Background: Although the majority of smooth muscle neoplasms found in the uterus are benign, uterine leiomyosarcoma is extremely malignant, with high rates of recurrence and metastasis. The development of gynecologic tumors is often correlated with secretion of female hormone; however, the development of human uterine leiomyosarcoma is not substantially correlated with hormonal conditions, and the risk factors are unclearly understood. Importantly, a diagnostic-biomarker, which distinguishes malignant human uterine leiomyosarcoma from benign tumor leiomyoma is yet to be established. Aims : It is necessary to analyze risk factors associated with human uterine leiomyosarcoma, in order to establish a diagnostic-biomarker and a clinical treatment method. Patients and Methods : Histology and Immunofluorescence Staining: Uteri obtained from LMP2^-/- mice or its parental mice (C57BL/6 mice) were fixed in 10% buffered formalin, incubated in 4% paraformaldehyde for 8 hours, and embedded in paraffin. Tissue sections (5 μm) were prepared and stained with H&E for routine histological examination or were processed further for immunofluorescence staining with appropriate antidodies. Furthermore, a total of 101 patients between 32 and 83 years of age and diagnosed as having smooth muscle tumors of the uterus were selected from pathological files. Immunohistochemistry staining for LMP2 was performed on serial human uterine leiomyosarcoma, leiomyoma and myometrium sections. Results: Homozygous deficient mice for a proteasome β1i subunit, LMP2 spontaneously develop uterine leiomyosarcoma, with a disease prevalence of ~40% by 14 months of age. Defective LMP2 expression in human uterine leiomyosarcoma was demonstrated, but present in human leiomyoma and myometrium. Conclusions : Loss in LMP2 expression may be one of the risk factors for human uterine leiomyosarcoma. LMP2 may be a potential diagnostic-biomarker and targeted-molecule for a new therapeutic approach.

Background: A review of the literature clearly indicates the absence of one set of guideline in the treatment of recurrent vulvovaginal candidiasis. In Lebanon, as physicians are trained in European or American schools of medicine, locally or abroad, they may be approaching the issue of recurrent vulvovaginal candidiasis using various methods. Aims: A national survey was conducted among Lebanese gynecologists to assess therapeutic protocols most commonly adopted to treat recurrent vulvovaginal candidiasis. Material and Methods: All obstetricians-gynecologists registered with the Order of Physicians were targeted. Bivariate analyses, comparing groups with specific prescription preferences, were tested using relevant statistical tests. All variables with significant bivariate associations with the outcomes were initially planned for a multivariate regression analysis to assess their interactive effects. Results: The study confirms that different approaches are used to treat recurrent vulvovaginal candidiasis. Most gynecologists (70%) recommended fluconazole 150 mg as first-line treatment. Fluconazole alone was significantly preferred by North American trained physicians, whereas European trained ones preferred to prescribe it in combination. However different dosage regimens were used with duration of treatment ranging from 2 to 4 weeks, with or without maintenance. Conclusions: The study revealed large diversity in prescription pattern, closely related to the specialization background of the physician. There is a need to generate evidence to establish national guidelines.

Background : Atherosclerosis remains one of the leading causes of death all over the world. Flax, pumpkin and purslane seeds are rich sources of unsaturated fatty acids, antioxidants and fibers, known to have antiatherogenic activities. Aims: This study was to examine the efficiency of using either flax/pumpkin or purslane/pumpkin seed mixture (components of ω-3 and ω-6) on hyperlipidemia, kidney function and as immunomodulators in rats fed high cholesterol diets. Materials and Methods: 40 male albino rats were divided into four groups: control group, hypercholesterolemic rats, fed the balanced diet supplemented with cholesterol at a dose level of 2 g/100 g diet; the other two groups of animals fed the same previous hypercholesterolemic diet supplemented with either flax/pumpkin seed mixture or pumpkin/purslane seed mixture at ratio of (5/1) (ω-3 and ω-6). Results The present study showed that 2% cholesterol administration caused a significant increase in total cholesterol, total lipids, and triacylglycerol in both serum and liver. Serum phospholipids, LDL-C, and atherogenic index AI also significantly increased compared to control group. Cholesterol-enriched diet significantly increased serum urea, creatinine, sodium and potassium levels as well as significantly increased serum IgG and IgM compared to healthy control. Consumption of flax/pumpkin or purslane/pumpkin seed mixtures by hypercholesterolemic rats resulted in a significantly decrement in lipid parameters and significant improvement in IgG and IgM levels as compared with hypercholesterolemic rats. Conclusion : Our results suggests that both flax/pumpkin and purslane/pumpkin seed mixtures had anti-atherogenic hypolipidemic and immunmodulator effects which were probably mediated by unsaturated fatty acids (including alpha linolenic acid) present in seed mixture.

