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Microorganisms can develop resistance to antibiotics used in the treatment with a variety of mechanisms.
In this article, the general mechanisms of resistance to antibiotics and resistance mechanisms that are frequently encountered in antibiotic groups were summarized.

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Surfactant administration via thin endotracheal catheter (Tec) seems to be less invasive than InSurE method. We analyzed data obtained from multicenter hospitals.
This multi center randomized clinical trial study was conducted concomitant within NICU of three university hospitals of Tabriz, Isfahan and Mashhad for a period of 20 months on neonates with gestational age of 27-32 weeks. All infants received nCPAP before administration of surfactant. If we required fio2>30%to maintain spo2 >85% then surfactant was administered. A 5f vascular catheter was placed through 1 to 2 cm below the vocal cords and surfactant was administrated slowly.
Mean gestational age in TEC was 29.6 weeks and in InSurE was the same. Mean weight in TEC was 1339 grams and in InSurE was 1304 gram. Surfactant was administered to 66 preterm via TEC method and to 70 infant via InSurE. Mortality in TEC group was significantly lower than InSurE. P<0.01RR=0.56, CI, 95(0.42-0.76). NEC reduced in TEC. CPAP duration decreased in two centers, p<.05 but increased in another center. Fio2 decreased rapidly and HCO3 increased 2 hours after surfactant P<0.03 in TEC. The average mean of Oxygen supplementation, BPD, Mechanical ventilation between two groups was not statistically significant.
TEC method was effective in treating RDS. Mortality was significantly decreased in TEC group. As TEC procedure is a new method of surfactant administration and there are few studies about it, so it is too early to be certain about all aspects of this procedure.

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A series of 25 cases of lower lip reconstruction with flaps including depressor anguli oris
muscle were presented. Depending on the general conditions of each patient, operations were performed under local or general anesthesia. In 4 of the patients, by elevating the flap bilaterally a complete lower lip reconstructions were performed. In three cases, since the defects existed without mucosal involvement, the flaps were elevated only as musculocutaneous flaps. The other cases were repaired by a flap including three layers of
skin-muscle and mucosa. In some cases, full thickness skin grafting were necessary, as the mucosa with the flap was not enough for lining. Although not seen in all cases, some fatty appearance on the flap peninsula was observed following the reconstruction. No attempts were made to preserve the so-called flap and mental nerve relationships, except for the first three cases among this series. No patient suffered from any sensorial loss on
the newly reconstructed lower lips. Taking into consideration the oral sphincteric functions, although the new oral sphincter was not competent as much as a healthy one, no patient showed incompetence. On the last 5 patients, the flap peninsula was elevated by direct cutting without caring the so-called motor nerve of the flap, too. In an earlier short article of us, it was argued that the depressor anguli oris flap’s sensorial innervation did not come from mental nerve but buccal nerve. Now, I would like to add one more discussion about the flap anatomy and this is to say that the flap can be elevated without any attempts to protect neither mental nor marginal mandibular nerve since it may have some cross innervations. This conclusion may make us think that the depressor anguli oris flap is an easy flap to elevate with very little morbidity and can be useful to reconstruct the lower lip defects, except those that are located centrally.

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Narghile, one of the names for water pipe, is an instrument for tobacco smoking that has
become a trend among the youth in Saudi Arabia. The mistaken opinion that smoking narghile is not as dangerous as smoking cigarettes makes the youngsters and their parents take it lightly and contributes to the expansion of its use. The link between tobacco smoke and cancer has long been established. Smokers are ten times at greater risk of developing lung cancer than that of non-smokers. Narghile smoking has become fashionable worldwide. Its tobacco pastes generally contains 30–70% tobacco. Tobacco contains minute amounts of radiotoxic elements which are inhaled via smoking. Radim-226 is a significant source of radon-222, an inert radioactive gas, which enters buildings through soil, construction materials or water supply. When tobacco smoke is present, the radioactivity attached to airborne smoke particles and the radioactivity concentration in
the room, increases very much compared to a smoke-free room. It remains suspended and available until inhaled as ‘secondhand’ smoke by anyone in the room. Thus, smoking indoors greatly increases lung cancer risks to all inhabitants. To investigate whether the narghile tobacco itself is a potential source of indoor radon, the level of radon and thoron from radioactive decay were measured in fifteen different brand narghile tobacco paste samples using CR-39 solid state nuclear track detectors (SSNTDs). The results showed that the 222Rn and 220Rn concentrations in these samples ranged from 129 to 273 Bqm-³ and 55 to 142 Bqm-³, respectively.

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An In Vivo attempt to induce psoriatic lesions in the skin of BALB/C mice by injection of bacterial superantigen.
Staphylococcus aureus that was isolated from skin lesions of psoriatic patients was subjected to gel filtrations chromatography for extraction and purification of their exoproteins. The skin of BALB/C mice was injected by 0.2 ml of the extracted purified exotoxin.
The induced lesions were markedly similar to that of human psoriatic lesions, although the histopathological changes were not completely mirrored to that of human psoriatic skin lesions.
There is an important role of Staph. aureus exotoxine (superantigen) in induction, triggering and maintenance of psoriatic lesions.

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From a total of 286 cases of Atopic Dermatitis (AD) patients, 94.4% and 86.36% yielded positive cultures of eczematous lesions and healthy area of AD skin. Twenty various bacterial types and a total of 959 and 744 isolates were identified from each of above areas respectively. Staph. aureus was the predominant bacterial agent isolated from 60.48% of eczematous lesions, while Staph. epidermidis was predominantly from 57.34% of healthy areas of AD patients (P< 0.001). The bacterial numbers ranged from (0.0292.0)x105cell/cm2
in eczematous lesions and (0.11-23.0)x 103cell/cm2 in healthy areas of atopic skin (P<0.001).

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