We presented 59 fingertip injury cases that we treated and followed up. Among the 59 patients, 50 were male and 9 were female. The methods we chose for reconstruction were as follows: repairing by a skin graft (n: 3), a V-Y advancement flap (n: 17), a cross-finger flap (n: 19), a thenar flap (n: 5), an abdominal interpolation flap (n: 8) and infraclavicular flap (n: 2). We performed 35 operations under local anesthesia and 24 under general anesthesia. The waiting time for the second séance of the interpolation flaps was not longer than 12 days for all cases, and we performed the shortest flap separating operation at the end of the seventh day. Since their fingers healed, the patients had no complaints about the donor area. In this study, we did not evaluate the two-point discrimination. Flap-thinning operations were required later, for the abdominal interpolation performed cases. None of the patients had hypersensitivity against touching or cold. From this study it is concluded that regardless of the preferred fingertip repairing method, the evaluation of the finger profile view should not be neglected. It is important to obtain a profile view of repaired fingers similar to that of healthy fingers, and we believe that the pulp softness should be maintained. Although there is a continuous tendency to describe technically complicated and detailed reconstruction methods in literature, we feel the need to emphasize that the classical methods have not lost the value if they are carried out properly.

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Noise as an unwanted sound is unpleasant to listener. It can be physically, mentally, and physiologically harmful, and it interferes with important activities. Some studies show negative effects of aircraft noise on education procedures. We aimed to assess the impact of noise on the performance of teachers in classrooms, and on other educational activities. Method: We selected 384 class teachers by simple random sampling in primary, secondary, and high schools in Firoozabad City, Iran. We distributed the questionnaire to these class eachers and collected on the same day. The results showed that traffic noise was a significant factor that affected the teachers by reducing their teaching efficiency and by disturbing other educational procedures. Therefore, it needs more effective controls and more consideration in city planning.

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The aim of this study is to find out the awareness on oral health among Ayurvedha and Siddha practitioners in Chennai, Tamil Nadu.
A cross-sectional survey was performed among a sample of 102 Ayurvedha and Siddha practitioners in Chennai, and data regarding their awareness of oral health were obtained using a closed-ended questionnaire. The SPSS software version 17 was employed to find the frequency distribution among the variables.
Among the 102 Ayurvedha and Siddha practitioners approached, 94.1% of the respondents knew the reason for the occurrence of dental caries. Around 76.5% responded that fluoride in toothpaste can prevent dental caries, but only 58.8% of them had advised their patients to use fluoride-containing toothpastes. A total of 89.2% knew that oral health was related to systemic diseases. About 92.2% responded that they informed the patients about the importance of oral hygiene and also about smoking and tobacco-related oral diseases.
Majority of them (99%) thought that Ayurvedha/Siddha medicine could cure oral diseases, with halitosis (40.2%) as the most common dental finding. Many of them (94.1%) responded that they had oral health as a part of their syllabus. Around 89.2% referred their patients to the dentists and also most of them (98%) thought that they need further information about prevention of oral diseases.
Ayurvedha and Siddha practitioners already have substantial amount of oral health knowledge, and they are keen to expand their knowledge. Patients regularly ask for their advice on both general and oral health care issues, and there is a definitive need for interdisciplinary symposia/lectures/conferences and providing them with access to information on available dental services.