Background : Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia. Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved. Aims : The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia. Patients and Method : The study consists of two phases. A cross-sectional review of randomly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview, with pre tested adherence and self management and monitoring tool questioner of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic. Result: Oral hypoglycemic agent were prescribed for 351(91.4) of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6%). About 312 (88.9%) patients on oral hypoglycemic agent were on mono therapy, the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3%) and metformine 80(25.7%). Only 41.8% of the patient had adequate glycemic control. The main external factors for non adherence were lack of finance (37.1%) followed by perceived side effect of drug 29.2%. Only 6.5% patient who missed their medications disclosed to physician during consultation. The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied. Conclusion: Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine. While the current prescribing strategy do not achieve glycemic control on majority of the patient. This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management.

Background: Nigeria has one of the worst maternal and child health indices globally. Aims: The objective of this study was to assess the risk status of pregnant women presenting for antenatal care in a rural health facility in Ebonyi State, South East Nigeria. Subjects and Method: This was a cross-sectional descriptive study of pregnant women selected by systematic random sampling. The study instrument was a pre-tested semi-structured interviewer-administered questionnaire. Result: The age range of the women in the study was 16-43 years. The mean age was 25.3 ± 1.3 years. According to the scoring system used, about one-fourth of the women (26%) had a high risk pregnancy while about a tenth (9.1%) had very high risk pregnancy. The vast majority of the women with at-risk pregnancies registered for antenatal care late: 58.9 % registered for antenatal care in the second trimester and 37.0 % registered for antenatal care in the third trimester of pregnancy. Of the women with an at-risk pregnancy, 79.5% had their last delivery at home and 67.1 % of them preferred to deliver at home in their current pregnancies. Conclusion: This study revealed that a substantial proportion of rural women with at-risk pregnancies go through their pregnancy period without significant modern antenatal care. The local government health department should intensify efforts through health enlightenment campaigns to educate rural pregnant women of the benefits of utilizing modern antenatal care services.

Context: Recurrent pneumothorax is common in cavitory pulmonary tuberculosis, but it is extremely rare in miliary tuberculosis. Case Report: A 25 year old female patient presented to us with the complains of shortness of breath since 3 days. She was also having fever and cough since 3 months. Chest roentgenogram (PA view) on admission showed a left sided pneumothorax with miliary mottling. An intercostals tube drainage was done on the left side resulting in relief of symptoms. Two days post intercostals tube drainage chest X ray (PA view) showed complete resolution of pneumothorax, and intercostals tube was removed. Patient was discharged on antitubercular drugs. After 1 month patient again presented to us with severe breathlessness, on repeat chest X ray pneumothorax again developed on left side, urgent intercostals tube drainage was done, and patient relieved immediately. Patient was kept in the hospital for 12 days and, and was discharged after intercostals tube removal. Conclusion: If a patient of miliary tuberculosis presents with shortness of breath diagnosis of pneumothorax should be considered.

