ObjectivesAcquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). People with AIDS are much more vulnerable to infections, including opportunistic infections and tumors, than people with a healthy immune system. The objective of this study was to correlate oral lesions associated with HIV/AIDS and immunosuppression levels by measuring clusters of differentiation 4 (CD4) cell counts among patients living in the middle western regions of Ghana.Materials and MethodsA total of 120 patients who visited the HIV clinic at the Komfo Anokye Teaching Hospital and the Regional Hospital Sunyani of Ghana were consecutively enrolled in this prospective and cross-sectional study. Referred patients' baseline CD4 counts were obtained from medical records and each patient received an initial physician assessment. Intraoral diagnoses were based on the classification and diagnostic criteria of the EEC Clearinghouse, 1993. After the initial assessment, extra- and intraoral tissues from each enrolled patient were examined. Data analyses were carried out using simple proportions, frequencies and chi-square tests of significance.ResultsOur study included 120 patients, and was comprised of 42 (35.0%) males and 78 (65.0%) females, ranging in age from 21 to 67 years with sex-specific mean ages of 39.31 years (males) and 39.28 years (females). Patient CD4 count values ranged from 3 to 985 cells/mL with a mean baseline CD4 count of 291.29 cells/mL for males and 325.92 cells/mL for females. The mean baseline CD4 count for the entire sample was 313.80 cells/mL. Of the 120 patients we examined, 99 (82.5%) were observed to have at least one HIV-associated intraoral lesion while 21 (17.5%) had no intraoral lesions. Oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis and xerostomia were the most common oral lesions.ConclusionFrom a total of nine oral lesions, six lesions that included oral candidiasis, periodontitis, melanotic hyperpigmentation, gingivitis, xerostomia and oral hairy leukoplakia were significantly correlated with declining CD4 counts.

BackgroundClear cell odontogenic carcinoma (CCOC) is a rare intraosseous carcinoma of the jaw; only 81 cases have been reported in the English literatures.Case presentationWe reported an additional case and reviewed the existing literature. A 70-year-old woman presented with a large painful radiolucent mandibular lesion from the right canine to the left angle area through the midline. No metastatic lymph nodes or distant metastases were detected. She underwent wide surgical resection and reconstruction with a composite fibula free flap. She had no recurrence or metastasis after 18 months.ConclusionCCOC occurs predominantly in women in their 50s–70s in the mandible. Painless swelling is the most common symptom, followed by pain, teeth loosening, and paresthesia. CCOC has a good prognosis after surgery. In large mandibular CCOC, wide resection and composite fibula free flap reconstruction is the treatment of choice.

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Here we report a patient with a blow-out fracture of the orbital floor that was treated by an intraoral transmaxillary approach. This 38-year-old man suffered a sudden blow to the periorbital area, which caused prolapse of the orbital contents into the maxillary sinus. The modified Caldwell-Luc approach was used to repair the orbital blow-out fracture and the maxillary sinus during was packed with Frazin gauze for 7 days to prevent recurrence of the prolapse. This was an easy and minimally invasive technique for the management of a blow-out fracture of the orbital floor.

Background A recent study from Taiwan suggested that Clostridium innocuum may be an unrecognized cause of antibiotic-associated diarrhea (AAD) and clinically indistinguishable from C. difficile infection. Our objective was to compare C. innocuum prevalence and strain between those with AAD and asymptomatic controls. Methods In this cross-sectional study, we collected stool from 200 individuals with AAD and 100 asymptomatic controls. We evaluated the association between AAD and C. innocuum in stool using anaerobic culture and qPCR. To identify strain-specific associations with AAD, we performed whole genome sequencing of C. innocuum isolates using Illumina MiSeq and constructed comparative genomics analyses. Results C. innocuum was isolated from stool of 126/300 (42%) subjects and more frequently from asymptomatic controls than AAD subjects (50/100 [50%] vs. 76/200 [38%], respectively; p = 0.047). C. innocuum isolation frequency was not associated with AAD in either the adult or pediatric subgroups. C. innocuum and C. difficile were frequently co-prevalent in individuals with and without diarrhea. There were no phylogenetic differences or accessory genome associations between C. innocuum isolates from AAD subjects and asymptomatic controls. Conclusion C. innocuum was frequently isolated and at a greater frequency in asymptomatic controls than those with AAD. We did not identify strain lineages or accessory genomic elements associated with AAD. These data highlight that differentiating C. innocuum-associated diarrhea from asymptomatic colonization, and differentiating diarrhea caused by C. difficile from C. innocuum, are clinical microbiology challenges that require additional investigation to identify host-specific factors and/or biomarkers that distinguish these conditions.

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adherence to road safety regulation and poor road conditions are some of the major factors leading to MVA in developing countries like Ghana. Mandibular fracture, which can occur solitarily or in combination with other facial and skeletal injuries is also frequently caused by assault, industrial accidents, contact sports, falls, and firearm injuries.The Department of Oral and Maxillofacial Surgery at the Sunyani Regional Hospital, which has a bed capacity of 450, supports the medical needs of the middle, northwestern, and northern belts of Ghana. This is the only accredited center in the middle and northern regions of Ghana. It thus receives referrals from five regions of Ghana as well as from eastern Cote d'Ivoire.The objectives of this study were to describe the epidemiology of the mandibular fractures in Ghana and to evaluate the efficacy of closed reduction and indirect fixation techniques to successfully manage mandibular fractures in a low-

Human sparganosis is a parasite infection caused by the larva of a tapeworm of the genus Spirometra. Ocular, central nervous system, auricular, pulmonary, intraosseous, intraperitoneal, and subcutaneous manifestations of this infection in the neck or inguinal region have been described.The authors report the rare occurrence of cutaneous forehead sparganosis of a 19-year-old male who presented with a soft subcutaneous mass in the forehead, along with a related literature review.