The nasopharynx is the commonest site for adenoid-related pathology. The second common disease in the area is nasopharyngeal carcinoma. Uncommonly other lesions, such as Thornwaldt cyst, lymphoma, or a granulomatous disease can be found. The case of nasopharyngeal tuberculosis (TB) is not well reported, especially if the lesion occurred at the fossa of Rosenmuller (FOR) with the presence of cervical lymphadenopathy.  It may be under diagnosed because of its rarity and it does not produce pathognomonic symptoms of TB. We report a case of a 14-year-old Malay girl who presented with left neck swelling for 2 weeks and sore throat. A rigid nasoendoscopy was performed and revealed fullness over the right FOR. A biopsy was reported as chronic granulomatous inflammation suggestive of TB. Ziehl-Nielsen stain for acid-fast bacilli was positive. The patient was started on anti-tubercular drugs and 2-week follow up later showed significant mass regression.

The dilemma of facing a facial cosmetic issue at a young age is the most troublesome symptom hampering social well-being. Beginning in the teen ages and progressing to variable extents, Parry Romberg Syndrome (PRS) leads to facial asymmetry in the form of hemiatrophy secondary to loss of subcutaneous tissues, often fat but sometimes the underlying muscles and bones. It is indistinctly associated with seizure disorders at times or with other neurological sequelae. The first case was an 18 year old Pakistani male who presented with progressive wasting of the left side of the face for the past two and a half years. The second case was an 18-year-old Pakistani girl who presented to the neurology OPD with primary complaints of a seizure disorder for 3 years. In addition, she had progressive subtle asymmetry of her face. Over the course of time, a faint curvilinear grooved line showed up towards the right side of her forehead reaching on to her head up to the vertex. She also had hair loss ipsilateral to the line. The presentation of above cases depicts that although some features of PRS like facial asymmetry is characteristic, the presentation of a patient primarily with seizures should ideally include a thorough search for a secondary cause or of possible associations so that prognosis can be defined and appropriate interventions planned.

BACKGROUND: College students are at risk of many sleep disorders that may affect their performance. We conducted this study to identify the sleeping patterns, poor sleep quality factors among medical students, and to observe if there is any relationship between the student’s grades and their level of distress.

METHODS: This study was a cross-sectional study that was conducted in King Saud bin Abdulaziz University for Health Sciences, College of Medicine (male campus), Riyadh. We included 101 (2^nd, 3^rd, and 4^th year) male medical students who completed a self-administered questionnaire. The students sleeping disturbances were evaluated by using Epworth Sleeping Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and their distress was evaluated by the Subjective Units of Distress Scale (SUD). A relationship between student’s distress and their grade was determined by using one-way ANOVA. The data was analyzed using SPSS version 21.

RESULTS: The mean ±SD of the number of hours medical students slept was 5.6±2.6 hours. The most common cause of disturbed sleep was not being able to fall asleep within 30 minutes after going to bed. The mean score for ESS was 8.2 ±5.4. Most students had an ESS score <10 indicating that they had a normal amount of daytime sleepiness and good sleep. There was a relationship between the academic year and ESS; a higher percentage of the students in 3^rd and 4^th year were sleepy (ESS ≥ 10) than 2^nd year (P = 0.04). There was no relation between the student’s grades and their level of distress (P = 0.37). 

CONCLUSION: Medical students got less actual sleep hours than the optimal sleep duration. However, most had normal day time sleepiness. There was no relation between the student’s grades and their level of distress.

BACKGROUND: Acute appendicitis is one of the causes of acute pediatric abdominal pain, requiring quick diagnosis with most cases requiring emergency surgery. Often another cause of acute abdominal pain is identified during surgery and this rate is significantly higher in children than adults. Mean platelet volume (MPV) has been suggested as a biomarker of inflammation. Therefore, we examined the association of MPV with acute appendicitis in children.

METHODS: This case-control study was conducted in 120 children. Sixty cases of acute appendicitis were identified, and 60 controls were identified who presented with abdominal pain but did not have acute appendicitis. Data on demographic and clinical characteristics and final diagnosis were extracted. Chi-square and t-tests were used to determine statistical significance.

RESULTS: The mean age of the study participants was 7.18 years (standard deviation 3.37).  There were 72 males (61%) and 46 females (39%). Mean±SD of MPV was 8.2±0.1 fl, ESR was 24.8±2.0 mm/hour, white blood cell count was 11.5±4.1 x 10³ per mL, neutrophils were 72%±1.6%, and lymphocytes were 26.5%±1.6%. There was no difference in MPV between patients with and without acute appendicitis as final diagnosis (8.27±0.13 f1 vs. 8.22±0.13 fl, P>0.05). 

CONCLUSION: We found no association between MPV and acute appendicitis in children. Other biomarkers need to be evaluated to support clinicians in making a diagnosis of acute appendicitis.

BACKGROUND: Resistance to antibiotics among Enterobacteriacae represents a serious therapeutic and infection control challenge. The objective of this study was to determine the frequency of carbapenem, colistin and   tigecycline resistant Enterobacteriaceae isolates obtained from patients admitted in medical intensive care unit (ICU) of a tertiary care hospital in Karachi, Pakistan. METHODS: This was a descriptive cross sectional study that was conducted at Liaquat National Postgraduate Medical Centre, Karachi, Pakistan during December 2015 to May 2016. Patients admitted in the medical ICU with systemic inflammatory response syndrome were included. The culture positive samples were analyzed for further identification and antimicrobial sensitivity was performed according to clinical laboratory standard institute (CLSI) 2014 guidelines. RESULTS: Of the 748 samples, 177 were positive for Enterobactericae. Most samples were taken from blood 75(42.2%) or tracheal secretions 67(37.9%). Most common organism isolated were Klebsiella pneumoniae 77(43.5%) and Escherichia coli 71(40.1%). Out of these 10.7% organisms were resistant to meropenem, while 2.8% and 20.3% were resistant to colistin and tigecycline respectively. CONCLUSION: Increasing spread of drug resistance among Enterobacteriacae reflects an important problem that can be controlled with effective policies of infection control, surveillance and antimicrobial stewardship.