Context : Trichilemmal (pilar) cysts are common skin lesions that often present on the scalps of mature men and women. These cysts often become inflamed when the wall of the cyst ruptures, but few reports have addressed the immunologic features of this process. Case Report: A 22-year-old female presented with rapidly growing nodule on her left cheek, with evidence of acute inflammation. Skin tissue for hematoxylin and eosin examination, as well as for immunohistochemical analysis was taken and reviewed. As controls, we utilized two archival, non-inflamed trichilemmal cysts. Hematoxylin and eosin staining demonstrated classic features of an inflamed trichilemmal cyst. No cytologic atypia was noted, and no significant number of mitotic figures was identified. Immunohistochemistry stains revealed that several cell cycle/tumor suppressor/apoptotic markers, antigen presenting cell markers, metalloproteinases and T cell response markers were highly expressed inside and around the disrupted cyst. The control, non-inflamed cysts were negative for the same markers. CD1a was also appreciated within the epidermis, suprajacent to the inflamed cyst. Conclusions : Upregulation and/or downregulation of selected cell cycle regulator and/or tumor suppressor/apoptotic markers, as well as antigen presenting cells and some protein kinases could recruit and activate T lymphocytes and other inflammatory cells to the non-disrupted cyst for unknown reasons. The immune response may be involved in the initial cyst rupture, or induced by an unknown alteration in the cyst. Larger studies are needed to address these questions.

Context : Hepatocellular carcinoma accounts for 1-2.5% of all cancer in America with extension to inferior vena cava and right atrium in 1-4% of the cases. Patients with advanced hepatocellular carcinoma invading the right heart are considered poor candidates for surgery. In the past, such patients had dismal prognosis due to complications like pulmonary embolism and sudden death. Case Report : Our patient was admitted with worsening jaundice, abdominal pain and significant weight loss. Abdominal ultrasound, elevated alfa feto-protein levels and computerized tomography pointed to the diagnosis of hepatocellular carcinoma. Transthoracic echocardiography demonstrated two masses in the right atrium with the base of masses extending from inferior vena cava into right atrium. The patient was diagnosed to have stage IV heptaocellular carcinoma. This is associated with dismal prognosis. But after being started on sorafenib, the tumor regressed considerably and was barely discernable on echocardiography performed a month later. Conclusion : Though aggressive surgical resection is the best therapeutic approach for hepatocellular carcinoma, it may not always be possible and in such cases combination of different therapeutic approaches such as chemotherapeutic agents, radiotherapy and chemoembolization may improve survival.

Context: Chylous ascites is the accumulation of milky chyle in the peritoneal cavity. Chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair, radical gastrectomy, duodenectomy, nephrectomy and Wilm's tumor resection. Our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection. We report about an elderly woman with a rare complication of chylous ascites after an emergent surgery for a perforated gastric ulcer. Case Report : A 70-year-old woman developed sudden respiratory distress on 5 ^th post-operative day after an elective C3-C7 cervical discectomy and fusion. Her past medical history was significant for cervical spondylosis. The Computed Tomography (CT) scan of the chest revealed air under the diaphragm suspicious for hollow viscus perforation. She underwent an emergent surgery for drainage of hematoma in the neck along with an emergent laparotomy to repair a large perforated gastric ulcer distal to the gastro-esophageal junction. The patient had worsening of abdominal distention on 4 ^th post-operative day. The CT scan of abdomen showed fluid collection in the abdomen. The abdominal drain revealed large amount of serous milky fluid at the rate of 1500 ml per day. The fluid analysis showed that the triglyceride level was 170 mg/dl and cholesterol level was 15 mg/dl. The fluid cultures did not grow any organism. She responded to treatment with octreotide and a diet of medium chain triglyceride oil. Conclusion: Any obstruction or damage to the lymphatic channels results in chylous ascites. Lymphomas, metastatic malignancies, and abdominal surgeries commonly cause chylous ascites. Ascitic fluid triglyceride level greater than 110 mg/dl is diagnostic of chylous ascites. Chylous ascites is a rare complication of a peptic ulcer resection which can be managed effectively with octreotide.