Dyskeratosis congenita (DC) is a rare hereditary disorder characterized by bone marrow failure, cancer predisposition (11-fold increase compared to general population), ectodermal dysplasia (nail dystrophy, oral leukoplakia, and abnormal skin pigmentation) and other additional somatic abnormalities. A 22-year-old man presented with fever, chills, and a painful throat. Leukoplakia was noted on his tongue and some of his fingers and toe nails were markedly dystrophic. His skin seemed spotted with pigmentation on the anterior chest and neck. Patient reported family history of “blood disease” and leukemia. He was admitted for the management of neutropenic fever (102.9 °F, WBC: 940, ANC: 404, platelets: 21,000 and Hb: 9.2), and was put on broad spectrum antibiotics. A bone marrow biopsy revealed normocellular marrow with erythroid predominance and mild dyserythropoiesis. Chromosomal analysis indicated no numerical or structural chromosomal abnormalities. The fluorescence in situ hybridization report did not reveal any assay specific abnormalities. Viral marker for hepatitis and studies of autoimmune antibodies showed negative results. CT scan had shown splenomegaly. Patient was discharged after he has been fever and symptoms free, with a follow-up at hematology clinic. Individuals with DC most commonly present with skin pigmentation, dystrophic nails and leukoplakia, as presented in this case. Genetic abnormality was not confirmed in our patient, but it is suggested that X-linked recessive pattern would be significant because of greater prevalence in men than in women (10:1). The distribution of blood counts and bone marrow biopsy categorizes our patient in the moderate aplastic anemia class which is the most prevalent pattern. When fever in young patients with a failing bone marrow is diagnosed, it is important that physicians rule out the possible underlying causes. DC is a rare disease, but can be diagnosed by simple inspection of the mucocutaneous abnormalities. DC is a severe multisystem disorder associated with premature morbidity and mortality. We believe that reporting this case would add more information to the existing fund of knowledge.

Introduction. Esotropia is a form of strabismus that can give the affected individual a “cross-eyed” appearance. Acute onset of esotropia is an uncommon form; in the vast majority of cases, no underlying neurological etiology is found. Case Presentation. A 22-year-old female with a long history of opiate abuse presented with acute onset of diplopia. She noted her eyes were crossing and started seeing double. She stopped using heroin 11 days prior to presentation. There was large inward deviation of her left eye. Convergence was difficult and accompanied by horizontal nystagmus. Diplopia resolved by covering each eye. Further investigations including imaging studies were normal. Discussion. Acute onset esotropia is rare and must be investigated right away to exclude central nervous system pathologies, where no opiates use is reported. Diplopia in the form of acute esotropia may manifest in up to 30% of individuals undergoing heroin withdrawal. Evaluating acute esotropia requires detailed information of medical history with an emphasis on drug use. Conclusion. Acute onset esotropia with double vision can be caused by abrupt withdrawal of opiates. This case should serve to raise awareness among health care professionals, to avoid costly and unnecessary diagnostic evaluations and interventions.

Abiotrophia is a nutrition-deficient gram-positive cocci comprising of mainly two species (A. adiacens and A. defective). The name Abiotrophia is derived from the Greek language meaning "life nutrition deficiency". Abiotrophia species is part of normal flora of the human upper respiratory, gastrointestinal, and urogenital tracts. It has been associated with serious infections like bacteremia and endocarditis. This paper discusses a case of A. adiacens causing bacteremia and vertebral osteomyelitis. A 62-year-old male presented with back pain, fever and chills. Spinal imaging study showed spinal abscess and spinal osteomyelitis, and the blood culture grew A. adiacens. Abiotrophia species, formerly referred to as nutritionally variant streptococci, needs supplemented media for growth and survival. There are extremely few cases that have been reported with spinal involvement due to Abiotrophia species. Resistance to multiple antibiotics has been described in this species. Abiotrophia-associated infections are rare but could be life-threatening. Clinicians should be cognizant of its potential in causing severe infections. We report this case in an attempt to increase awareness about this organism.

The general objective of this study was to investigate EFL teachers' implementation experiences of communicative language teaching with reference to selected secondary school EFL teachers in East Wollega Zone, Ethiopia. To achieve the intended objective, descriptive survey research design with mixed approach was employed. Data was collected through questionnaire, classroom observation, interview and textbook analysis. The teachers were selected through availability sampling technique for questionnaire, and randomly for classroom observation and interview. The quantitative data was analyzed by descriptive statistics using SPSS version 20 while the qualitative data was analyzed by narrating the information thematically. Accordingly, it was found out that the teachers rarely implemented communicative language teaching in the EFL classrooms. Opportunities were rarely given for learners to communicate in English language. There was very little interaction between the teachers and the students or among the students themselves in English language. Teaching and learning through lecture was the regular teaching activity in the study area. Teaching was seen as writing note on the blackboard, letting students copy the notes, and explaining the notes with examples. Contrary to this, grades 11 and 12 English language textbooks are designed in a way they engage students in communication. Contextual challenges related to students, teachers, university entrance examination wash back and school context affect the implementation of communicative language teaching. Therefore, it is recommended that EFL teachers should get sufficient training to implement communicative language teaching.

Acute aortic dissection is associated with significant morbidity and mortality, often from complications including aortic regurgitation, cardiac tamponade and myocardial infarction. Typical clinical presentation includes a sudden onset of severe chest pain, although this is not always consistent. Clinical signs and symptoms are diverse with an estimated 38% of cases being missed on initial evaluation. Primary neurological symptoms at presentation are rare but have been reported often to coexist with chest pain. We present a case of acute aortic dissection in which the initial presenting symptoms were predominantly neurological. Stanford type A dissection is a surgical emergency with a high burden of cardiovascular death; thus, aggressive identification and management is paramount. Our case re-emphasises the importance of having a higher index of suspicion and a keen clinical eye for atypical presentations of acute aortic dissection.