iosr-JDMS   Volume-13 ~ Issue-9 ~ September-2014

Abstract: Cardiac tumours in the paediatric age group are extremely rare, occurring approximately 1 in 100,000 live births. Rhabdomyomas are the most common type of cardiac tumours. Approximately 70-95% of rhabdomyomas are associated with tuberous sclerosis. We are reporting a rare case of term neonate, with antenatally diagnosed cardiac tumour. Finally diagnosed as tuberous sclerosis with secondary epilepsy with large multiple cardiac rhabdomyomas. Child is now 2 years old, under follow-up without any cardiac manifestations and rhabdomyomas are regressing on repeat echocardiograms. Only few such cases are reported in literature so far and none from Rajasthan.

Key Words: rhabdomyomas, cardiac tumours, tuberous sclerosis

[1]. Park M.K., editor, Cardiac tumors. In: Pediatric cardiology for practitioners. 5th Edition. Philadelphia: Mosby Elsevier, 2008: 402-406

[2]. Spicer R, Ware S. Tumors of the Heart. In: Kliegman R.M., Stanton B.F., Geme J.W.S., Schor N.F., Beherman R.E., editors. Nelson's textbook of pediatrics. 19th edition. Philadelphia: Saunders Elsevier, 2012:1637
[3]. Aggarwal M, Sachan R, Arya S, and Chellani H. Cardiac rhabdomyoma—a case report. Journal of Tropical Pediatrics, 2010, 56;5:345-347
[4]. Ibrahima C.P.H., Thakkera P., Millerb P.A., Barron D. Cardiac rhabdomyoma presenting as left ventricular outflow tract obstruction in a neonate. Interactive cardiovascular and thoracic surgery 2003; 2:572–574
[5]. Aideyan U.O., Zaleski C G., Rodriguez M. M..Pediatric case of the day. Radiographics, May-June 1997:805-807
[6]. Erdem S, Küçükosmanoglu O, Salih O. K, Poyrazoglu H, Erdogan F, Tunali N, Özbarlas N. A case report: rhabdomyoma caused right ventricular outflow tract obstruction in an infant. Anadolu kardiyol derg, 2003; 3: 171-173

Abstract: Aims: To determine any functional lung impairment amongst patients diagnosed with hypothyroidism by spirometry. Methods: 21 hypothyroid subjects with TSH ≥10 mIU/L aged between 18-52 yrs were studied along with 21 healthy controls in the department of Physiology, Regional Institute of Medical Sciences (RIMS), Imphal. Hypothyroid subjects with other conditions/diseases which affect PFT were excluded. Spirometric parameters were conducted by means of computerised spirometer HELIOS 401/701(RMS, Chandigarh).The spirometric parameters studied are FVC, FEV1, FEV1/FVC, FEF25-75%, PEFR. Unpaired T-test and Pearson correlation was used and P value <0.05 was taken as significance. Result: Hypothyroid subjects showed a reduction of the % predicted value of FVC, FEV1, FEF25-75%, PEFR as compared to control subjects even though these values are within the normal values for their age, sex and gender. But the difference is statistically significant only for FVC. And the % predicted value for FEV1/FVC of hypothyroid subjects is found to be significantly increased than the controls. On analyzing and classifying only the hypothyroid subjects based on FVC values, 47% of the hypothyroid subjects were normal while 9% had mild restrictive lung impairment and the rest 43% had moderate to severe restrictive impairment. A negative correlation was found between TSH levels with the spirometric parameters FVC, FEV₁, FEV1/FVC and a positive correlation was found between T4 levels with FVC, FEV₁, FEV1/FVC. But none of the findings were not statistically significant. Conclusion: The pulmonary functions can be affected in hypothyroidism and they show a restrictive pattern of lung impairment.

