Gram positive cocci are responsible for a large number of infections, involving the skin and skin structures, respiratory tract, bloodstream etc., both in the community as well as in the hospital settings. However, the recent emergence of multidrug resistant strains has compromised therapeutic options as well as made therapy less effective and costlier. As medicine continues to evolve to combat these pathogens, they always seem to be a step ahead of us. Vancomycin, the drug of choice for resistant strains of gram positive cocci, has also seen the development of bacteria resistant to it. The introduction of ceftobiprole, a novel fifth-generation cephalosporin, has brought with it new hope for combating these pathogens. It exerts its antibacterial effect by binding to the PBP (penicillin-binding protein), blocking formation of the bacterial cell wall and ultimately leading to cell lysis and death. It has also got a wide antibacterial spectrum covering many gram negative bacteria as well as anaerobes. Ceftobiprole has been evaluated in various clinical trials including the multicentric STRAUSS 1 and 2 trials, and the results have demonstrated favourable efficacy of ceftobiprole against gram positive cocci. Thus, although ceftobiprole provides us with another option in our battle against the microbes, its judicious use is imperative so that we do not run out of therapeutic options in the near future.

Ameloblastoma, a relatively common epithelial odontogenic tumor includes several histopathologic subtypes like follicular, plexiform, acanthomatous and desmoplastic variants. Hybrid desmoplastic ameloblastoma (DA) composed of typical desmoplastic ameloblastoma along with areas of follicular/plexiform ameloblastoma is an extremely rare variant of ameloblastoma and to date only 16 cases have been documented. We report a new case of hybrid DA which additionally showed remarkable histologic findings of extensive bone formation and presence of mucous cells. It occurred in a 64 year old female patient involving the left maxilla from lateral incisor to distal to first molar. A comprehensive review of hybrid DA and the unusual findings aimed to offer an insight into the pathogenesis of these heterogeneities in odontogenic epithelium and clinical implications was also undertaken. Hybrid DA showed characteristic clinicopathologic features of a desmoplastic ameloblastoma with the exception of predominant mandibular occurrence. A likelihood of areas of solid multicystic ameloblastoma being a part of histopathologic spectrum of DA questioning the need for use of term “hybrid” was observed. Regarding the osteoplasia, most cases occurred in Asians and in anterior maxilla. The prominent TGF-ß expression seen in our case adds emphasis to its role in desmoplasia and osteoplasia. Furthermore, we identified an interesting association of desmoplasia with incidence of mucous cell metaplasia in ameloblastoma.

To investigate the prevalence of asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) in school-age children, we conducted a cross-sectional study. We investigated the prevalence of asymptomatic MRSA in children at a single, private school serving a low-income population in 2009. The school possesses Kindergarten through 8th grade classes. We excluded all children currently on antibiotics effective against MRSA and all children treated for a skin infection in the previous month. We sampled a single surface culture from both anterior nares. Each swab was then tested for MRSA utilizing a polymerase chain reaction test. We collected the following data on each child: age, grade, gender, recent abscess, current antibiotics, family member with a recent abscess, heath care worker living with student, and participation in sports. Our study included 87 school-age children (57% of the total population). The participants had a mean age of 9.5 years, 50.6% were female, 4.6% reported an abscess in the last year, 9.2% had a family member with an abscess in the last year, 26.4% had a healthcare worker at home, and 64.4% participated in organized sports. Six (6.9%) of the 87 children tested positive for MRSA. There was no significant difference between MRSA positive students and MRSA negative students for age, grade, gender, abscess in last year, family member with an abscess, healthcare worker in the family and sports participation. The prevalence of MRSA in asymptomatic school-age children was seven percent. Compared to other point prevalence studies, the prevalence of MRSA colonization appears to be rising.

A key goal in post-transplant monitoring is the diagnostic detection of harmful processes in the allograft early which can be easily and non-invasively assessed. Cytokines are crucial mediators involved in immune responses leading to rejection. It is known that episodes of viral infections and acute rejection can cause an increase in pro-inflammatory cytokines in transplant recipients. This study is significant since detailed analysis of cytokines was performed in kidney transplant patients pre- and post-transplant to assess the impact of graft implantation. Twenty patients with mean age of 35 years and comprising 8 females who underwent renal transplantation were included in the study. The mean follow-up time for the study cohort was 5 months. Using a multiplex microassay, twelve cytokines [IL-1?, IL-1?, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12, granulocyte–macrophage colony-stimulating factor, IFN-? and tumour necrosis factor] were measured simultaneously before and after transplant. A strong pro-inflammatory response was seen as the levels of circulating IL-1? (p<0.02) and IL-6 (p<0.01) increased post-transplant. A Th1 bias was due to increased IFN? (p<0.05) and absent IL-4 and IL-10 post-transplant. Levels of IL-1?, IL-2, IL-7, IL-12, GM-CSF and TNF? remained low and unchanged whilst IL-8 levels was reduced (p<0.02). These findings show a strong pro-inflammatory response with a Th1 cytokine bias and this immunological outcome places the patient at risk of graft rejection. We suggest that diagnostic parameters such as cytokines can be used to monitor allografts non-invasively and may have the potential to guide clinical decisions regarding immunosuppressive therapy which could improve outcomes post-transplantation.

