Context: Postpartum ovarian vein thrombophlebitis is an uncommon life-threatening situation. It should be systematically evoked in case of persistent fever during the postpartum. Diagnosis is often not immediately apparent clinically and there are many that mimic this condition. Case Report: A 26-year-old female presented with fever and acute right loin pain during four days after delivery. Right ovarian venous thrombosis was demonstrated on sonography and confirmed with computed tomography. The patient was given antibiotics and anticoagulation therapy with good response. Conclusion: Search for postpartum ovarian vein thrombophlebitis should be undertaken in patients with persistent fever. Treatment is more often medical.

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Background: The body's physiological stability is maintained by the influence of the autonomic nervous system upon the dynamic interaction of multiple systems. These physiological systems, their nature and structure, and the factors which influence their function have been poorly defined. A greater understanding of such physiological systems leads to an understanding of the synchronised function of organs in each neural network i.e. there is a fundamental relationship involving sensory input and/or sense perception, neural function and neural networks, and cellular and molecular biology. Such an approach compares with the bottom-up systems biology approach in which there may be an almost infinite degree of biochemical complexity to be taken into account. Aims: The purpose of this article is to discuss a novel cognitive, top-down, mathematical model of the physiological systems, in particular its application to the neuroregulation of blood pressure. Results: This article highlights the influence of sensori-visual input upon the function of the autonomic nervous system and the coherent function of the various organ networks i.e. the relationship which exists between visual perception and pathology. Conclusions: The application of Grakov's model may lead to a greater understanding of the fundamental role played by light e.g. regulating acidity, levels of Magnesium, activation of enzymes, and the various factors which contribute to the regulation of blood pressure. It indicates that the body's regulation of blood pressure does not reside in any one neural or visceral component but instead is a measure of the brain's best efforts to maintain its physiological stability.

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Background: Unsafe abortion is a major Public health problem in developing countries, where women make several unsafe attempts at termination of the unintended pregnancy before turning to health services. Community health workers can act as a bridge between the community and their health facilities and can use Emergency Contraceptive Pills to significantly reduce the mortality and morbidity related to unsafe abortions. Aims: This study explores the knowledge, attitudes and practices of the Lady Health Supervisor of the National Program for Family Planning, district Rawalpindi, regarding emergency contraception pills. Materials and Methods: The cross sectional survey was conducted during the monthly meeting of Lady Health Supervisors. Self administered, anonymous and voluntary questionnaire consisting of 17 items, regarding demographic profile, awareness, knowledge, attitudes and practices, was used. Results: Insufficient knowledge, high misinformation and strongly negative attitudes were revealed. More than half did not know that emergency contraceptive pills do not cause abortion. About four fifths believed that emergency contraceptive pills will lead to 'evil' practices in society. More than four fifths recognized that the clients of National Program for Family Planning need emergency contraceptive pills. The attitudes were significantly associated with knowledge (P=0.034, Fisher's Exact Test). Conclusion: The awareness of emergency contraceptive pills is high. Serious gaps in knowledge have been identified. There is a clear recognition of the need of emergency contraceptive pills for the clients of National Program for Family Planning. However, any strategy to introduce emergency contraceptive pills must cater for the misplaced beliefs of the work force.

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Context : Superior mesenteric artery syndrome is a life- threatening upper gastrointestinal disorder due to compression of duodenum as it poses a difficult diagnostic dilemma. Third part of duodenum is in fixed compartment bounded anteriorly by the root of mesentery and superior mesentery artery and posteriorly by the aorta and lumbar spine. On barium contrast study and abdominal computerized tomography (CT) showed the dilatation of second part of duodenum and compression of the third part of duodenum between aorta and superior mesentery artery. Case Report : A 22 year young asthenic man admitted with the complaint of recurrent abdominal pain, epigastric fullness, and vomiting and weight loss. Abdominal examination revealed epigastric fullness and hyper peristaltic bowel sounds. Upper gastrointestinal barium study showed a dilated stomach with dilated second part of the duodenum and cut off at the third part of duodenum with no intrinsic mucosal abnormalities. There was no relief of obstruction in the left lateral decubitus or prone position. Conservative treatment was tried for one month but failed. Intra-operative findings confirmed the extrinsic obstruction of third part of duodenum with distension of 2 ^nd part. A retrocolic duodenojejunostomy, side to side anastomosis done. In post-operative follow up, patient was symptom free. Conclusion : Superior mesentery artery syndrome is a life threatening disease. It should be treated as soon as possible. Conservative trial can be given but Surgery is the treatment of the choice.

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Background : Hyperviscosity syndrome has been suggested as not simply an acute reaction. Yet, erythrocyte sedimentation rate is associated with whole blood viscosity and it is an indirect acute phase inflammation marker. Aims : This work investigates the prevalence of hyperviscosity in acute phase inflammation. Materials and Methods : Archived clinical pathology data for the period of 1999 to 2008 were utilized. 40,632-cases tested for C-reactive protein and/or erythrocyte sedimentation rate from five alternate years, which were concomitantly tested for haematocrit and total proteins, were extracted. The prevalence of abnormal viscosity associated with positive results of C-reactive protein and erythrocyte sedimentation rate were evaluated. Results : Hyperviscosity is infrequently associated with positive C-reactive protein (2.9%) and erythrocyte sedimentation rate (2.7%) sub-populations, and are not statistically different from their respective negative sub-populations. Normoviscosity is significantly more prevalent in the positive sub-populations (p < 0.01). Further analyses indicate that prevalence of acute phase inflammation is statistically significantly less in hyperviscosity compared to normoviscosity sub-population (p < 0.00001). Actual blood viscosity level increases with level of inflammation though. Conclusion : The study demonstrates that although blood viscosity level may increase with inflammation, hyperviscosity is not frequent in, or sensitive to acute phase inflammation. It portends that whole blood viscosity is not unspecific as acute phase inflammation markers. It calls for clinicians to consider utilizing whole blood viscosity in disease conditions where stasis is implicated, in which it is specific and valuable. It would also benefit to establish whether hyperviscosity is a chronic phase inflammation marker.

