Actinomycosis of the Upper Lip

Actinomycotic infections are known to have an association with difficulties in diagnosis and treatment. These infections usually involve the head, neck, thorax, and abdomen. Actinomycosis of the upper lip is a rare condition and an important one as well, because it can imitate other diseases. As the initial impression, it can easily be mistaken for a mucocele, venous lake, or benign neoplasm. An 82-year-old man presented with an asymptomatic normal skin colored nodule on the upper lip. Histopathologic findings showed an abscess and sulfur granules in the dermis. Gram staining results showed a mesh of branching rods. In this report, we present an unusual case of actinomycosis of the upper lip and discuss its characteristics and therapeutic modalities

Pelvic actinomycosis presenting as a malignant pelvic mass: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively.</p> <p>Case presentation</p> <p>A 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period). The cytology revealed inflammatory cells with aggregates of <it>Actinomyces</it>. Penicillin therapy was given for six months without any complication.</p> <p>Conclusions</p> <p>Pelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy or dental infection. Surgeons should be aware of this infection in order to avoid excessive surgical procedures.</p

Eye Guidelines

This chapter provides review of common eye conditions seen in primary care

Taking Action on Asthma: Increasing Influenza Vaccination Rates in Pediatric Asthma Through Quality Improvement

Introduction: Through a QI Collaborative, a school-based health center (SBHC) program was tasked with identifying ways to decrease asthma mortality and promote national asthma guidelines with evidence-based interventions. Children with asthma are at increased risk for influenza complications such as pneumonia, hospitalization, and death. Flu vaccinations reduce these morbidities. Methods: Utilizing the Institute for Healthcare Improvement Framework, a clinical microsystems assessment and root cause analysis evaluated both enablers and barriers in improving flu vaccination rates in asthma students. Continuous quality improvement over three academic years with adaption of process efficiencies including asthma database tracking, flu vaccination rates, and asthma preventative visits was demonstrated. Results: The number of students with asthma who received their flu vaccination increased from 11% to 47%. Discussion: The SBHC program improved flu vaccination rates and targeted asthma preventative services. Additional successes included the adaptation of a vaccination campaign to 14 SBHCs, education on flu vaccination, and better electronic health record documentation of asthma severity