Keywords: Spirometer, hypothyroidism, FVC, FEV1, FEV1/FVC

[1]. Braverman LE, Utiger RD. Introduction to hypothyroidism. In: Braverman LE, Utiger RD, Werner SC, Ingbar SH,editors. The thyroid: A fundamental and clinical text. 9th Ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p.697-9.
[2]. Zwillich CW, Pierson PJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. N Engl J Med 1975; 292: 662-5.
[3]. Siafakas NM, Salesiotou V, Filaditaki V, Tzanakis N, Thallassinos N, Bouros D. Respiratory muscle strength in hypothyroidism. Chest 1992; 102(1): 189-94.
[4]. Cakmak G, Saler T, Saglam Z, Yenigen M, Demir T. Spirometry in paients with clinical and subclinical hypothyroidism. Tüberküloz ve Toraks Dergisi 2007; 55(3): 266-70.
[5]. Biondi B. Thyroid and obesity: An intriguing relationship. J Clin Endocrinol Metab 2010 Aug; 95(8): 3614-7.
[6]. Salome CM, King GG, Berend N. Physiology of obesity and effects on lung function. J Appl Physiol 2010; 108: 206-11.
[7]. Brent GA, Davies T. Hypothyroidism and Thyroiditis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, Editors.Williams Text book of Endocrinology. 12th ed. Philadelphia WB. Saunders Co, 2011. p.409.

Abstract: Rapid emergence of ESBL production in GNB has put forward a major challenge in their detection as well as treatment options. Therefore for proper management of these resistant bacteria it is very important and necessary to correctly identify them. Aim: To know the prevalence of ESBL producing GNBs in all clinical isolates received in the Microbiology Laboratory of GMCH Aurangabad. Method: The study was conducted from June 2008 to July 2009. Our study group included 711 GNB,s identified by Grams staining, colony morphology and biochemical reactions. AST was done on MHA by Kirby Beurs disc diffusion method. All the organisms suspected of producing ESBL by the CLSI screening criteria were confirmed by the phenotypic confirmatory disc diffusion test (PCDDT). Result: Out of the 711 GNB tested, 433(61%) were found to be ESBL positive by the PCDDT method. The different GNB's identified were Klebsiella pneumoniae (47%) E. coli (23%), Pseudomonas spp. (21.37%), etc. ESBL production was most common in Klebsiella pneumoniae (74%), followed by E. coli (62%), Enterobacter spp. (60%) etc. Imepenem showed the highest rate of sensitivity (97%). Conclusion: Since ESBL producing GNBs are on a constant rise, it is very necessary to test all the organisms for ESBL production by the screening and confirmatory methods. Spread of these ESBL producers should be prevented by infection control policy and empirical use of antibiotics.

Keywords: ESBL, Infection control policy, Multidrug resistance, PCDDT, Prevalence

[1]. Nurul M A, Loo H K C, Subramaniam G, Wong E H, Selvi P, Ho S, Kamarulzaman A. and Parasakthi N. Faecal prevalence of extended-spectrum ß- lactamase (ESBL)-producing coliforms in a geriatric population and among haematology patients. Malaysian J Pathol 2005; 27(2): 75 – 81.
[2]. Ali A M, Rafi S, Qureshi AH. Frequency of Extended Spectrum Beta Lactamase Producing Gram Negative Bacilli among Clinical Isolates at Clinical Laboratories of Army Medical College, Rawalpindi. http://ayubmed.edu.pk/JAMC/PAST/16-1/Aarif.htm [3]. David L. Paterson and Robert A. Bonomo. Extended-Spectrum ß-Lactamases: A Clinical Update. Clinical Microbiology Reviews 2005: 18(4): 657-686.
[4]. Sanders CC, Barry AL, Washington JA, Shubert C, Moland ES, Traczewski MM, Knapp C, Mulder R. Detection of ESBL producing members of the family Enterobacteriaceae with the Vitek ESBL test. J Clin Microbiol 1996; 34: 2997-3001.
[5]. Andrea J. Linscott and William J. Brown. Evaluation of Four Commercially Available Extended-Spectrum Beta-Lactamase Phenotypic Confirmation Tests. Journal of Clinical Microbiology 2005; 43(3): 1081–1085.

