and histopathology results.

METHODS

It was a cross-sectional study that included ninety (n = 90) high-risk patients with inconclusive diagnoses of upper gastrointestinal lesions on WLE and WLE-based biopsy histopathology. These patients underwent CLE, and the definitive diagnosis was confirmed using CLE and CLE-target biopsy histopathology. Diagnostic accuracy was determined by comparing the sensitivity, specificity, predictive values, and accuracy between the procedures.

RESULT

The mean patient age was 47.43 ± 11.18 years. CLE and target biopsy confirmed that 30 (33.3%) patients had normal histology, while 60 (66.7%) patients were diagnosed with gastritis, gastric intestinal metaplasia, high-grade dysplasia, adenocarcinoma, Barrett's esophagus, and squamous cell carcinoma of the esophagus. The results of CLE were superior to those of WLE in terms of diagnostic parameters. Additionally, CLE demonstrated nearly similar results in sensitivity (98.33%), specificity (100%), positive predictive value (100%), negative predictive value (96.77%), and accuracy (98.89%) when compared to CLE-target biopsy.

CONCLUSION

CLE showed higher diagnostic accuracy in differentiating normal, premalignant and malignant lesions. It effectively diagnosed patients who initially had inconclusive WLE and/or biopsy results. Furthermore, early detection of upper gastrointestinal premalignant or malignant lesions may improve prognosis and reduce morbidity and mortality.

Oxidative balance score and dietary phytochemical index can reduce the risk of colorectal cancer in Iranian population

BACKGROUND

No previous study has assessed the association between oxidative balance score (OBS) and dietary phytochemical index (DPI) with colorectal cancer (CRC) simultaneously. Therefore, this study investigated the association between OBS and DPI with the odds of CRC among the Iranian population.

METHODS

This hospital-based age and sex-matched case-control study was conducted between September 2008 and January 2010 (142 controls and 71 cases were entered for analysis). New diagnosed CRC cases were selected from the Cancer Institute, Imam Khomeini Hospital of Tehran. Dietary intakes were determined by a semi-quantitative food frequency questionnaire (FFQ). Then, dietary indices were calculated by food items and nutrient intake. Logistic regression was utilized for assessing the tertiles of OBS and DPI.

RESULTS

In multivariate analysis, OBS was associated with a 77% reduction in CRC odds in the last tertile than the first tertile (odds ratio (OR) = 0.23, confidence interval (CI): 0.07-0.72, P_trend = 0.017). Also, we found a 64% reduction in CRC odds in the last tertile of DPI compared to the first tertile (OR = 0.36, CI: 0.15-0.86, P_trend = 0.015).

CONCLUSIONS

A diet rich in phytochemicals and anti-oxidants, including fruits and vegetables (citrus fruits, colored berries, and dark-green leafy vegetables) and whole grains, may reduce the CRC odds.

Optimization of spray dried yogurt and its application to prepare functional cookies

Introduction

Spray-dried yogurt powder (SDYP) has shelf stability and other functional properties that improve solubility and facilitate the use, processing, packaging, and transportation of other food derivatives, such as bread and pastries on a large scale. The present research was conducted to develop SDYP and further its utilization to prepare functional cookies.

Methods

Yogurt was spray-dried by employing different outlet air temperatures (OAT) (65°C, 70°C & 75°C) and inlet air temperature (IAT) (150°C, 155°C & 160°C). Spray drying shows that increasing the temperature increases nutritional loss, whereas S. thermophilus culture shows resistance to the intensive heat approaches. On the other hand L. delbrueckii subsp. Bulgaricus culture was found to be significantly affected. A total of 4 treatments, including one control for the functional cookies development.

Results and discussion

A directly proportional relation was investigated between the increasing concentration of SDYP and baking characteristics and cookie's mineral and protein profile. Bioactive parameters like antioxidant activity of 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH), 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS) and total phenolic content (TPC) were also affected significantly. The sensory profile shows an incline towards T0 (0% SDYP) to T3 (10% SDYP) in all attributes but starts to decline when the concentration of SDYP reaches 15%. This study suggests that by employing a certain combination of temperatures (OAT: 60°C IAT: 150°C); maximum survival of inoculated culture can be achieved, and this powder can be utilized in the development of functional cookies with enhanced sensory as well as biochemical characteristics significantly (P< 0.05).

The Influence of Polyphenols on Atherosclerosis Development

Polyphenols have attracted tremendous attention due to their pro-health properties, including their antioxidant, anti-inflammatory, antibacterial and neuroprotective activities. Atherosclerosis is a vascular disorder underlying several CVDs. One of the main risk factors causing atherosclerosis is the type and quality of food consumed. Therefore, polyphenols represent promising agents in the prevention and treatment of atherosclerosis, as demonstrated by in vitro, animal, preclinical and clinical studies. However, most polyphenols cannot be absorbed directly by the small intestine. Gut microbiota play a crucial role in converting dietary polyphenols into absorbable bioactive substances. An increasing understanding of the field has confirmed that specific GM taxa strains mediate the gut microbiota-atherosclerosis axis. The present study explores the anti-atherosclerotic properties and associated underlying mechanisms of polyphenols. Moreover, it provides a basis for better understanding the relationship between dietary polyphenols, gut microbiota, and cardiovascular benefits.

