The Bioagent Transport and Environmental Modeling System: Avian Influenza Surveillance Index (BioTEMS AISI) model produces a quantitative index that can be evaluated for utility against observed data. The BioTEMS AISI has been demonstrated to correlate with biotic and abiotic factors, particularly biodiversity and physical and chemical soil properties. Highly Pathogenic (HP) H5N1 has not been identified to date in the Eastern U.S. However, numerous strains have been collected from waterfowl. Similar biotic and abiotic factors that may influence the presence and survival of HP H5NI occur in Benghazi, Libya as well as other coastal areas globally. Given the concern by Libyan and U.S. Governments in protecting the Libyan people and poultry from influenza, the BioTEMS AISI model was used to identify optimal monitoring sites for avian influenza in and around Benghazi, Libya. International and state agriculture agencies, health departments, poultry farmers, and poultry processors, can use this technology proactively to monitor for avian influenza virus in the environment. Similar BioTEMS surveillance systems can be developed for monitoring foot and mouth disease and sporadic cases of plague and anthrax in Libya.

It has been shown that an increase in prolidase enzyme activity is correlated with increased rates of collagen turnover. In previous studies, it has been investigated that whether prolidase activity may be an index of liver fibrosis, but the results are controversial. Therefore, the aim of this study was to investigate serum prolidase activity in patients with biopsy-proven chronic viral hepatitis (CVH) and to find out whether prolidase enzyme activity is correlated with histopathological findings in those CVH patients. Fifty-four patients with CVH and 44 healthy controls were enrolled. Serum prolidase enzyme activity was measured spectrophotometrically. Serum prolidase activity was significantly higher in CVH than controls (p<0.001). A significant correlation was observed between serum prolidase activity and fibrosis score in patients with CVH (r=0.525, p<0.05). Our findings indicated that prolidase activity seems to be correlated with the level of fibrosis. Thus, serum prolidase activity may be an adjunctive tool in predicting the degree and stage of liver histopathological findings.

In the present study the aqueous extract of Lepidium sativum L. (family: Brassicaceae) was investigated for possible antinociceptive effect in Swiss - albino male mice. In this experiment three groups of male mice were used (n=6). Two models were used to study the effects of the extracts on nociception, acetic acid-induced writhing test and hot plate test in mice. Lepidium sativum L. Extract was administered in the dose of 20 mg/kg orally 30 minutes prior to pain induction. The aqueous extract showed significant (p<0.05) analgesic activity evidenced by increase in the reaction time by hot plate method and significant (p<0.05) reduction in acetic acid - induced writhings in mice with a maximum effect of 27.00% reduction. These effects were compared with the control and standard drug, diclofenac sodium (50 mg/kg, p.o). The results indicate that aqueous extract of Lepidium sativum L. Possesses a significant antinociceptive activity in central and peripheral pain models in mice and therefore, it can be used as supplemental therapy in acute or chronic pain conditions.

Despite little evidence, many various complaints might be associated with teething in children. Symptoms related with teething mostly result in delay diagnosis of underlying disease. In this study we explore the relationship between teething and symptoms commonly seen in pediatric clinics. Children less than 36 months of age, who came to Medipol University Faculty of Medicine, between October 2013 and May 2014 for routine well-child visit, were recruited in the study. At visit time 318 infants (60.5%) had one or more visible tooth eruption. Participants were divided in five subgroups according to their age. Parents of infants (mean age 11.5 months) completed questionnaires. The most commonly reported symptom was irritability in 12-18 months (74%), 24-30 months (57%) and 30-36 (44%) months’ periods, drooling in 6-12 months (87%), loss of appetite in 18-24 months (64%). Irritability was statistically significant in all groups except 18-24 month. (p=0.54). Febrile fever was only statistically significant in 6-12 and 12-18 months groups. Increase in biting was become statistically significant after 12 months. Although rates vary according to age group, many mild symptoms previously thought to be associated with teething were found temporally correlated with teething. Before parents/caregivers attribute these symptoms to tooth eruption other possible causes must be ruled out.