Abstract: Giant pulmonary hamartoma (diameter > 9cms) is a very uncommon benign tumor with only eleven reported cases. Here we report such a rare case of giant pulmonary hamartoma measuring 12cms in diameter occupying almost whole of the left hemithorax. CT guided FNAC was done in suspicion of a malignant tumor but the cytomorphological features were of a benign cartilaginous neoplasm. The cytological findings were correlated with the radiological features and a diagnosis of chondroid hamartoma was suggested on FNAC. The diagnosis was later confirmed by histopathological examination.

Key Words: lung, giant chondroid hamartoma, fine needle aspiration cytology

[1]. Van den Bosch J, Wagenaar S, Corrin B, et al. Mesenchymoma of the lung (so-called hamartoma): A review of 154 parenchymal and endobronchial cases. Thorax 1987;42:790-3.
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[4]. Bateson EM. So-called hamartoma of the lung-a true neoplasm of fibrous connective tissue of the bronchi. Cancer 1973;31:1458-67.
[5]. Tallini G, Vanni R, Manfioletti G, et al. HMGI-C and HMGI(Y) immunoreactivity correlates with cytogenetic abnormalities in lipomas, pulmonary chondroid hamartomas, endometrial polyps and uterine leiomyomas and is compatible with rearrangement of the HMGI-C and HMGI(Y) genes. Lab Invest 2000;80:359-69.

Abstract: Amniotic fluid is the nourishing & protecting liquid of the amnion of a pregnant woman& at 10 weeks it contains proteins, carbohydrates, lipids, phospholipids, urea, electrolytes all of which helps in the growth of fetus & in later stages it consists of fetal urine. As the fetus grows amniotic fluid increases to maximum of 800-1000ml at 34 weeks and decreases to 600-800ml at 40 weeks. It protects the baby by cushioning too. Any decrease in the amniotic fluid leads to intra uterine growth restriction, meconium aspiration syndrome, severe birth asphyxia, low Apgar scores, congenital abnormalities, contracture of the limbs, clubbing of feet & hypoplastic lungs. so early detection and intervention might decrease the perinatal mortality and morbidity and decrease in the C-section rate also. Aims & Objectives: To study the effect of severe oligohydramnios on maternal morbidity, neonatal morbidity & mortality & incidence of congenital abnormalities. Materials & Methods: 100 cases of term pregnancies with severe Oligohydromnios admitted to labour room, between June 2013 to Dec 2013 were selected. After considering inclusions & exclusion criteria, a detailed history was taken and general physical examination, obstetric examination& clinical pelvimetry was done & Bishops score was assessed. Severe Oligohydromnios was confirmed by estimation of AFI by USG & in all cases Doppler study was done. Conclusion: Severe Oligohydromnios has been linked with adverse perinatal outcome which includes structural anomalies, SGA, IUGR, post maturity syndrome, cord compression, MAS &FHR variations & increased perinatal morbidity & mortality. Hence it demands early diagnosis, intense antenatal care of maternal & fetal factors, intervention with hydration and isotonic therapy, intense intrapartum care, intervention at the appropriate time to decrease fetal morbidity & mortality.

Key words: Oligohydromnios , Maternal outcome ,Fetal outcome ,Caesarean section , Induced labour

[1]. OLT WJ Revaluation of the relationship between amniotic fluid volume & perinatal outcome. AMJ Ob Gynec:2004:192:1803-1809.
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[5]. Casey BM, MC intire DD, Bloom SL,Lucas MJ, Santos R,Twickler DM et al. Pregnancy outcomes after antepartum diagnosis of oligohydromnios at or beyond 34weeks of gestation.AMJ Obstetrics & Gynaecology 2000;182(4) 909-12.

