Nutrigenomics: Epigenetics and cancer prevention: A comprehensive review.

Due to change in lifestyle and food habits, people are more at risk of diet-related diseases and cancers. It is also established that dietary modifications significantly reduce the risk of diseases. Nutrigenomics is relatively fresh discipline, but possess an enormous potential that can apply for prevention and management of certain carcinomas and diseases. This review enables us to generate useful information for scientists and health professionals regarding the role of Nutrigenomics in the prevention of diet and lifestyle-related diseases like cancer. It influences health conditions of individuals and susceptibility of disease by defining the metabolic response and gene expression. Epigenetic modifications can perform a significant role in disease occurrence and pathogenesis. DNA methylation and chromatin remodeling are the most common epigenetic mechanisms. Omega 3 fatty acids are the best example of nutrients and gene interaction not involving DNA methylation while certain bioactive food compounds have a proven role in cancer prevention through an epigenetic mechanism. Dietary polyphenols substantially take part in prevention of oral, breast, skin, esophageal, colorectal, prostate, pancreatic and lung cancers. Moreover, minerals and vitamins involve regulatory processes. Zinc, Selenium and folate involve in DNA repairing process have anticancer properties. Consumption of multivitamins prevents methylation of cancer cells.

Emergency obstetric hysterectomy.

OBJECTIVE: To assess the frequency of obstetric hysterectomy, its indications and associated maternal and perinatal morbidity and mortality. METHODS: The retrospective observational analytical study was conducted at the Department of Obstetrics and Gynaecology, Unit-I, Jinnah Postgraduate Medical Centre, Karachi from January 2003 to December 2009. Records of all patients who had underone hysterectomy at the study centre during the study period were explored for age, parity, booking status indication and the type of operation performed. Maternal and foetal morbidity and mortality were also recorded. SPSS 13.0 was used for statistical analysis. RESULTS: Against the total 44,612 deliveries during the period, 121 hysterectomies were performed for obstetric indications. The frequency of the procedure, as such, was 1 in 368 (0.27%) deliveries. The major indications were ruptured uterus in 57 (47.1%), and severe postpartum haemorrhage due to atony of uterus in 35 (28.9%). Other indications included severe haemorrhage due to placental abnormalities in 14 (11.6%); placenta previa in 3 (2.5%); abruptio placenta in 4 (3.3%); and severe infection following vaginal delivery in 3 (2.5%). Infection was the commonest complication seen in 14 (11.6%) patients. There were 11 (9.0%) maternal deaths and 65 (53.7%) perinatal deaths. CONCLUSION: Emergency obstetric hysterectomy remains a necessary tool for consultant obstetricians. Acting at the optimal time with clear judgment, and professional surgical technique can reduce morbidity and mortality in such cases.

Management of iron deficiency anaemia in gynaecological patients at Jinnah Postgraduate Medical Centre, Karachi.

OBJECTIVE: To determine the efficacy and safety of subcutaneously administered recombinant human erythropoietin in combination with intravenous iron sucrose for the management of iron deficiency anaemia in gynaecological patients in Jinnah Postgraduate Medical Centre Karachi. METHODS: It was an interventional quasi experimental study carried out in the Department of Obstetrics /Gynaecology, at JPMC from 1st Nov 2007 to May 2008. All patients with indications for major Gynaecological surgery with iron deficiency anaemia having a mean haemoglobin level of 7 gm/dl were selected and the target haemoglobin was 11 gm/dl. Patients who were symptomatic, had chronic bleeding, renal failure or had signs of anaemia other than iron deficiency were excluded from the study. All investigations were done on day one before the start of therapy, and then treatment was initiated with recombinant human erythropoietin in a dose of 5000 IU subcutaneously and injection Iron Sucrose 200 mg in 100cc NaCI intravenously on 3 alternate days. The parameters checked in succession on day 4 and day 10 included increase in haemoglobin level, haematocrit, reticulocyte count, and time required to reach the target haemoglobin. RESULTS: Twenty three patients fulfilled the inclusion criteria and were selected for the study. At the end of 10 days of starting therapy increase in haemoglobin was on an average of 2.8 gm/dl, increase in mean corpuscular volume was 4fl, Serum Iron increased by 99.86 ug%, total iron binding capacity decreased by 30.86%, transferrin saturation increased by 15.5% .There were no serious reactions to Erythropoietin or Iron sucrose CONCLUSION: It is concluded that recombinant erythropoietin along with iron sucrose safely increased the haemoglobin level in 10 days to the target level thus rendering the patients fit for surgery and, none of the selected patients needed blood transfusion.

