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.

Does serum albumin level affect the healing outcomes of simple diaphyseal tibial fractures?

Aims: to quantify the serum albumin level and its correlation with fracture healing progression and outcomes in adult Patients

Settings and Design: a prospective cohort study at an institutional trauma center

Materials and Methods: a total of 50 adult patients with simple, fresh traumatic diaphyseal fractures of both bones of the leg managed conservatively were included in the study. Serum albumin was measured initially and at the 6[th] week postfracture. The clinico-radiological follow-up was done to analyze the fracture healing progression and their final outcomes, which were correlated with the quantified serum albumin level of the patients

Statistical Analysis Used: student t-test, Mann-Whitney U-test and Pearson correlation coefficient

Results: as per the last clinico-radiological follow-up at the 24[th] week, patients were grouped into two groups: Group I [normal union n = 38] and Group II [impaired healing n = 12]. The mean serum albumin levels were significantly higher in Group I when compared to Group II. The association between the serum albumin level at baseline and at the 6[th] week was moderate. The best cut-off measure of serum albumin level was 3.45 g/dL, both at baseline and at the 6[th] week after fracture to predict the healing outcome. The correlation of serum albumin levels with fracture healing outcomes was statistically significant

Conclusion: serum albumin is moderately associated with the baseline and 6[th]-week values and showed a positive correlation with the bony healing progression and may provide an early predictor of the healing outcomes of simple diaphyseal tibial fractures

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

Cytological versus serological diagnosis of Herpes Simplex Virus type 2 infection among women with cervicitis without external genital ulcer or blistering lesions in Hawler Maternity Teaching Hospital

Herpes simplex virus type 2 linked to the genital tract infection may produce significant acute or chronic cervicitis. Identification of the virus is important due to its association with genital tract disease and sexual transmission. The virus establishes lifelong latency with periodic reactivation. Therefore, it causes significant physical and psychological morbidity. The aim of this study was to assess and compare cytological examination with serological test in the diagnosis of genital herpes simplex virus type 2. This study included 104 women. Pap smear was collected from 24 healthy women as a control group [group A], 40 patients with severe cervicitis on cytological examination [group B] and 40 patients with atypical cervicitis [group C]. Blood sample was obtained from the patients and the control group and tested for Herpes simplex virus type 2 specific serology. The ages of the studied groups ranged from 21-53 years. They were referred to the Maternity Teaching Hospital and private laboratories in Erbil city, Kurdistan region, Iraq during the period from December 2011 to December 2012. Herpes simplex virus type 2 IgG antibodies were found in 10 sera from patients with nonspecific cervicitis [group-B] and only in three patients with atypical cervicitis [group-C]. No positive serological test was identified in the control group. All Pap smear results showed features suggestive of cervicitis but without viral cytopathic herpetic changes. The serological test was superior to cytology for the diagnosis of Herpes simplex virus type 2 infection in women presented with cervicitis with no clinically apparent genital ulcer or blisters

Assessment of gestational age; comparison between transcerebellar diameter versus femur length on ultrasound in third trimester of pregnancy

To compare correct assessment of gestational age between Transcerebeller diameter versus femur length in third trimester [28-40] using first day of last menstrual period for actual period of gestation. Cross-sectional descriptive study. Department of Obstetrics and Gynecology, Bahawal Victoria Hospital, Bahawalpur from Jun 2012 to Dec 2012. This study was performed on 327 patients in third trimester of pregnancy from 28-40 weeks fulfilling the inclusion criteria. Ultrasound measurements of transcerebellar diameter [TCD] and femur [FL] were made with commercially available real time ultrasound equipment Toshiba Nemio-10 model 2009, Transducer frequency 50/60 Hz. Collected data was analyzed by SPSS version 10. Out of 327 patients, TCD was found to give correct assessment corresponding to the gestational age by LMP in 262 [80.1%] patients, while in 232 [70.9%] patients FL was found to give correct assessment corresponding to the gestational age by LMP. Transcerebellar diameter is more reliable method of gestational age determination in third trimester of pregnancy than femur length. TCD can be used as a tool to assist in the assessment of gestational age in third trimester