The prospect of Xihuang pill in the treatment of cancers

Background

Xihuang pill, a Traditional Chinese Medicine (TCM) prescription and a representative of Huoxuehuayu therapy (one of the TCM therapies to promote blood circulation and remove blood stasis), has been widely used in breast cancer treatments. Although some evidence suggests the efficacy and safety of the Xihuang pill in treating certain cancer, the overall efficacy of the Xihuang pill in other cancer treatment is uncertain.

Objective

This study aimed to summarize the current clinical literature and provided evidence support for addressing the research question of whether the Xihuang pill is safe and effective in the treatment of various cancers as Huoxuehuayu therapy, and possibly identify the clinical dosage range and therapeutic effect of Xihuang pills.

Method

Seven Chinese and English databases such as PubMed, CNKI, and Google Scholar were searched to collect the publications on Xihuang pill and cancer. Then the researchers extracted data from the articles that met the inclusion criteria and used SAS statistical program version 9.4 (by SAS Institute, Cary, North Carolina, USA) for statistical statistics.

Results

Our search identified 78 studies, including 69 RCTs (randomized control trials), 6 NRCCs (non-randomized concurrent control trials), and 3 BAS (before-after study), evaluating 3151 patients in total. The daily doses of Xihuang pills/capsule were between 2 g and 60 g, and duration between 2 weeks and 5 years, mostly used in the middle or late stage of cancer. The therapeutic effect of the Xihuang pill was mainly reflected in improving Complete Response (CR, a term from The Response Evaluation Criteria In Solid Tumors) or Partial Response (PR, a term from The Response Evaluation Criteria In Solid Tumors), reducing adverse reactions, promoting quality of life (QoL), regulating immunity, alleviating pain, prolonging survival, reducing metastasis and recurrence, reducing inflammation, regulating estrogen levels, decreasing hypercoagulative status, and reducing tumor markers.

Conclusion

Xihuang pill representing Huoxuehuayu therapy has a good prospect in the treatment of cancer.

Development of functional yogurt by using freeze-drying on soybean and mung bean peel powders

Introduction

Plant-based yogurt has earned much interest in current times due to the rising demand for milk substitutes, which is tied to ethical and health needs.

Methods

Freeze-drying impact on soybean peel powder (SPP) and mung bean peel powder (MPP) and their use in creating functional yogurt at various concentrations was checked. In functional yogurt, total flavonoid content (TFC), total phenolic content (TPC), antioxidant activity and chemical profile are checked.

Results

The maximum concentration of TPC was 4.65±0.05 (mg GAE/g), TFC was 1.74±0.05 (CE mg/g) and 82.99 ± 0.02 % antioxidant activity was calculated in sample T6, having the highest concentration of SPP, which was substantially more significant than the treatment samples containing MPP. Sensory attributes of the yogurt samples were analyzed, which indicated a decrease when SPP and MPP values increased when introduced at 3 or 6 % of an optimum level. There was no notable loss of the sensory profile compared to the control group. The results were found to be significant at p &lt; 0.05. The freeze-dried SPP had the complete chemical composition compared to MPP except for ash and fiber content.

Discussion

The physicochemical profile of the treatments of functional yogurt had a linear proportional connection in the percentage of both powders in the meantime. When both the dry level of powders increased, the protein and fat levels decreased. In the food industry, the freeze-dried soybean peel and the peel of mung bean can be utilized in functional yogurt as a source of bioactive components.

Cancer care in times of conflict: Treatment of patients from Afghanistan, in Pakistan

Introduction

Afghanistan has been in a near-continuous armed conflict, which has degraded the country's health infrastructure. Due to this, Afghans have opted to seek cancer treatment in Pakistan. This manuscript aims to understand the complex cancer journey of patients from Afghanistan seeking care in the largest tertiary care cancer institutions in Pakistan.

Methods

This retrospective study explores the demographics, epidemiology and outcomes of Afghan cancer patients treated at the Shaukat Khanum Memorial Cancer Hospital and Research Centres (SKMCH&RC) in Lahore and Peshawar, Pakistan, over the period from 1995 to June 2022.

Results

A total of 6,370 patients from Afghanistan have undergone cancer care since 1995. The mean age at presentation was 40.7 years, 57% were male, and 87% were adults >19 years. Close to 30% of these patients came from Kabul and Nangarhar districts. 56% of all patients presented with stage III or IV disease. 34% of adult patients achieved a complete response to treatment, but more than half of all patients have since been lost to follow-up. Children generally had better outcomes, with 43% showing a complete response to treatment.

