Aberrant Promoter Methylation at CpG Cytosines Induce the Upregulation of the E2F5 Gene in Breast Cancer / 한국유방암학회지

PURPOSE: The promoter methylation status of cell cycle regulatory genes plays a crucial role in the regulation of the eukaryotic cell cycle. CpG cytosines are actively subjected to methylation during tumorigenesis, resulting in gain/loss of function. E2F5 gene has growth repressive activities; various studies suggest its involvement in tumorigenesis. This study aims to investigate the epigenetic regulation of E2F5 in breast cancer to better understand tumor biology. METHODS: The promoter methylation status of 50 breast tumor tissues and adjacent normal control tissues was analyzed. mRNA expression was determined using SYBR® green quantitative polymerase chain reaction (PCR), and methylation-specific PCR was performed for bisulfite-modified genomic DNA using E2F5-specific primers to assess promoter methylation. Data was statistically analyzed. RESULTS: Significant (p<0.001) upregulation was observed in E2F5 expression among tumor tissues, relative to the control group. These samples were hypo-methylated at the E2F5 promoter region in the tumor tissues, compared to the control. Change in the methylation status (Δmeth) was significantly lower (p=0.022) in the tumor samples, indicating possible involvement in tumorigenesis. Patients at the postmenopausal stage showed higher methylation (75%) than those at the premenopausal stage (23.1%). Interestingly, methylation levels gradually increased from the early to the advanced stages of the disease (p<0.001), which suggests a putative role of E2F5 methylation in disease progression that can significantly modulate tumor biology at more advanced stage and at postmenopausal age (Pearson's r=0.99 and 0.86, respectively). Among tissues with different histological status, methylation frequency was higher in invasive lobular carcinoma (80.0%), followed by invasive ductal carcinoma (46.7%) and ductal carcinoma in situ (20.0%). CONCLUSION: Methylation is an important epigenetic factor that might be involved in the upregulation of E2F5 gene in tumor tissues, which can be used as a prognostic marker for breast cancer.

Reasons of patients transfer from peripheral teaching and non teaching hospitals to a surgical unit, lady reading hospital Peshawar: a pilot study

Objective: to determine the reasons of referral/transfer of patients from other health facilities to a surgical unit of Lady Reading Hospital Peshawar

Methodology: this is a descriptive cross-sectional study conducted in surgical unit "C" Lady Reading Hospital [LRH] Peshawar from February 28 to September 14, 2014, using consecutive non-purposive sampling technique. All patients admitted in our unit living outside the catchment area of Peshawar were included. Age, gender, address, reason for referral and perception of the patients about Lady Reading Hospital Peshawar was recorded on a proforma. Data was analyzed using SPSS version 20. Mean and standard deviation was calculated for quantitative output responses and frequency and percentages for qualitative output responses. Chi-square test was applied on the variables when compared and p value of <0.05 was considered significant

Results: total patients received in the study period of [six and half months] were 195.Out of these 75.4% were male. The mean age of patients was 37.2+ 17.49 years. The percentage admitted via emergency was 88.7%. Out of 195 patients, 147[75.4%] attended a health facility before coming to LRH. The reasons given for referral was lack of equipment, lack of staff, lack of ICU, lack of specialty, lack of out of hours services and seropositivity given in 88[59.8%], 74[50.3%],71[48.2%], 70[47.6%], 70 [47.6%] and 04 [2.7%] patients respectively.Dissatisfaction towards the local health facilities was shown by 137 [70.3%]

Conclusion: the peripheral health care system is being underutilized resulting in excessive burden on tertiary care health facilities. It is therefore important to address the problems and to implement a structured referral system

Routine preoperative chest X-ray and its impact on decision making in patients undergoing elective surgical procedures