To compare the prevalence of Streptococcus pneumoniae by rapid urinary test and blood culture in children with respiratory tract infection and healthy children (controls). Pneumococcal antigenuria was detected in 31.5 % of CAP, 31.5 % of rhinosinusitis cases and 6 % of controls. Pneumococcal antigenuria was significantly more frequently detected in both CAP and rhinosinusitis cases than controls (Fishers exact test; CI 95%, p = 0.01). In no cases of non pneumococcal CAP was antigenuria detected. Compared with blood culture, the specificity of the Pneumococcal antigenuria test was 94%. Nasopharyngeal carrier states for S.pneumoniae in healthy control are very low (6%). We recommend the rapid urinary antigen test to conventional cultural methods for early diagnosis of pneumococcal respiratory infection as a basis for starting appropriate treatment.This study help to inform policy making for the mass infant immunization with PCV7 in our country to decrease incidence of invasive pneumococcal disease.

Recurrent or chronic adenotonsillar infections mainly affect children.The possible role for infectious agents in adenoid hypertrophy have reported. Searching the DNAs (PCR) of M. pneumonia, C. pneumonia and H. pylori in resected adenoid of children with adenoid surgery. A cross-sectional study done in ENT and Pediatric Department of Rasul Akram Hospital during 2006-2008. 53 children with recurrent or chronic adenotonsillar infections candidate for adenoid surgery were selected .The resected adenoid tissues (1cm) during surgery removed by surgeon. The tissue samples were centrifuged and homogenized, DNAs were extracted and searched for DNAs of M. pneumonia, C. pneumonia and H. pylori by qualitative PCR. Mean age of cases was 8 ±1.9 years. 48% male; 51.9% female 23%. Most cases aged between 6-9 years (71.5%). Most adenoid surgery was done in winter (32%). M. pneumonia- DNA detected in 28%; C. pneumonia in 13.2%; H. pylori in 15% of tissue samples with no relation to sex and age of cases. Most positive PCR results for C. pneumonia and H. pylori (p=0.05; 0.02) were seen in spring and summer but not for M. pneumonia ( p=0.5) We could detect at least 1 of these 3 unusual infectious agents (M. pneumonia, C. pneumonia and H. Pylori) in adenoid tissues of 60% cases. These unusual infections may have a relative role in etiology of adenoid hypertrophy. Chronic sinusitis and ear infection might be added to infected adenoid tissue as a reservoir for these unusual bacteria. The search by more specific method such as Real time-PCR; or specific culture may elucidate better the role of these unusual infections in adenoid hypertrophy in future. The decision for use of antibiotics to eradicate these unusual infections in recurrent or chronic adenotonsillar infections before adenoid surgery (with or without rhinosinusitis or chronic ear infection) needs Randomized Controlled Trial studies.

Retrospective evaluation of 105 patients with gynecologic malignancy. One hundred and five patients with gynecologic malignancies diagnosed at Obstetrics and Gynecology Clinics of Medical School, Dicle University, Diyarbakir, between 2001 and 2005 were analyzed retrospectively. Gynecologic malignancies were classified. Distribution of 105 patients with gynecologic malignancies were; cervical cancer 19.04 % , endometrial cancer 21.90 %, uterine sarcoma 10.47%, primary ovarian cancer 40.95%, metastatic ovarian cancer 5.71%, carcinoma of the fallopian tubes 0.95%, choriocarcinoma 0.95%. 17 of 20 (85 %) patients with invasive cervical cancer were in stage?IIa. Endometrioid cancer was the predominant (86.95%) histologic type in 23 patients with endometrial cancer. Leiomyosarcoma was the most frequent (72.72%) histologic type in 11 patients with uterine sarcoma. 33 of 43 patients (76.74%) with ovarian cancer had epithelial type carcinoma. Six patients had metastatic ovarian cancer and 4 patients (66.66%) in this group had Krukenberg tumors (signet-ring cells), 1 patient had primary tubal adenocarcinoma and 1 patient had choriocarcinoma. Ovarian cancer was the most frequent gynecologic malignancy in our study.