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-lactams are the most widely used group of antimicrobials; however, growing resistance to these invaluable drugs mediated by extended spectrum -lactamase (ESBL) enzymes is a major concern. The present study was undertaken to determine the prevalence of these enzymes and their effect on antimicrobial susceptibility pattern by different phenotypic detection tests in clinical isolates of Escherichia coli in Benghazi, Libya. Antimicrobial susceptibility testing was carried out by Kirby-Bauer method. Ceftazidime and cefotaxime were used for screening potential ESBL producers. Confirmation was done by a combination of double disk synergy test (DDST) and phenotypic confirmatory disk diffusion tests (PCDDTs).
A total of 120 E. coli strains (40 urine, 20 sputum, 20 blood, and 40 wound swabs) from inpatients at different hospitals of Benghazi, Libya, were included in the study, of which, 24 (20%) isolates were ESBL producers. The resistance pattern to the tested antibiotics was as follows: ampicillin (80% ), co-trimoxazole (60%), ciprofloxacine (40%), cefotaxime (30%), ceftazidime (30%), Ceftriaxone (30%), gentamicin (30%), cefpirome (35%), ofloxacin (30%), imipenem (25%), and nitrofurantoin (40%).
All the isolates tested showed resistance to two or more drugs and were considered to be multidrug resistant. A higher rate of ESBL production and multidrug resistance was seen among isolates from pus swabs as compared to other sources. ESBL producers mediated high resistance to both -lactams and non--lactams. Prolonged hospital stay and prior use of third-generation cephalosporins were identified as important risk factors for ESBL acquisition.
There is insufficient data regarding ESBL prevalence among E. coli strains from Benghazi, Libya. ESBLs not only pose a great threat to future of -lactams, but they also endanger the utility of many non--lactams. To ensure rationale in antibiotic treatment, ESBL detection and reporting assumes a priority in near future in Benghazi, Libya.

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Fifty-two clinical samples collected from patients with postoperative wound infections in various age groups were examined for presence of multidrug-resistant bacterial pathogens – in especially – Staphylococcus aureus. The majority of samples were for age between 31 and 40 yrs (32.69%) followed by other age groups, while the lowest samples were taken from age group 1 to 10 yrs (5.76%) P<0.05. A total of 131 isolates were identified and the main causative agent was S. aureus (24 isolates 18.32%), while other bacterial types isolated from postoperative wounds were as follow: Escherichia coli 16 (12.21%), Klebsiella spp 11(8.39%), Enterobacter cloaeca 8 (6.1%), Proteus spp 7(5.34%), Pseudomonas aeruginosa 20 (15.26%), Staphylococcusepidermidis 11 (8.39%), Staphylococcus saprophyticus 8 (6.1%), Staphylococcus xylosus 5 (3.81%), Viridance streptococci 10 (7.63%), Streptococcus pyogenes 7 (5.34%), and Enterococcus faecalis 4 (3.05%) P<0.01. Sixteen antibiotics were used to test the resistance of S. aureus. Penicillin G gave 100% resistance ratio for all of 24 tested isolates, while the highly affected antibiotic was cefotaxime that gave the lowest resistance percentage (16.66%). Other antibiotics had ranges of resistance between these limits P<0.01. S. aureus developed a resistance mode for at least eight antibiotics. The biggest percentage of resistance was for the resistance of four antibiotics (21.18%) P<0.01.

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Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney characterized by the presence of gas in renal parenchyma, collecting system or perinephric tissue. It can be life threatening if not recognized and treated promptly. We have reported the case of a 56-year-old woman with a previous history of diabetes mellitus, who was suffering from left-sided flank pain and fever. Diagnosis workup revealed an extensive destruction of the left kidney secondary to an EPN. We opted for a left nephrectomy and intravenous antibiotics. The immediate postoperative course was uncomplicated but the patient developed a chronic renal failure within 1 year.

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During dissection of the posterior compartment of the thigh of a female formalin-fixed cadaver, a variation of profunda femoris vein directly communicating with the popliteal vein was encountered on the right side. The profunda femoris vein was 18 cm long with a diameter of 0.5 cm. Such a direct communication between the profunda femoris vein and popliteal vein is known to be rare.
The site of the thrombosis that develops in the lower limbs is of importance in terms of diagnosis and treatment. Proximal or distal placement of such a thrombosis leads to diversity of diagnosis and treatment. Thus variations related with the veins of the lower limb should be well known. Furthermore awareness of such variations may be important to avoid unexpected complications during surgery of this region.

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