Risk factors in spreading odontogenic infection

Spreading odontogenic infection is the extension of infection from its original site and can create potential life threatening situations. There are several risk factor reported for spreading odontogenic infection in literature including systemic health, virulence of organism and anatomical site. Apart from these factors odentogenic infection also observed in normal individuals. The objective of this study is to identify Risk factors in spreading odontogenic infection. Descriptive Case Series Study. This study was conducted in Department of Oral and Maxillofacial Surgery, Institute of Dentistry, LUMHS from January 2011 to February 2012. A descriptive case series study on 60 patients of spreading odontogenic infection was conducted. Male female ratio was 2.3:1, 2[nd] and 3[rd] decade was common presentation. The most frequent clinical findings were pain, swelling, trimus. The Buccal space was the most frequent location for a single space infection [53.3%], followed by Submandibular space [35%], Canine space [5%]. Three patients presented with multi space involvement [6.6%]. The most common involved tooth was mandibular third molar 26 [43.3%].The most common cause of the infection was periapical infection followed by pericronitis. 83.3% patient were healthy patients with no co morbid, only 16.7% patients were with co morbid like DM, hypertension and pregnancy. There was also no difference for mean WBC count. This study shows that lower molars were the most common involved teeth and buccal space was frequent space to be involved. The site of infection is important risk factors. We observed Odentognic infection in common in healthy individual than non-healthy individuals

Maxillofacial fractures in Hyderabad city: a 1-year study of 448 patients

This descriptive study assesses the cause, type, incidence and treatment modalities of maxillofacial fractures managed at our center during the 1-year of time period. Descriptive Study. This study was carried out at Department of Oral and Maxillofacial surgery Institute of Dentistry LUMHS, Jamshoro. A total 384 cases were studied. A detailed history, clinical examination was performed and finally diagnosis confirmed with the help of radiograph, at least two radiographs were taken. Records of patients enrolled who were either treated in the Emergency Room, Out-Patients Department or in the Ward. A numbers of parameters, including Age, gender, cause, type of injury and treatment provided were assessed. Out of 448 patients, 318 were male and 130 were female. Majority of patients belong to 3[rd] decade [21-30 years] of life. Road traffic accidents 56.91% accounted for the majority of cases of maxillofacial fractures followed by assault 10.49%, fall 19.86%, sports 4.68% Mandible was seen as the most commonly fractured bone 44% [287] followed by maxillary bone 23.92% [156], Zygomatic bone complex 18.40% [120] and majority of the bony maxillofacial injuries were treated by open reduction and internal fixation [ORIF]. Males of age group 21-30 years were more frequently involved in maxillofacial fractures. Road traffic accident was the most common cause of trauma in this part of the country, which requires proper implementation of traffic legislation use of helmet while riding the cycle or motor bike. Mandible was fractured in majority of cases; common treatment modality of maxillofacial fractures at our center was Maxillo-mandibular fixation with miniplates

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

Preventable Lifestyle Risk Factors for Non-Communicable Diseases in the Pakistan Adolescents Schools Study 1 (PASS-1) / 예방의학회지

OBJECTIVES: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. METHODS: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. RESULTS: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had > or =2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). CONCLUSIONS: Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