Chronic exposure to Ethylene Oxide (EtO) gas was suggested to be associated with many health hazards. This study was conducted on thirty one workers exposed to EtO gas in different production areas and classified into three groups; group I included seven workers with direct exposure, group II included thirteen workers with partial exposure and group III included eleven workers with indirect exposure. One group included 20 non exposed persons and served as a control group (group IV). All of them underwent analysis of complete blood count, T-lymphocytes subsets (CD3, CD4, CD8) by flowcytometery technique, serum IgG concentration by ELISA technique and p53 gene mutational changes. Platelet count was significantly reduced in all exposed groups. Both CD3% and CD4% were significantly decreased in group I and II (p?0.05, p?0.001) respectively. Also, the absolute value of T-helper lymphocytes was significantly reduced in group I and II (p?0.05). However, CD8% was significantly increased only in group III (p?0.05). A significant elevated value of total IgG was found in group I and II (p?0.05). Variable gene mutation was detected in p53 exons (5b, 6 and 7) which were 28.5% (group I), 7.7% (group II) and 9% (group III) for exon 5b, 28.5% (group I) and 15.4% (group II) for exon 6 and 14.2% (group I), 7.7% (group II) and 9% (group III) for exon -7. There was significant reduced platelet count in all exposed groups. Both CD3% and CD4% and the absolute value of T-helper lymphocytes were significantly reduced in group I and II. EtO gas exposed personals showed a remarked IgG concentrations increments. There were genetically observed mutational changes located at p53 gene post EtO gas exposure.

Combined FV and FVIII deficiency is a rarely seen hereditary coagulation disease. Here, we presented two cases diagnosed with combined FV and FVIII deficiency. Factor V levels were 12% and 3% and FVIII levels were 7% and 2%, respectively. For both cases, prothrombin time and activated partial thromboplastin time were prolonged. The first case presented with nasal bleeding while the second case was diagnosed with an abdominal hemorrhage. These cases make us remember that when a hereditary bleeding disorder is considered in the presence of simultaneous prolongation of PT and aPTT, the possibility of combined FV and FVIII deficiency should be considered, although it is seen very rarely.

We described the first case report in the literature who developed Complex Regional Pain Syndrome (CRPS type I) symptoms in his right shoulder and right hand within 15 days after open cardiac surgery and discussed shoulder-hand syndrome (CRPS type I) and frozen shoulder diagnosis along with the reasons of no report of CRPS type I in these patients. We also speculated whether frozen shoulder seen in postthoracotomy and postcardiac surgery patients might be CRPS type I in fact.

Bentazone (Basagran®) is a commonly used and easily available agricultural herbicide. We report a 41-year-old-man who developed rhabdomyolysis with acute renal failure after bentazone toxicity. Four hours later after oral intake of liquid bentazone for suicidal attempt, the patient admitted to emergency service and his initial renal function tests were in normal range. However on the 15th hour of intake, urine output decreased, and blood urine nitrogen, creatinine and creatinine kinase levels were increased. On the fifth day of hospitalization, creatinine and creatinine kinase levels had turned to normal levels. As a result, bentazone intoxication may cause rhabdomyolysis with acute renal failure. Thus, renal functions must be followed up closely.

Abnormal uterine bleeding is one of the most common presentations in gynecology practice with too many causes. Acute promyelocytic leukemia is one of the serious causes of uterine hemorrhage. Frequency and severity of hemorrage seen in acute promyelocytic leukemia is often associated with disseminated intravascular coagulation which can be life-threatening. A 37-year-old women was admitted to the emergency room with acute severe uterine bleeding, increasing weakness and weight loss. There was no gynecologic pathology that could clarify the situation. High suspicion of acute promyelocytic leukemia was noticed during evaluation. All-trans retinoic acid treatment with aggressive blood product support was started immediately. Pathological examination of sternal bone marrow confirmed the suspicions. Our aim is to report a case of massive uterine hemorrhage leading to diagnosis of acute promyelocytic leukemia for the first time and to take attention on acute promyelocytic leukemia as a very rare cause of uterine hemorrhage.