Hystroscopic management of Ashermans syndrome.

OBJECTIVE: To confirm the diagnosis of Asherman's syndrome in patients with scanty menses/amenorrhoea or infertility and to assess the effectiveness of hysteroscopy in the treatment of Asherman's syndrome. METHODS: A hospital based descriptive study conducted on 20 patients presenting with amenorrhoea, oligomenorrhoea, or infertility from Jan 2004 to June 2005. They were selected after excluding hormonal imbalances, premature ovarian failure and congenital uterine abnormalities. All patients underwent diagnostic hysteroscopy and resection of adhesions. Specimens were sent for Histopathology and bacterial culture. RESULT: A total of 20 patients were included in this study, the median age was 26 years, 65% had presented with scanty menses with secondary infertility, 20% with secondary ammenorrhoea, and 15% with primary infertility alone. Hysteroscopic findings showed thick fibrous adhesions in 45% patients, 40% had flimsy adhesions and 15% had muscular adhesions. It was seen that 65% had adhesions in the body of uterus, 25% at the site of internal os and 1% had adhesions in the cervical canal as well as the body of the uterus. Normal menstrual cycle was resumed in 95% patients, whereas two patients conceived and were followed to term. Dense fibrous tissue with few patches of calcification and no signs of secretory or proliferative cells was found in 35% patients. In 45% endometrium showed proliferative changes and collagen fibers. Only 1 patient had a positive AFB culture and the histopathology showed few graulomas with epitheloid cells most of the tissue replaced by necrotic tissue with patchy areas of caseation. CONCLUSION: Hysteroscopy is an effective procedure for not only diagnosing Ashermans Syndrome, but is equally effective for treating it..

Child birth in squatting position.

OBJECTIVE: To assess the risks and benefits of squatting position during second stage of labour and its comparison with the supine position. METHODS: The study was conducted at the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi from 1st January 1999 to 31st January 2000. A total of two hundred patients of similar ante partum, intrapartum and socio-economic conditions were selected. Only patients of gestation more than 37 weeks, presenting in active labour with cephalic presentation were included. Patients with multiple gestation, malpresentation, previous scar, maternal fever and prenatal diagnosed fetal malformation were excluded from the study. Random selection was done after informed consent and alternately divided into two groups A and B. Both groups were ambulatory during first stage of labour. In second stage, group-A adopted the squatting position, while group-B remained supine in lithotomy position. The third stage of labour in both the groups was conducted in the supine position. RESULTS: There was no difference in the application of episiotomies in both groups, however extension of the episiotomy occurred in 7% patients of the non-squatting group (P < 0.05). Para urethral tears occurred in 5% patients in squatting group, but all occurred in patients who were not given an episiotomy. Second degree, and third degree perineal tears occurred in 9% patients in the non-squatting group but none in the squatting group (P < 0.05). Forceps application was also significantly less in group-A 11% and 24% in group-B (P < 0.05).There were two cases of shoulder dystocia in group B but none in the group-A. During the Third stage of labour there were no cases of retained placenta in group A but there were 4% cases of retained placenta and 1% case of postpartum haemorrhage of more than 500 ml due to atony of the uterus in group-B. One patient in the non-squatting position had to have a caesarean section due to persistent occipito posterior position. There was no significant difference in the apgar scores, foetal heart rate patterns or requirement of neonatal resuscitation. CONCLUSION: It appears that squatting position may result in less instrumental deliveries, extension of episiotomies and perineal tears.