It is the routine of our hospital that all patients undergoing any kind of surgery in any specialty are subjected to routine pre-op chest x-ray [CXR]. However there is increasing evidence that this practice does not have much influence on patient management and thus could be limited to a very small number of patients in whom it is justified. We conducted this study to know the significance of routine pre-op x-rays chest in patients admitted in a surgical unit for elective surgery and to what extent such routine x-ray affected our surgical intervention. It is a cross sectional study in which 500 consecutive adult patients admitted in surgical 'C' unit of Lady Reading Hospital Peshawar, for elective surgical procedures were included. The age, gender, co-morbidity, delay in operation if any was recorded and CXR were reported upon by a qualified radiologist. The influence on decision making regarding fitness of patients for general anaesthesia/surgery was also determined. Data were analysed using SPSS- 20. Out of total of 500 chest x-rays 109 [21.8%] were reported to have some abnormality in the film. Out of these 109, 58 were male 51 were female patients. The percentages of abnormal CXR according to age were 13.6%, 35.8%, and 50% in the 16-39 years, 40-69 years and 70 year age groups respectively. Amongst the patients with abnormal CXR, 30 had their surgery delayed. However in only one patient out of the 30 the delay was on the basis of significant finding on the CXR. Good medical history and clinical examination can save many patients from unnecessary CXR. Preoperative CXR may only be done in patients who have a clear indication for this investigation

Comparison between predicted position of appendix on clinical examination and position of appendix as an intraoperative finding in patients with clinically suspected acute appendicitis

To compare the position of appendix as determined preoperatively on the basis of clinical examination with the intra-operative finding and to document the most common position of appendix on intra-operative finding. This cross sectional study of one year duration from February 2009 to January 2010 was conducted in Surgical "A" Unit, Lady Reading Hospital, Peshawar. Out of 100 admitted patients undergoing appendicectomy, the position of appendix was compared preoperatively on the basis of clinical examination with the intraoperative finding. Out of 100 patients, 71% were males and 29% females, 53% were in the age group of 12-20 years, followed by 25% in age group of 21-25 years. The mean age was 22.63 +/- SD 8.58 years. On preoperative clinically, retrocecal; pelvic; subcecal; paracecal and subhepatic position were observed in 51%, 25%, 13%, 06% and 05% cases respectively while on intra-operative examination, the frequency of positions were 56%, 23%, 10%, 07% and 04% cases respectively. For comparison between clinical and intraoperative position of the appendix, the p value of the retrocecal position was 0.478, subcecal position was 0.506, pelvic position was 0.741, paracecal position was 0.774 and subhepatic position was 0.733. The most common position of appendix is retrocecal both on clinical and there is no difference between clinical diagnosis and intraoperative findings of positions of the appendix

Frequency of hepatitis C infection in diabetic patients

Diabetic patients are at an increased risk of acquiring Hepatitis C Virus [HCV] infection owing to the nature of the disease and its inherent complications or frequent parental exposure. On the other hand HCV infection may itself contribute to the development of Diabetes Mellitus. The epidemiological evidence of this association has not been studied in Pakistan at a population level and its exact biological mechanisms are not obvious. Objective of this study was to study the frequency of HCV infection among adult diabetic patients attending the Hospital the study comprised of 100 Diabetic patients visiting the outpatient clinics or admitted in the medical wards of a Teaching Hospital, in Peshawar. Diabetes was confirmed according to the new diagnostic criteria based on 2 fasting or 2 random plasma glucose levels of more than 126 milligram per deciliter [mg/dL] and 200 mg/dL respectively. The presence of HCV infection was confirmed by Enzyme Linked Immuno-Sorbent Assay [ELISA] method. A concise history of the patient, examination and laboratory findings were recorded on a Performa. Out of the hundred diabetics 36% were found to be anti HCV positive and all of them had type II diabetes. There was no gender difference in the seropositive cases. Serum Glutamic-Pyruvic Transaminase [SGPT] level was raised in 75% of the positive cases as compared to the 25% of the seronegative patients. The seropositive cases had a comparatively higher blood sugar level. HCV infection occurs more often in type II diabetic and further investigations should be done in diabetic patients with raised SGPT for the presence of chronic HCV infection