Medical Bulletin 1/ April/ 2024

In a recent review and meta-analysis published in the journal Nutrition, Metabolism and Cardiovascular Diseases, researchers reviewed and examined available literature investigating the health outcomes of 'ancient' grains, including oats, brown rice, buckwheat, chia, and others.

Diabetes mellitus, characterized by high blood sugar levels, has seen a dramatic global prevalence increase, projected to exceed 700 million by 2045. Alongside medical treatments, dietary changes are key in managing the condition. Ancient cereals, untouched by human genetic modification, offer promising benefits against diabetes mellitus. These grains contain higher levels of phytochemicals and fibers known to lower blood sugar compared to modern varieties.

In the present review, researchers aimed to discuss evidence from the literature investigating ancient grain consumption outcomes on DM patients. Specifically, the review provided an overview of the glycemic control impacts of ancient grains on T1DM and T2DM; the ancient grains most often studied using randomized controlled trial methodologies, and the effectiveness of ancient-grain-based diets in managing DM as conventional therapeutic enhancers.

Meta-analysis results highlighted that while the consumption of ancient grains does produce generally positive outcomes in T2DM patients (especially in the case of oats, brown rice, and millets), inter-study heterogeneity makes these results lacking in reliability, preventing their current recommendations as anti-DM interventions.

The study suggested that ancient grains may help in managing type 2 diabetes mellitus (T2DM) due to their higher fiber content, lower glycemic index, and rich array of phytochemicals. These grains, untouched by modern genetic modification, can help stabilize blood sugar levels, improve insulin sensitivity, and reduce inflammation associated with T2DM. Additionally, their balanced nutrient profile and potential prebiotic effects on gut health contribute to overall well-being in individuals with diabetes. Incorporating ancient grains into the diet presents a promising dietary strategy for T2DM management and improved health outcomes.

"Further emphasis should be placed in designing future RCTs with better definition of dietary interventions, adequate sample sizes for relevant clinical outcomes, and sufficient duration of treatment. Furthermore, studies specifically designed for patients with Diabetes mellitus should be implemented," said the study authors.

Reference: Magi, C. E., Rasero, L., Mannucci, E., Bonaccorsi, G., Ranaldi, F., Pazzagli, L., Faraoni, P., Mulinacci, N., Bambi, S., Longobucco, Y., Dicembrini, I., & Iovino, P. (2024). Use of ancient grains for the management of diabetes mellitus: A systematic review and meta-analysis. Nutrition, Metabolism and Cardiovascular Diseases, 34(5), 1110-1128, DOI – 10.1016/j.numecd.2024.03.005, https://www.sciencedirect.com/science/article/pii/S0939475324000929

According to a report in the journal BMJ Case Reports, Inhaling the synthetic opioid fentanyl may cause potentially irreversible brain damage (toxic leukoencephalopathy). The doctors warned after treating a middle-aged man found unresponsive in his hotel room after snorting the drug.

Leukoencephalopathy refers to inflammation and damage to the brain’s white matter—the network of nerve fibres that enable the exchange of information and communication between different areas of the brain’s grey matter. Toxic leukoencephalopathy is a sudden or longstanding neurological syndrome, which has been reported after heroin inhalation. The condition manifests in various signs and symptoms, the most obvious of which are neurological and behavioural changes, ranging from mild confusion to stupor, coma, and death.

In this case, a previously healthy man was discovered unconscious in his hotel room with unidentified crushed pills nearby. Upon admission to the hospital, he exhibited neurological deficits, including an inability to respond to questions or commands, and only responding to pain stimuli in his legs.

Brain imaging revealed inflammation and swelling in the white matter and cerebellar injury, affecting his gait and balance. Despite testing negative for epilepsy, a urine test indicated exceptionally high levels of fentanyl, leading to a diagnosis of toxic leukoencephalopathy induced by fentanyl inhalation.

Over the following weeks, he remained bedbound and required various medical interventions for urinary incontinence, kidney injury, cognitive impairment, suspected opioid withdrawal, pain, agitation, and pneumonia. After 26 days, he was discharged to a rehabilitation facility and later returned home with outpatient physiotherapy and occupational therapy support. Remarkably, within a year of his hospitalization, he fully recovered and resumed full-time work.

“This is the first reported case associated with fentanyl. This case illustrates the need for the inclusion of fentanyl in routine urine drug screens for earlier identification and appropriate management,” said the report authors.

Reference: Eden CO, Alkhalaileh DS, Pettersson DR, et alClinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathyBMJ Case Reports CP 2024;17:e258395.

According to a new study presented at the American College of Cardiology annual scientific session, people who use e-cigarettes have a much higher risk of developing heart failure compared to those who have never vaped.

More than 64 million people globally are affected by heart failure — a cardiovascular condition where the heart muscle is not able to pump enough blood for the body. Heart failure can occur if the heart muscle is damaged by infection, illegal drug use, high blood pressure, a congenital heart defect, heart attack, irregular heart rhythm, certain diseases including diabetes and coronary artery disease, and cigarette smoking.

For this study, Yakubu Bene-Alhasan, a resident physician at MedStar Health in Baltimore and lead author of this study, along with his team reviewed data from electronic health records and surveys of more than 175,000 adults from the All of Us study, run by the National Institutes of Health. Upon analysis, researchers found that people who used e-cigarettes at any point in their lives were 19% more likely to develop heart failure than those who had never used e-cigarettes. They also found e-cigarette use had the biggest impact on a certain type of heart failure.

The researchers reported that the increased heart failure risk linked to e-cigarette use was statistically significant for heart failure with preserved ejection fraction- also known as diastolic heart failure – which occurs when the heart can pump normally, but the muscle is too stiff to allow it to properly fill with blood.

“A recent meta-analysis in NEJM found that vaping increased (the) risk of cardiovascular disease among others. Animal studies have also found changes in the heart leading to reduced contractility and relaxation after exposure to e-cigarettes. These are the same changes seen in heart failure,” said Bene-Alhasan.

“Heart failure with preserved ejection fraction is relatively less understood but is gaining more recognition. The traditional medicines used to treat heart failure have less mortality benefits in this type of heart failure. As such, its management should include strategies to prevent it from developing in the first place. Knowing that e-cigarettes could potentially lead to this type of heart failure is important (in) drawing up preventive interventions,” he concluded.

Reference: bene-alhasan, y, Mensah, S, Almaadawy, O. et al. ELECTRONIC NICOTINE PRODUCT USE IS ASSOCIATED WITH INCIDENT HEART FAILURE - THE ALL OF US RESEARCH PROGRAM. J Am Coll Cardiol. 2024 Apr, 83 (13_Supplement) 695; https://doi.org/10.1016/S0735-1097(24)02685-8