Problem-based learning (PBL) is a cornerstone of modern medical education. Principles of PBL are the construction of knowledge, prior knowledge activation, organization of knowledge, elaboration of knowledge, stepwise transfer across contexts and cooperation with other learners. It provides the ability to identify the knowledge, generate and analyze hypotheses that lead to the differential diagnosis of the case according to the complaint of the patient by using history taking, physical exam, and investigations. Application of any innovation such as PBL faces many challenges and obstacles that are related to the students, tutors, learning environment and other stakeholders. We can overcome these obstacles by more training sessions for tutors and students. In addition, the construction of PBL curriculum should be based on a community-oriented approach because it depends on the priorization of common health problems in the surrounding community.

Cyclosporiasis epidemics are caused primarily by food contaminated essentially with Cyclospora cayetanensis protozoa from Phylum Apicomplexa. National Outbreaks Reporting System (NORS) provides comprehensive monitoring and records for outbreaks in the USA. The pattern of the microbial epidemics could be investigated using statistical process control (SPC) techniques including Pareto analysis and control charts. The incidence of this outbreak is higher in some states more than others, especially Florida and transmitted mainly through herbal food constituents as a vehicle. Process-behavior charts show disease patterns and trends with the rate of occurrence per day 14.4%. Most of illness cases tend to occur in the summer environment except for March in one-year due spiking in the number of affected individuals during a solitary outbreak episode.

Orbital exenteration is a mutilating surgery that involves the total removal of the orbital contents with partial or total excision of the eyelids. It is usually associated with an extremely disfiguring cosmetic outcome which requires some degree of reconstruction before an artificial eye can be placed into the socket. Often times, the orbital cavity needs to be filled with a soft tissue cover especially if the orbital fissures and optic canal is exposed. Free tissue transfer is thought to be the best option in reconstructing complex defect. However, some conditions do not permit a free flap reconstruction to be performed like in a previously irradiated bed as it increases the risk of vascular complications. We present a case of post orbital exenteration who is not suitable for a free flap and wound coverage was done with a paramedian forehead flap as an alternative.

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