Present study highlights a case of 26 year old male patient who was diagnosed as flaccid dysarthria due to delayed anoxic encephalopathy by attempting suicide through hanging. Assessment and management based on speech therapy has been emancipated. This case study concluded the importance of counseling and family centered approach regarding speech therapy outcome and alternative and augmentative communication (AAC). However, patient preferred verbal mode of communication and his lack of motivation failed the use of AAC with him. A composite therapy approach including traditional approaches, prosody and naturalness, increasing respiratory support along with visual biofeedback were used, which did not turned out to be effective. This dilemma to either direct therapy for verbal mode of communication which is not effective for the case or to use AAC needs further thinking and studies with more participants to find an appropriate solution which could lead us out of this impasse to some direction. Thus the challenge for speech therapists exists.

Lichen planus is a common mucocutaneous disease in adults. Childhood lichen planus is an extremely rare entity which is characterized by violaceous, scaly flat topped polygonal papules with the oral involvement being extremely uncommon. Early and correct diagnosis is very important to avoid further complications. We report a nine year old boy with disseminated lichen planus involving the flexor aspect of the wrists and legs as well as, oral and genital mucosal involvement which regressed after treatment. This is to add another case of lichen planus in a child and to emphasize its consideration in the differential diagnosis of oral mucosal white patches in children.

Myeloma cast nephropathy, also known Bence Jones cast nephropathy or myeloma kidney is the most common form of renal disease associated with multiple myeloma. Clinically, it may present as progressive renal insufficieny or acute renal failure. We describe a case of multiple myeloma who presented with acute renal failure due to light chain cast nephropathy and had a primary diagnosis made by renal biopsy. A renal biopsy was performed for acute renal failure in a 44 year old female patient. The renal biopsy showed numerous dilated tubules filled with pink eosinophilic fractured casts surrounded at places by multinucleated giant cells and accompanied by moderate interstitial infiltrate consisting of lymphomononuclear cells. There was tubular atrophy with interstitial fibrosis. The renal biopsy is occasionally the first test indicative of myeloma in a patient with acute renal failure of seemingly unknown origin. Thus the microscopic appearance of the tubules in this biopsy is easy to appreciate and is diagnostic of light chain cast nephropathy.

Mucoepidermoid carcinoma is the most common malignant salivary gland neoplasm. It affects both major and minor salivary glands and when major salivary glands are affected, the parotid gland is the most common. The incidence has been reported to range from 4-12% of all the parotid tumors. Mucoepidermoid carcinoma of parotid gland is usually of low grade type with a marked cystic component causing considerable diagnostic difficulties. Hence cystic lesions of parotid gland should not be merely dismissed as benign entities and mucoepidermoid carcinoma should be always included in differential diagnosis. In this presentation, we report a case with initial diagnosis of benign cystic lesion based on FNAC and MRI findings which was later diagnosed histologically as low grade mucoepidermoid carcinoma of the parotid gland.

A 70 year old female presented with intermittent, dull aching pain in right upper abdomen lasting for four months . Examination revealed hepatomegaly and a hard globular swelling continuous with the right costal margin. Enzyme linked immunosorbant assay for hydatid was positive. Ultrasonography of abdomen revealed a large multicystic lesion in right lobe of the liver and hyperechoic shadows in gall bladder fossa. Contrast enhanced computerized tomography of abdomen documented huge hydatid cyst in right lobe of liver and a thick walled calcified cystic lesion in segment-VI of the liver which was confirmed as a gall bladder at laparotomy. Histopathological examination of the specimen confirmed hydatid cyst of the gall bladder. Larval stage of echinococcus causes hydatid disease. Four species can produce disease in humans. E. granulosus and E.multilocularis cause cystic and alveolar hydatid disease respectively while E. vogeli and E. oligarthus rarely infect humans. Hydatid cyst of the gall bladder is extremely rare and this case report highlights the rarest location of hydatid disease.

Bifid Mandibular condyle is a rare case, which is usually diagnosed after radiological examination or after physical examination of a patient who refers with temporomandibular joint disorders and pain. It is usually unilateral. A bifid mandibular condyle and mandibular dislocation were diagnosed in a 6-year-old boy who presented difficulty in closing his mouth. The patient had a history of trauma, due to a fall while running three months ago. Extracondyle was found to be located bilaterally close to the superomedial region of the zygomatic arch and was seen to be stuck at the temporal fossa. In this case, the extracondyle pulled the real mandibular condyle to the anterior by settling at zygomas’ superomedial region. In this case, bifid mandibular condyle was the reason for mandibular dislocation.

Congenital macrostomia (transverse facial cleft) is a rare congenital anomaly. It is most commonly associated with anomalies of the first and second branchial arches. We present two patients with Tessier number 7 unilateral cleft and their treatment.