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Context : Hiatal hernia is an infrequent but serious cause of dyspnea. We report a case of acute dyspnea and paroxysmal nocturnal dyspnea secondary to hiatal hernia and epicardial fat pad. Case Report : A 78-year-old woman presented with dyspnea and paroxysmal nocturnal dyspnea. Lab data and physical examination were normal. Computed tomography scan demonstrated a large hiatal hernia and epicardial fat pad. Conclusion : Although rare, hiatal hernia should be suspected in patients who develop unexplained dyspnea.

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Background : South and Southeast Asia represent the largest number of new HIV infections, while Sub-Saharan Africa represents the highest rate of new infections, followed by Latin America and the Caribbean. Yet no study that has emerged in the Caribbean has comprehensively examined young people's sexual and reproductive health attitudes, knowledge and practices, comparing the result with those who are HIV infected. Aim : The present study examines core issues of sexual and reproductive health among youths, particularly with respect to HIV. Material and Methods : The sample was 1,800 respondents ages 15-49 years. Multivariate logistic regressions were fitted using one outcome measure: self-reported confirmed positive HIV test results. Results : Almost 34% of the sample had been tested for HIV, and 16.9% had done this in the past 12 months. Only 0.2% of the sample knew that they were HIV positive and 4% had positive HIV test results when they did the test. Of those with a positive HIV test result, 58.1% were females. Approximately 16% of those with HIV have had an STI infection in the past, and 61% were actively practicing religion. The mean age of first sexual relations for the sample was 15.4 years (SD = 3.2 years), and 15.6 years for those infected with HIV. Four variables emerged as statistically significant factors of Jamaicans' willingness to do an HIV test in the future. Conclusion : The findings of this research are far-reaching and can be used to guide public health policy formulation.

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Background: Few articles have linked the consumption of green tea to certain liver diseases but several articles have disputed these assertions and the consumption of green tea has been on the increase. Aims: The effects of oral administration of green tea on the liver of Wistar rats were studied in order to compare biochemical findings with histological findings. Materials and Methods: 36 male and female Wistar albino rats were grouped into 6, consisting of 6 rats in each group. They were given 1%, 2%, 3%, 4% and 5% concentration of green tea in tap water for 42 days. The 6 ^th group was on normal diet and received 0% of the tea. Their blood samples were analyzed for total and conjugated bilirubin, total protein, albumin, globulin, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase. The liver tissues were also processed for histological examination. Results: The liver tissues were essentially normal and similar to the control tissues. The biochemical parameters studied were also normal and similar to the results obtained from the control animals. Conclusion: Sub chronic consumption of green tea has no injurious effects on the liver of Wistar rats.

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Background : Hepatitis B genotypes influence the course and severity of the disease. Aim: To compare the treatment outcome of chronic hepatitis B genotype B and C patients after treating with nucleos(t)ide analogues for six months. Patients and Methods: Forty chronic hepatitis B patients attending the liver clinic of Hospital for Tropical diseases, Bangkok, were studied in retrospective cohort design. Six genotype B patients (15%) and thirty-four genotype C patients (85%) were treated. Serum hepatitis B viral load , serum alanine amino transferase level, HBeAg status and alpha-feto protein level were measured at the time of starting nucleos(t) analogues therapy, and six months later. Besides, achievement of undetectable viral load was assessed in patients with normal serum alanine amino transferase compared to patients with high serum alanine amino transferase level. Results: After six months of nucleos (t) analogues treatment, achievement of undetectable hepatitis B viral load was higher in genotype B patients (66.7%) than in genotype C patients (42.4%) (Relative Risk=1.57, 0.79-3.14). Biochemical remission, HBeAg seroconversion and tumor marker levels between the two groups were not significantly different. Moreover, achievement of undetectable hepatitis B viral load was significantly higher in normal alanine amino transferase level (75%) than in patients with high serum alanine amino transferase level (33.3%) on nucleos(t)ide analogue treatment (Relative Risk=2.25, 1.20- 4.20). Conclusion: Chronic hepatitis B treatment outcome between genotype B and C were not significantly different. Patients with normalized serum alanine amino transferase level tend to achieve undetectable viral load after nucleoside analogues treatment.

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Background : The understanting of the dental fluorosis process, that begins with enamel maturation, is important to Dentistry students, since fluoride has drastically decreased the incidence of caries in several population groups, with a resultant increase in fluorosis prevalence and severity, as shown in literature. Aims : The objective of this paper is to report the changes in the level of knowledge about dental fluorosis of undergraduate Dentistry students at Guarulhos University. Subjects and Methods : One hundred and twenty-four undergraduate students enrolled in the first and second semester (2008) and seventh semester (2008) were evaluated. The data was obtained through questionnaires with dichotomic questions (true and false) and an alternative to evaluate whether the subject had been presented in the classroom. The data obtained was submitted to statistical analysis using the Chi-square test (α=0.05). Results : When evaluating the first semester students, differences were verified in numbers of the questions assigned with the alternatives true or false, when compared with seventh semester students (p<0.001). However, there were no differences when the same questionnaire was applied to the first semester students after six months (p=0.358). Conclusions : It is possible to conclude that the six months period was insufficient to increase the level of knowledge about dental fluorosis, and when the students beginning and concluding the dentistry course were compared, there was an increase in the number of correctly assigned true or false questions in the latter group.

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