Physiology and Anatomy

Muscle lymphoma is a very rare disorder, comprising only a very small subset of lymphoma cases. It can develop either as primary extranodal intramuscular lymphoma or as intramuscular manifestation of disseminated disease. There are characteristic imaging features which, if recognized, can prevent delay in diagnosis and treatment, particularly when not suspected clinically. We herein present a rare case of primary muscle non Hodgkin lymphoma with a description if the associated clinicopathological findings and a review of the relevant literature.

Anal canal cancer represents only 1-2% of colorectal cancers. Adenocarcinoma is a rare histological type of anal cancer .The distinction between anal and rectal adenocarcinomas determines the therapeutic indication. Analysis of all morphological, immuno phenotypic and clinical criteria makes it possible to determine the anal or rectal origin of the tumor. Imaging is important for the diagnosis. It gives a precise analysis of the tumor extension to guide therapeutic management. Pelvic MRI allows loco-regional extension and evaluates loco-regional lymph node involvement. The treatment is based on the radio chemotherapy combination.

CBR as a strategy within community development for rehabilitation, equalization of opportunities, and social inclusion of all people with disabilities. The purpose of the study was Designing Community Based Rehabilitation Model using SEM. This study is a comparative-descriptive research that has been performed by factor analysis method. In the qualitative stage the process owners were 45 experts and in factor analysis stage, there were 564 CBR experts of Iran, CBR departments and rehabilitation deputies of 31 provinces and the CBR specialists and rehabilitation deputies of the CBR executing counties. The data collection tool was researcher-made questionnaire the content validity of which was determined through expert panel and its construct validity was determined through exploratory factor analysis by principal component analysis method with varimax rotation using SPSS16 software. Its reliability was also confirmed by test-retest and internal consistency method using Cronbach's Alpha (96%) and the most important community-based rehabilitation factors were identified through path analysis and structural equation modeling using LISREL software 8.8. In exploratory component analysis, 7 main components were identified; using semi-professional people with 9 variables, 43.1% variance, and 23.28 eigenvalue as the most important factor and social integration of the disabled people with 2 variables and 2.19% variance as the less important factor clarified the community-based rehabilitation changes; however, in the fitted model which is the most complete saturated model, 7 factors of subsistence with ß= 0.20, using semi-professional people with ß= 0.19, medical procedures with ß= 0.19, socio-political supports with ß= 0.18, social integration of the disabled people with ß=0.18, educational measures with ß= 0.16, and health practices with ß= 0.14 had the highest predictive power in the order of importance. Considering the cultural, economic, political, and social context of Iran, usage of the obtained factors can promote the dignity of the disabled people and their family in the society as well as empowering and equalization of their opportunities.

The styloid process is a sharp, slender, elongated pointed bone just below the ear. It extends downwards, forwards and medially. Normal length of styloid process is 2-3 cm. If it exceeds more than 3 cm it is called as elongated styloid process. Several variations in the length of styloid process have been reported. Sign and symptoms produce by elongated styloid process is known as Eagle’s syndrome which is characterized by severe pain in the throat, side of the face and ear. This may be classified as an entrapment syndrome which deserves the attention of the neurosurgeons, ENT surgeons, orofacial surgeons and physicians. The aim of this case report was to familiarize neurosurgeons, ENT surgeons with Eagle’s syndrome, its diagnosis, workup and management. In this case, we found an unusual case of long styloid process with ossification of stylohyoid ligament on the right side. Total length of the process from the base to the apex was 5.6 cm on the right side while on the left side it was normal in length i.e. 2.5 cm.

The research study investigates similar in eating habits and sleeps patterns among medical students studying for United State Examination Licensure Examination Step 1 and relationships between sleeping patterns, and eating habits on daily question banks performances. Eating Habits and Sleep Patterns Among Medical Students studying is quantitative research conducted at the Pass Program in Champaign, IL. Evaluation of eating habits and sleep patterns among medical students can be conducted by using a survey. The survey would consist of close-ended questions provided to the student for evaluations. The questionnaire would require the student to respond to eating habits such as if students are eating junk food, or eating at home by preparing their meal if students are all three meals. The second part of the survey requires an evaluation of sleep patterns such as how many hours of sleep students are getting. The third part of the questionnaire would consist of questions of on student’s performance. The surveys would require information on daily question banks based on eating and sleep habits such as if student performance increases or decreases with meals or if skipping meals have any effect on performance. The research study provided 210 students with questionnaires from which 196 Students responded, and 151 student responses were recorded. 45 Students got eliminated due to consumption of medication and fasting during the study. The results have shown 58.5% of students preferred to prepare home-cooked meals. 25.8% of students do not skip breakfast. 54.3% of students consumed pre-packaged meals on a weekly basis due to easier access and cost-effectiveness. 58% of students stated skipping meals could alter their USMLE question back performance. 67% of students indicated a lack of sleep could change their USMLE question back performance. Students are obtaining 6 hours of sleep daily but prefer 8 hours of sleep. The research study has identified risk factors such as stress, lack of sleep and time management as complications while studying for national boards. The research has shown a lack of sleep to be a significant factor that altering student’s daily performances on test bank rather than eating habits. Further evaluation of eating habits and sleep patterns are required to determine performances yearly as wells as other behavior patterns of students while studying for USMLE examinations.

