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  Background & Objectives: Clostridium difficile as an etiologic agent of pseudomembraneous colitis and major cause of nosocomial antibiotic-associated diarrhoea is typed by phenotypic and molecular methods. The aim of this study was to investigate the distribution of ribotypes of the organism in the given region and time.

  Methods: In this study 18 strains isolated from patients from different hospital wards of Poland in 2002 and 2003, were examined and identified by susceptibility to vancomycin and metronidazole. The samples were re-identified using UV and latex agglutination to ensure the existence of A and B toxins. DNA was extracted and after amplification by PCR and electrophoresis, the strains were ribotyped.

  Results : The findings showed that all the strains were susceptible to vancomycin and metronidazole and all the colonies showed greenish-yellow fluorescence under UV. Moreover, all the strains were positive in terms of latex agglutination. Seven strains were toxin A positive and all were toxin B positive except one strain. In molecular ribotyping it was found out that these strains belonged to seven ribotypes, namely 12, 14, 17, 18, 29, 70 and 90 most of which were ribotype 17 (61%).

  Conclusion: Our observations imply that in each area a particular ribotype of c.difficile is of higher prevalence and ribotyping of this clostridium is necessary for epidemiologic studies. Identification and PCR-ribotyping of common strains of this organism in Iran are recommended for epidemiologic follow-ups.

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  Background and Aims: Staphylococcus aureus as a�Gram- positive coccus causes a variety of infections in humans. It is one of the infectious agents in hemodialysis patients. Those patients who carry this organism at their nose are exposed to infection and possible morbidity and mortality due to this bacterium. Resistance to antibiotics in staphylococci is increasing. Resistance development is due to mutation and by plasmid DNA transmission. The aim of this study was to determine plasmid profile and antibiotic resistance of Staphylococcus aureus strains isolated from nasal carriers in dialysis patients in Imam Khomeini Medical Center. Susceptibility testing to antibiotics, plasmid extraction and analysis and epidemiologic relationship of these isolates were investigated.�

  Methods: In this study nasal specimens of 107 patients in dialysis ward of Imam Khomeini Medical Center were collected and cultured on blood agar plates. The colonies were identified as S.aureus strains. The susceptibility of 50 strains isolated from the patients against 12 antibiotics were tested using Kirby- Bauer standard method. A standard S.aureus strain (ATCC29213) was used to control quality of antibiotic discs. The isolates were cultured on LB medium and plasmid DNAs were extracted and electrophoresed on agarose gel using Parisi et al method.

  Results : The results of resistance rate against 12 used antibiotics were as follows: resistance of the strains against gentamicin, oxacillin, neomycin, clindamycin, erythromycin, cotrimoxazole, choloramphenicole, tetracycline, and ciprofloxacin were 20%, 28%, 30%, 26%, 30%, 44%, 32%, 36%, and 10%, respectively. All of the strains were resistant to amoxycillin and penicillin and none of them were resistant to vancomycin. Of 50 S. aureus strains, only 27 strains contained plasmid DNA. Most of the strains revealed a big plasmid. Plasmid profiles of the strains will be presented.

  Discussion: Our results showed that there was a close relationship between high resistance to antibiotics and presence of plasmids in S. aureus strains. Similarities among resistance to antibiotics and plasmid profiles in our strains isolated from the same ward showed that these strains were from the same sources and indicated a unique clonal possibility. The resistance to antibiotics of the strains lacking plasmids could be from choromosomal resistance

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Introduction: Skin defect reconstruction following tumor resection, is a challenge for surgeons. Nose as a key point of aesthetics has a significant role in this scenario. One of the practical approaches is dorsal nasal flap (Rintala) to cover lower 1/3 nasal defects. The disadvantages of this method are limitation to reach lower areas, especially nose tip, flap ischemia and wound dehiscence.
Case report: A 47 years old man with supratip BCC lesion underwent tumor resection and prepared for dorsal nasal flap reconstructive surgery, in which dorsal hump resection caused relaxed flap transfer and ultimately more acceptable profile view.
Conclusion: Advancement of the dorsal nasal flap more distally can be achieved by dorsal hump reduction in selected patients, which makes patients more satisfied with their new nasal form and appearance and reduces the risk of distal flap ischemia.