Discussion

The cancer journey for these patients remains long and difficult and the inability to ensure follow-up in so many remains frustrating for both patients and providers. The lack of a cancer infrastructure in Afghanistan after decades of conflict, means that policymakers need to develop and support alternative systems and structures to provide post-conflict domestic and cross-border cancer care.

Crocin: Functional characteristics, extraction, food applications and efficacy against brain related disorders

Crocin is a bioactive compound that naturally occurs in some medicinal plants, especially saffron and gardenia fruit. Different conventional and novel methods are used for its extraction. Due to some control conditions, recent methods such as ultrasonic extraction, supercritical fluid extraction, enzyme-associated extraction, microwave extraction, and pulsed electric field extraction are widely used because these methods give more yield and efficiency. Crocin is incorporated into different food products to make functional foods. However, it can also aid in the stability of food products. Due to its ability to protect against brain diseases, the demand for crocin has been rising in the pharmaceutical industry. It also contain antioxidant, anti-inflammatory, anticancer and antidepressant qualities. This review aims to describe crocin and its role in developing functional food, extraction, and bioavailability in various brain-related diseases. The results of the literature strongly support the importance of crocin against various diseases and its use in making different functional foods.

NMI: a potential biomarker for tumor prognosis and immunotherapy

N-Myc and STAT Interactor protein (NMI) is an interferon inducible protein participating in various cellular activities, and is widely involved in the process of tumorigenesis and progression. Studies have shown that the loss of NMI expression in breast cancer can promote its progression by inducing epithelial-mesenchymal transition (EMT). However, the expression level of NMI in other tumors and its impact on immune cell infiltration, patient prognosis, and drug treatment are still unclear. Here, we analyzed the role of NMI in pan-cancer through multiple omics data. We found that NMI was abnormally expressed in a variety of tumor tissues. The expression of NMI was closely related to the unique molecular and immunotyping, diagnosis and prognosis of various tumor tissues. In addition, we identified the main proteins that interact with NMI, and focused on the relationship between the clinical parameters of lower grade glioma (LGG) and NMI expression. Subsequently, we found that the expression of NMI was correlated with the infiltration of multiple immune cells and the expression of immune checkpoints. Finally, we also found that the expression of NMI was correlated with the sensitivity to multiple antitumor drugs. In conclusion, our comprehensive pan-cancer analysis of NMI revealed that it is a potential molecular marker for tumor diagnosis and treatment, plays an important role in tumor immunity, and is a promising molecular target for cancer treatment.

Oxidative stress and metabolic diseases: Relevance and therapeutic strategies

Metabolic syndrome (MS) is a prominent cause of death worldwide, posing a threat to the global economy and public health. A mechanism that causes the oxidation of low-density lipoproteins (LDL) is associated with metabolic abnormalities. Various processes are involved in oxidative stress (OS) of lipoprotein. Although the concept of the syndrome has been fiercely debated, this confluence of risk factors is associated with a higher chance of acquiring type 2 diabetes mellitus (T2DM) and atherosclerosis. Insulin resistance has been found to play a significant role in the progression of these metabolism-associated conditions. It causes lipid profile abnormalities, including greater sensitivity to lipid peroxidation, contributing to the increased prevalence of T2DM and atherosclerosis. This review aims to cover the most recent scientific developments in dietary OS, the consequence of metabolic disorders, and their most significant clinical manifestations (T2DM and atherosclerosis). It will also emphasize the effects of dietary approaches in alleviating OS in MS.

The Disposition of Bioactive Compounds from Fruit Waste, Their Extraction, and Analysis Using Novel Technologies: A Review

Fruit waste contains several bioactive components such as polyphenols, polysaccharides, and numerous other phytochemicals, including pigments. Furthermore, new financial opportunities are created by using fruit ‘leftovers’ as a basis for bioactivities that may serve as new foods or food ingredients, strengthening the circular economy’s properties. From a technical standpoint, organic phenolic substances have become more appealing to industry, in addition to their application as nutritional supplements or functional meals. Several extraction methods for recovering phenolic compounds from fruit waste have already been published, most of which involve using different organic solvents. However, there is a growing demand for eco-friendly and sustainable techniques that result in phenolic-rich extracts with little ecological impact. Utilizing these new and advanced green extraction techniques will reduce the global crisis caused by fruit waste management. Using modern techniques, fruit residue is degraded to sub-zero scales, yielding bio-based commodities such as bioactive elements. This review highlights the most favorable and creative methods of separating bioactive materials from fruit residue. Extraction techniques based on environmentally friendly technologies such as bioreactors, enzyme-assisted extraction, ultrasound-assisted extraction, and their combination are specifically covered.