Abstract: A 25 year old male patient, farmer presented with symptoms of pain, swelling and restricted right knee movements since 6 months. Range of motion was severely restricted with fixed flexion deformity of 20 degrees. X-ray of knee (anterior posterior and lateral view) showed osteolytic lesion involving distal femur with intra-articular extension and MRI showed involvement of distal 10 cms of ephiphysiometaphyseal area of femur with focal intra-articular extension and into tibia. Biopsy was done initially following the standard principles. Histopathological report turned out to be gaint cell tumour without sarcomatous changes. The treatment options available were biological knee construction (i.e. arthrodesis with internal/external fixation and auto bone grafting) and megaprosthetic knee replacement. Excision of tumour followed by arthrodesis with custom made intramedullary interlocking nail with fibula and iliac bone grafting. Post operatively there was 2 cms shortening was present. On 1 year follow up patient is carrying out his daily living activities and radiographs done showing good graft consolidation and without any signs of recurrence.

Key Words: Gaint cell tumour, biologic reconstruction.

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[3]. Cheng et al., 2001. Cheng C, Shih H, Hsu K, Hsu R: Treatment of giant cell tumor of the distal radius. Clin Orthop Relat Res 2001; 383:221.
[4]. Forest et al., 1998. In: Forest M, Tomeno B, Vanel D, ed. Orthopedic surgical pathology: diagnosis of tumors and pseudotumoral lesions of bones and joints, Edinburgh: Churchill Livingstone; 1998.
[5]. Current concepts in Bone and soft tissue tumors: Dr Ajay puri, Dr.M.G.Aggarwal Labs et al., 2001. Labs K, Perka C, Schmidt R: Treatment of stages 2 and 3 giant-cell tumor. Arch Orthop Trauma Surg 2001; 121:83

Abstract: Hydatid disease is a cyclo-zoonotic parasitic infection mainly affecting liver and lung. Primary hydatid cyst in the muscle is very rare and is usually secondary, resulting either from the spread of cysts spontaneously or after surgery. Here, we report a case of primary hydatid cyst within brachialis muscle, with emphasis on the fact that it should be included in the differential diagnosis of peripheral cystic mass to avoid invasive investigations like FNAC. It results in better patient management because leakage of the cyst contents may not only result in recurrence and dissemination, but may also cause anaphylaxis and subsequent surgical resection difficult. Key words: Hydatid Cyst; Echinococcosis; Intramuscular

[1]. Nepalia S,Joshi A,Shende A et al. Management of echinococcosis. J assoc Physicians India 2006;54:452-456.

[2]. Akhter J,Khanam N,Rao S.clinico epidemiological profile of hydatid diseases in central India,a retrospective and prospective study. Int J Biol Med Res 2011;2:603-606.

[3]. Arora V, Nijjar IS, Gill KS, Singh G. Primary hydatid cyst of muscle-A rare site. Indian J Radiol Imaging.2006;16:239–41.

[4]. Muñoz Sánchez JA, Conthe Gutiérrez P, Arnalich Fernández F, Fernández A, García Seoane J, Ortiz Vázquez J, et al. The incidence of hydatidic disease in a general hospital. I. Epidemiological analysis of 1056 cases. Med Clin (Barc) 1982;78:421–6. [PubMed]
[5]. Merkle EM, Schulte M, Vogel J, Tomczak R, Rieber A, Kern P, et al. Musculoskeletal involvement in cystic echinococcosis: report of eight cases and review of the literature. Am J Roentgenol 1997;168:1531-4.

Abstract: Background: Insulin is a valuable drug in treatment of Diabetic Mellitus (DM)patients. Insulin will have tremendous impact, when it is used properly. Aim of Study: To determine the mean differences of nurses' years of practice by socio-demographic characteristics, knowledge about DM as well as with insulin injection technique among volunteering nurses of three main hospitals in Al-Hillah CityMaterials and Methods: Ahospital-based cross sectional study design was carried out on 200 volunteering nurses from three main general hospitals. The study duration was from January and May 2014. Categorical variables were presented as frequencies and percentages. Continuous variables were presented as means with their 95% confidence interval (CI). Independent sample t-test was used to compare means between two groups. One way Analysis of variance (ANOVA) was used to compare means between more than two groups. A p-value of ