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.

Surgical site infection; in-vitro anti-bacterial activity of different brands of ceftriaxone against bacteria commonly implicated in surgical site infection and their cost effectiveness

Ceftriaxone is used in wide range of day to day microbial infections in clinical practice3. Despite the incumbent drug regulating authority in Pakistan, there is scanty literature comparing the anti-microbial efficacy of different available br and s of ceftriaxone. Objectives: To know the in-vitro activity of various br and s of ceftriaxone against bacteria most commonly isolated from surgical site infection [SSI]. A comparison of five days cost of these br and s will also be done. Design: Experimental study. Period: Feb 2013 to Aug 2013 Setting: Surgical "C" unit Lady Reading Hospital [LRH] in collaboration with departments of pharmacology Khyber Girls Medical College [KGMC] and microbiology department of Lady Reading Hospital Peshawar. Material and Methods: Isolates of five bacteria i.e. Staphylococcus aureus, Proteus mirabilis, Escherischia coli, enterobacter Spp, and Klebsiella pneumoniae, found sensitive to ceftriaxone were grown on 50 slops each and the zone of inhibition was checked for each of the ten br and s of ceftriaxone. Results: The zones of inhibitions of different br and s of ceftriaxone against the above mentioned bacteria were not significantly different. The cost of therapy was significantly different for ten br and s. Conclusions: Various br and s of ceftriaxone of variable cost had no influence on their activity against bacteria involved in SSI.

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

GBS and AFP [acute flaccid paralysis] system in AJK

Main objective of the study is to highlight the major cause of AFP and% of GBS represents the AFP during the study period. Retrospective analytical study. This study was conducted in AJK, for the duration of three years from January 2011 to December 2013. Retrospective analysis of AFP cases reported during 2011-2013. Primarily the AFP cases investigated through history and clinical examination. Principal cause of AFP [Acute flaccid Paralysis] cases were investigated through specific tests like serum electrolytes, CSF [cerebrospinal fluid], electromyogram and viral culture from stool sample to exclude poliovirus. All the cases reported from AJK and taken on the line list labeling as GBS were included in the study during 2011-2013. Three years data analysis shows more than 50% GBS cases presenting AFP and the numbers are increasing every year. Most of the GBS and even AFP belong to 6-59 months age group. More than 55% GBS cases recover completely and this proportion increased from 2011-2013. Data analysis revealed GBS is a major cause of AFP in AJK and needs not to be overlooked to keep poliovirus transmission ceased here. AFP surveillance system is huge resource and this is a high time to study all the causes responsible for acute flaccid paralysis to strengthen polio eradication efforts and to develop understanding for prevention and control, to avoid acute flaccid paralysis related morbidity and mortality amongst children in Pakistan

Evaluation of AFP surveillance sensitivity in AJK

Main objective of the study is to analyse sensitivity of the surveillance system, required to keep poliovirus circulation ceased in AJK. Retrospective analysis of AFP cases reported during the study period. This study included all the AFP cases reported during the study period in AJK from Jan. 2011 to Dec. 2013. Historical data is used to analyse AFP surveillance for detecting poliovirus infection in children age <15 years in the study area based on few assumptions that all the results are negative and adequate information were available to make ultimate diagnosis of each AFP case reported in the area during study period. Surveillance sensitivity analysed using AFP surveillance criteria recommended by WHO and variable used in AFP surveillance system. Surveillance sensitivity is analysed based on two indicators "non polio AFP rate" and stool adequacy. Sensitivity level analysed in AFP cases aged 6-59 months for >/= 7 OPV doses including routine and SIAs revealed 6/10 districts have high sensitivity. Long absence of Polio virus in the area, creeping up of boredom among health human resource, Clinician's failure to notify all AFP cases resulting in down going Surveillance sensitivity

Frequency of common bacteria and their antibiotic sensitivity in patients with symptomatic cholelithiasis

To determine the frequency of common bacteria and their antibiotic sensitivity in patients with symptomatic cholelithiasis This cross sectional descriptive study was conducted at Department of Surgery, Lady reading hospital, Peshawar for 6 months i.e., from December 2012 to May 2013. The total number of patients were 126. They presented with symptomatic cholelithiasis. Bile was aspirated preoperatively before cholecystectomy from gall bladder and was sent for culture and sensitivity test. The data was analyzed using Statistical Package for Social Sciences[SPSS] version 10.0. On culture and sensitivity test, 74 [58.73%] have positive growth while 52 [41.27%] have no growth. The most common bacteria was E. Coli isolated in 28 [22.22%] patients followed by Klebseilla in 22 [17.46%], Salmonellain 16 [12.70%] and Shigella in 8 [6.35%] patients. On culture and sensitivity test, all the 4 isolated bacteria showed sensitivity to Cefuroxime, Ceftriaxone and Ciprofloxacin in more than 50 % cases, while all the four bacteria showed resistance to amoxicillin in more than 50 % cases. The most common bacteria of symptomatic cholelithiasis are E. coli and Klebseilla followed by Salmonella and Shigella. These bacteria showed maximum sensitive to cefuroxime and ceftriaxone

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

Awareness and practice of thromboprophylaxis among surgeons in tertiary care hospitals of Khyber Pukhtunkhwa

To find out the awareness and practice of thromboprophylaxis among surgeons working in teaching hospitals of Khyber Pakhtunkhwa. This was a descriptive study carried out in Hayatabad Medical Complex, Khyber Teaching Hospital, Lady Reading Hospital Peshawar and Ayub Teaching Hospital Abbottabad. Consultants from General and Orthopaedic surgery in four teaching hospitals working as senior registrar or above grades were included in the study and were interviewed using proforma about use of thromboprophylaxis. The results were analysed using SPSS version 10.0. A total of 48 consultants participated in this study. 20 of these were orthopaedic surgeons and 28 were general surgeons. Thirty two [66.6%] of the consultants were using thromboprophylaxis but out of these, only 7 [22%] were following the national guide lines. Out of the 16 [33.4%] who were not using thromboprophylaxis, 10 [62.5%] consultants had the impression that it is not necessary while 4 [25%] thought that it increased the risk of bleeding and 2 [12.5%] consultants had the impression that it is expensive. Eight [16.7%] consultants said that they have departmental policy for thromboprophylaxis. Although majority of surgeons were using throboprophylaxis, however few were well versed about the guidelines and very few were following these

Technology for treatment and recycling of wastewater of automobile service stations

A prototype treatment plant was fabricated and tested at varied hydraulic retention times for settling the suspended/settleable matter and skimming out oil and grease at laboratory plants of 40 L and 56 L. The results showed that 99.7% of oil and grease and almost all total suspended solids were removed and sparkling clear water was obtained, reusable for washing vehicles

Child labor; determinants in Shadman market Lahore

Child Labor is any kind of work that harms or exploits the children in some way [physically, mentally, morally or blocking access to education]. Child labor is quite common in Pakistan, and is still ignored; which depicts the society's attitudes towards child care. Child labor is an ethical dilemma and special attention must be given to this issue. To determine the factors responsible for child labor in Shadman Market Lahore. Descriptive, Cross sectional. Place and duration: Shadman Colony Lahore, July-August 2010. Structured Pretested questionnaire was used to asses the factors responsible for child labor. Large family size, low income per capita and parental illiteracy were shown to be responsible for child labor. Family size, income per capita and patrental education has a large scale effect on child labor.Key words:-Child labor, Family size, income per capita, parental education

Knowledge about the management of avulsed toothamong Karachi school teachers

The objective of this study was to assess the knowledge of school teachers regarding management of avulsed tooth. The information about the management of avulsed tooth was collected through a specifically designed questionnaire. A total of 150 questionnaires were distributed among teachers of five different private schools of Karachi who were dealing with children of 6 to 12 years old. Out of 150 teachers only 100 answered the questionnaire [66%]. Majority [80%] of the teachers knew about the importance of emergency management of tooth avulsions. One third [34%] teachers answered affirmative regarding their experience with tooth avulsions. 26% said that they would replant the avulsed tooth by themselves. More than half [57%] of the teachers, preferred water as the best storage medium than normal saline. Knowledge of school teachers regarding management of avulsed tooth was unsatisfactory. It should be improved by continuous dental educational seminars in schools

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

Anatomical position of appendix in emergency care patients

To identify the anatomical position of the appendix in patients presenting at the emergency surgical ward, Lady Reading Hospital Peshawar. This descriptive study was conducted in surgical 'A' Unit, Lady Reading Hospital, Peshawar from January to June 2008. Patients coming to emergency surgical ward were examined after detailed history and investigation; and then operated. Position of appendix along with other findings was noted. 100 patients were admitted and examined. 68% were male and 32% were female. During surgery retrocaecal position was the most common [78%] followed by pelvic position in 16% of patients. Perforated appendix was observed in 06% [all retrocaecal appendixes]. Retrocaecal appendix was the commonest in patients presenting to emergency with acute appendicitis. Less symptoms/signs lead to delay in diagnosis and complications

Cost effectiveness of bilateral simultaneous versus staged knee arthroplasties

To evaluate the cost effectiveness of bilateral simultaneous knee arthroplasty in experienced hands. This descriptive study was done in the Shotley Bridge General Hospital county Durham England from 2000-2003 on 26 patients undergoing bilateral simultaneous knee arthroplasty. Patients were randomized in two equal groups. Group A included 13 patients and had staged knee arthoplasty i.e. they had the same procedure in two hospital admissions under different anesthetic session. Group B comprised of 13 patients, underwent simultaneous knee arthroplasty. Same type of knee prosthesis was used in all cases and were operated by same surgeon in same institution. In group A, 9 [69.2%] patients had osteoarthritis and 4 [30.8%] had rheumatoid arthritis while in group B twelve patients had osteoarthritis and one had rheumatoid arthritis. Only one patient had transient ischemic attack in group A while there was one case of deep vein thrombosis in group B. Average hospital stay for both groups was 15 days. The average cost for group A was Sterling [pound] 8950/-[Rs.1163500/-] and for group B was Sterling [pound] 5265/-[Rs.684450/-]. This study shows that bilateral simultaneous arthroplasty is cost effective in experienced hands and do not have increased rate of complications

Experience with the surgical management of fracture penis

To know the etiology, complications and outcome of surgical management of fracture penis. This descriptive study carried out in the surgical departments of Lady Reading Hospital Peshawar from April 2000 to March 2005. Patients with the clinical diagnosis of fracture penis were admitted and operated. All patients except those with haematuria were catheterized. Most of these patients were explored via a circumcoronal incision and the defect in the tunica of corpus cavernosum repaired with 3/0-vicryl suture. No drain was used and a light compression dressing was done in all patients. Catheter was removed on the second postoperative day. Follow up was arranged at 6 and 24 months of operation. During the study period 51 patients were operated for fracture penis. Mean age at presentation was 32 years. The commonest cause of fracture penis was manual fiddling with the organ to overcome an erection [39.2%]. The incidence of associated urethral injury was 1.96% [n=1/51]. The commonest mode of presentation was with a cracking sound, local pain and immediate detumescence [90%, 98% and 94% respectively]. Average hospital stay was 3.4 days. Immediate postoperative complication was urinary retention in 2 patients [3.92%]. Long-term complications were negligible. There was only one readmission at 6 months for urethral stricture that responded well to optical urethrotomy. The commonest cause of fracture penis is manual manipulation to overcome an erection. The best treatment option is immediate surgical repair

Bilateral simultaneous testicular seminoma: a case report and review of literature

A case of 28 years old patient with bilateral testicular seminoma is reported here with literature review

Status epilepticus: aetiology and outcome in children

Convulsing Status Epilepticus [CSE] is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus [SE] and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen [12%] patients expired while neurological complications secondary to brain injury developed in 10[8%] cases. Mean seizure duration was 4.92 +/- 9.18 hours in children with normal outcome, 5.93 +/- 5.76 hours in children who died, and 12.85 +/- 12.91 hours in children with abnormal neurological outcome at discharge [p > 0.05]. Correlation between age and duration of seizure was not significant [p > 0.05]. SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE

Frequency of helicobacter pylori in patients presented with perforated peptic ulcer

To study the frequency of H-pylori infection in patients with perforated peptic ulcer disease [Duodenal and Gastric]. During the study period a total of 85 patients were admitted with acute perforated peptic ulcer to surgical "C" unit Lady Reading Hospital, Peshawar from June 2004 to December 2005. They were operated and post operatively blood sample was taken for identification of antibodies against H-pylori by ELISA method. All patients irrespective of gender and age who were operated for perforated peptic ulcer were included in the study. Patient who gave history of intake of H2 receptor antagonist and Proton Pump Inhibitors up to six weeks prior to their presentation were excluded. Out of 85 patients studied and analyzed for antibodies against H-pylori, 77 [90.59%] were male and 8[9.41%] were female. Age ranged from 30-75 years. ELISA showed that 56.46% [n=48] were positive while 43.54% [n=37] were negative for antibodies against H-pylori. 87% [n=54] patients gave history of chronic dyspepsia. 47 of these were positive for H-pylori. All patients were treated with eradication therapy which consisted of clarithromycin, metronidazole and omeprazole. Six weeks after initial surgery blood samples were analysed for H-Pylori and were found to be negative. Patients who present with perforated peptic ulcer and gave history of chronic dyspepsia should be given eradication therapy post-operatively in order to reduce the incidence of recurrence

Conservative treatment of appendicular mass without interval appendicectomy: is it justified?

To evaluate the justification for conservative treatment of appendicular mass without interval appendicectomy. This study was conducted at the department of surgery Postgraduate Medical Institute HMC Peshawar. It was a descriptive study including all those patients who presented with appendicular mass from January 2000 to December 2005. These patients were treated conservatively. Patients who responded to conservative treatment were sent home and were followed for months for any recurrent attack. Patients who did not respond to conservative treatment, were explored after further investigation. Patients who had recurrent attack in the follow up were offered appendicectomy. No patient was offered interval appendicectomy. Total number of the patients included in the study was 125. Patients responded to conservative treatment were 88% [n=110]. Failure of conservative treatment occurred in 12% [n=15]. Out of these abscess formation occurred in 8% [n=10] who responded well to open drainage with out appendicectomy while 4% [n=5] were explored after CT abdomen. Appendicitis was found in 2 cases [1.6%], ileoceacal tuberculosis, colonic tumour and appendicular tumour in 1 case each [0.8%]. All patients except for the 5 cases already explored were followed up for 18 months. Recurrent attack of acute appendicitis occurred only in 8.33% [n=10/120] and appendicectomy was performed on these patients. Conservative management is effective in the majority of the patients. Randomized control trial is needed to study the real need of interval appendicectomy