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

Diabetic foot infections and their management in a tertiary care hospital

Diabetic foot is a common complication of diabetes world over. We conducted this study to determine common microbiological pathogens in Diabetic Foot Infections [DFI] at a tertiary care hospital and their management. In this observational study deep wound swabs of all admitted diabetic patients were taken, pathogens isolated, antibiotic used and its response depending on complete resolution of symptoms and biochemical markers were recorded. Data were analysed on SPSS-11. A total of 114 cases were recorded. Sixty-eight [59%] cases had ulcers on forefoot, 28 [25%] mid-foot and 18 [16%] hind-foot. One hundred and four pathogens were isolated from wound swabs after debridement. Commonest pathogen isolated was Staphylococcus aureus [52, 46%] followed by E. coli [11, 10%], MRSA was found in 10 [9%] cases, streptococcus in 6 [5%] and pseudomonas in 5 [4%] cases. Polymicrobial infection was also seen in a few cases. Surgical intervention included superficial debridement in 88 [77%] cases, toe amputation/forefoot amputation in 19 [17%] cases, and below/above knee [major] amputation in 7 [6%] cases. Commonest antibiotic used was Cefoperazone/Sulbactam in 43 [38%] cases, alone or in combination, followed by Ceftraixone 36 [33%] cases. Linezolid was used for MRSA. Ninety-four [82%] patients responded to treatment and were recorded as 'cured'. Diabetic Foot ulcers often present with serious foot infections. Commonest pathogens are Staph. aureus, E. coli, Pseudomonas spp. and MRSA. Treatment was effective with Cefoperazone/Sulbactam and Ceftraixone. MRSA was treated successfully with Linezolid

audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan

Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority [68%] of the audited medical records were of females. Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of 'excellent' or 'good' diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% [95% CI: 71.1-87.9] of cases. Physical activity advised/reinforced at every visit was least observed [27.3%; 95% CI: 18.0-36.6]. In addition, blood sugar control was reported in less than a quarter [23.9%] with 95% CI of 15.0-32.8. This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale

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

Awareness diabetic retinopathy amongst known diabetics

To study awareness regarding Diabetic Retinopathy [DR] amongst established diabetics. This cross-sectional observational study was done at Department of Diabetes and Endocrinology, Hayatabad Medical Complex Peshawar, Pakistan with technical support from Hyber Institute of Ophthalmic Medical Sciences, Peshawar. Two hundred and two indoor patients were interviewed and duration of diabetes, drugs taken for the control of diabetes, history of any previous eye examination was recorded. Later dilated fundoscopy was done by endocrinologist and finally all the patients were sent for independent assessment by an ophthalmologist for categorizing DR and if needed laser was done for the affected eyes. Of 202 patients only 9 [4%] patients had optimum diabetic control with HbA[1]C of <7. Ninety four [47%] had previous eye examination while 18 [53%] had never had their eyes examined. Of those examined 77 [81.9%] had been seen by ophthalmologist, 13 [13.8%] by physician/endocrinologist and only 4[4.3%] by general practitioners [G.Ps]. Dilated fundoscopy showed 118[58%] patients had retinopathy. Thirty eight [18.8%] patients were offered laser treatment after appropriate investigations. Screening and awareness of DR amongst patients is particularly low in our setup. We need to increase awareness amongst our patients regarding this complication of diabetes

Assessment of knowledge, beliefs and practices of our population regarding effects of viewing a solar eclipse

To assess the prevalence of knowledge, beliefs and practices of people coming to The Aga Khan University Hospital, about viewing a solar eclipse. A cross-sectional survey was conducted at The Aga Khan University Hospital, Karachi from January 2000 to April 2000. A self-administered questionnaire was filled by the patient or attendant who were aged 18 and above. Total of 202 respondents were interviewed. The data was analyzed by Epi Info. Mean age of respondents was 35.8 years. Overall, awareness regarding the harmful effects to their eyes by viewing an eclipse directly was 83.2%. Females were more knowledgeable. Majority had obtained information from TV. One third thought it was safe to view the eclipse through binoculars or through smoked glasses. Half of the respondents thought the same about photographic films and sunglasses. Viewing an eclipse by a pregnant mother had an adverse effect on the fetus and on herself was thought to be 50% and 45% respectively. Use of knife or scissors by pregnant females at the time of solar eclipse was thought to be harmful for the fetus and to herself by 41% and 38% respectively. Majority knew that viewing a solar eclipse could be harmful to their eyes but they did not know the safest way. As there is no effective treatment for solar retinopathy, the emphasis should be on prevention. We need to increase public awareness regarding the safest way to watch an eclipse, which is by indirect method using projection. Myths regarding ill effects of solar eclipse on pregnant mother and on fetus need to be removed