Propofol is a sedative-hypnotic drug with rapid onset and recovery time. There are limited number of studies in which propofol was used for bronchoscopy. In this current study, we evaluated our patients who received propofol sedation for bronchoscopy in our clinic and investigated the usefulness of the procedure for both patients and physicians We prospectively evaluated patients who had bronchoscopy in our clinic between 2012 January and 2013 January. We recorded demographic features, indications for bronchoscopy, procedures of bronchoscopy, duration of the procedures, minor and major adverse events and hemodynamic parameters of the patients. All patients were monitored until they were discharged from the bronchoscopy unit. In total, 97 patients were included in the study. The mean age of the participants was 65 years, 60 of them were male (61%) and 37 were women (39%). Major indications were lung lesions that were suspected to be central or peripheral lung cancer. Other indications were mediastinal-hilar lymph nodes, hemoptysis, tuberculosis, atelectasis, chronic cough and tracheomalacia. Mean propofol dose was 90 mg in patients who had biopsy and 70 mg for those who did not have biopsy. Mean duration of the procedure was 14 minutes in those who had biopsy and 10 minutes in those who did not have biopsy. One patient had epistaxis after receiving topical lidocaine and two patients had respiratory arrest that required ambulation with a mask. Thirty-five patients (36%) had desaturation, which was reversed by providing adequate oxygenation. Propofol is a useful and applicable sedative-hypnotic for patients and physicians for fiberoptic bronchoscopy.

The aim of the current study was to outline the demographic, clinical and polysomnographic characteristics of sleep apnea in patients with heart failure. A retrospective, clinical study was conducted on 29 heart failure patients in our tertiary care center. Patients who reported snoring, witnessed apnea episodes and excessive daytime sleepiness underwent full-night polysomnography. Baseline features, types and frequencies of sleep disorders were noted. In addition, we have compared mild-moderate Obstructive sleep apnea (OSA) patients to severe OSA cases in terms of demographic, clinical and polysomnographic variables. Of these 29 cases, three patients (10.3%) had mild OSA, while 6 patients (20.7%) were diagnosed with moderate OSA and severe OSA was determined in 15 (51.7%) patients. Four patients (13.8%) were diagnosed with central sleep apnea (CSA) and one patient (3.5%) had normal polysomnographic result. The mean age of the total group consisting of 11 females (37.9%) and 18 males (62.1%) with a mean age of 57.8±10.9 (range: 29.0-74.0) years. Severe OSA patients were older (p=0.02), had a lower ejection fraction (p=0.02), higher arterial oxygen desaturation index (p<0.001), prolonged mean apnea duration (p=0.02), and lower minimum arterial oxygen concentration (p=0.02). Our results indicate that OSA may occur in the vast majority of heart failure patients that suffer from sleep disorders. Close collaboration between disciplines is crucial for effective management of these cases.

Pediatric spinal injuries are very rare conditions and account for 1%-10% of all spinal injuries Domestic accidents, such as falling and bumping, are frequent events during childhood.In this study, a 1-year-old boy who was under treatment due to a penetrating trauma at the posterior thoracolumbar intersection is presented. The patient was referred to our clinic after a needle became impaled into his back due to an accident that occurred at home. The patient’s neurologic assessment was normal. A radiologic study of the patient showed the presence of a metallic foreign object, extending into the paravertebral muscle on the left side of the T12-L1 intersection. The needle was removed promptly after an emergent surgical procedure. No any complications were present during the follow-up visit after 1 month. Emergent surgical intervention is necessary in paraspinal and spinal penetrating traumas.

Mullerian adenosarcoma (MA) was first defined as a special malignancy of uterine corpus in 1974. Although a few hundred cases were reported about uterine adenosarcomas, extrauterine adenosarcomas (EMA) are very rare. Thus, clinic and pathologic knowledge about extrauterine adenosarcomas are limited. This case report represents an ovarian mesodermal (mullerian) adenosarcoma, which contains dominantly high grade sarcomatous components along with chondrosarcoma components and very limited classical adenosarcoma areas in a 25 year-old female. To our knowledge, this is the first case report in the literature reporting the combination of features as diffuse presentation of sarcomatous overgrowth (SO) areas, scarcity of classical adenosarcoma areas, existence of chondrosarcoma areas in such a young patient.