Brown tumor or fibrocystic osteitis is a rare benign bone lesion secondary to exposure to excessive parathyroid hormone secretion in hyperparathyroidism. It can affect the entire skeleton; mandibular localization remains exceptional. We report a case of a 28-year-old female patient, who presented a swelling of the chin evolving for 1 year. Radiological examination revealed the presence of two mandibular lytic lesions. Histological examination after biopsy revealed a giant cell tumor, on which the diagnosis of brown tumor was evoked and confirmed by the discovery of primary hyperparathyroidism profile on parathyroid adenoma whose surgical treatment allowed a spectacular regression of the mandibular tumor. Our patient's case illustrates how the Brown tumors should be considered in the differential diagnosis of osteolytic lesions to avoid unnecessary and harmful interventions.

To present an unusual case of Multiple primary malignant neoplasms and to describe the steps we followed to evoke each diagnosis trying to reveal an underlying genetic disorder and to discuss the best strategy of treatment of our patient. We describe the work-up, diagnosis, and treatment course of a 50-year-old woman who presented with papillary thyroid carcinoma, parathyroid adenoma, pulmonary adenocarcinoma and pheochromocytoma. The tumor involvement of the parathyroid and the adrenal gland led us to think about NEM2 syndrome. Instead of medullary thyroid cancer which is invariably present in NEM2 syndromes, our patient presented a papillary thyroid cancer. We could think that the total thyroidectomy that have been performed in our patient could have prevented the appearance of a medullary thyroid carcinoma. The possibility of carrying out a DNA sequencing with research of germline RET mutation could have been very interesting to determine if this case can be considered as an unusual MEN 2A syndrome. Tumor DNA sequencing has a major role to determine molecular characteristics in different tumors and research eventual common biomolecular abnormalities, which can provide a genetic counseling.

Influenza A (H1N1) caused 18,449 deaths globally in 2009-2010 and 3,907 deaths in India from 2009- 2013. Pregnant women are at high risk. In June 2016, a pregnant woman tested H1N1-positive in Bhildeva village, Pali district, Rajasthan. We investigated to confirm and describe the outbreak, describe case management and response, and to make recommendations for prevention and control.We analyzed H1N1 January 2014-May 2016 data. We defined a suspect case as fever and cough between 15 May-15 June 2016 in a Bhildeva village resident and conducted active surveillance by house-to-house survey. We reviewed medical records and interviewed index case’s family. We compared and analyzed case management against government protocol. During January 2014- May 2016, Bhildeva village, Pali district had no H1N1 cases. We identified 21 suspect cases (attack rate: 6%); 13 (62%) were females, and 10 (47%) were relatives of index case. Median age was 22 years (range: 1-40 years). All had fever (21, 100%), cough (18, 86%), nasal secretion (6, 28%), head ache (5, 23%), body ache (2, 9%), and sore throat (1, 5%). All cases received prophylaxis, advised isolation, and demonstrated respiratory hygiene. Index case was a 24-year-old pregnant woman (23 week gestation, gravida 3) who received only one antenatal check-up at 12 weeks gestation. She initially visited two unqualified practitioners. Seven days after illness onset, she visited a private medical provider but died one week later. Three days before illness onset, she was exposed to a family member with respiratory illness.In June 2016, Pali district, Rajasthan had influenza A (H1N1) outbreak. Immediate response and case management as per protocol minimized transmission. Late diagnosis and management of high-risk index case probably contributed to death. Educate unqualified/qualified practitioners about detection, monitoring of symptomatic high-risk groups, and referral to reduce morbidity and mortality.

Dermatofibrosarcoma protuberans (DFSP) is a relatively rare skin tumor that is considered to have intermediate malignancy; it demonstrates frequent local recurrence, but systemic metastasis is rare [1]. A 38 year old male presented with multiple cutaneous nodular lesions of DFSP since 6 months, who underwent for CT scan that revealed distant metastasis to: the pleura, pancreas and psoas muscle.

Rapunzel syndrome is defined by the presence of a gastric trichobezoar that extends beyond into the small intestine. It is an uncommon pathology, which mainly affects female patients. The association with intussusception is rare. Here we report the case of a 5-year-old girl who presented to the emergency room with abdominal pain and was diagnosed with Rapunzel syndrome complicated by intussusception. She was then operated on with satisfying post-operative results and recovery