Patients with chronic kidney disease (CKD) are prone to bleeding due to the platelet dysfunction caused by uraemia. Therefore, the mortality and morbidity in patients with chronic kidney disease increase. The 81-year-old female patient, in dialysis dependent CKD, had an emergency cholecystitis operation with uremia-induced platelet dysfunction has evolved. Patient with gross bleeding intraoperatively had a cardiac arrest during operation. After cardiopulmonary resusitation cardiac impulses were started and patient was taken into intensive care unit. After the administration of estrogen and Factor VIII Inhibitor Bypass Activity treatment for the bleeding diathesis, bleeding has reduced and after 6 days from the operation patient was externed to his service. The chronic kidney disease may lead to hemorrhagic diathesis and unexpected abundant bleeding by creating a platelet dysfunction. Such being the case, the utilization of desmopressin and Factor VIII concentrate during the treatment is an efficient treatment option.

Adrenal cysts are rare lesions that usually progress asymptomatically. They are often determined post-mortem. Our case was a 50-year old-male who had presented to our clinic with upper right quadrant pain. The computed tomography demonstrated a cystic mass in the adrenal gland. No abnormalities were determined in the laboratory tests. According to the histopathological and immunohistochemical examination, the cyst was evaluated as a mixed-type adrenal cyst, the wall of which was covered with endothelium, mesothelium and cubic epithelium. We believed that the case was worth presenting, since it was the first diagnosed mixed-type adrenal cyst in the literature.

Cervical adenocarcinomas are the second most common malignant tumours of the cervix after squamous cell carcinoma. Their frequency is reported to be gradually increasing. These tumours are polypoid or papillary in 50%, diffuse or nodular in 15%, and occult (cannot be observed macroscopically) in 10-15% of the cases. We present the pathological features of three cervical adenocarcinoma cases that could not be observed macroscopically but were found by endocervical curettage. Cervicovaginal smears of the cases were prepared by conventional methods and PAP stained. Endocervical curettage and resection materials were reexamined. One patient’s smear material could not be found. No positive findings were detected in the smears of other two cases. The carcinomas could be determined with endocervical curettage in all three cases. All cervixes were sampled and the tissues were processed as the tumour could not be seen macroscopically in hysterectomy materials. Clear cell carcinoma was diagnosed in one case and endocervical mucinous adenocarcinoma in the other two cases. Cervical adenocarcinomas can be occult in some cases and can not be observed during macroscopic examination as in our cases. A large number of paraffin-embedded blocks should be prepared, and if necessary, all cervixes should be processed to find the tumor in such cases. The possibility of diagnosing the tumors which cannot be seen macroscopically and cannot be determined clinically increases if the number of samples taken from the cervix is increased in hysterectomy materials and if conization can be performed after positive ECC which properly performed before endometrial sampling.

The clinical appearance of Mycobacterium tuberculosis (TB) in patients on dialysis are substantially non-specific that makes diagnosis difficult. We report a case of extrapulmonary and intrapulmonary TB in end stage renal disease (ESRD). A 58- year-old female with ESRD was admitted to emergency with the complaints of intermittent fever, weakness, impairment of consciousness for last three days. Because of mental confusion she was entubated, transferred to the intensive care unit. Thorax CT showed widespreadcentryasinarnodules in both lungs. The empirically anti-TB therapy was initiated. There was in size of 4x5 cm palpable lymphadenopaty on left supraclavicular region, excisional biopsy revealed caseating granulomatous lymphadenitis. Lumbar puncture was performed and analysis was consistent with TB meningitis. The patient was diagnosed as miliary TB, TB meningitis and TB lymphadenitis and died on the tenth day on admission. Increased awareness of TB in the ESRD population, early diagnosis and treatment are very important.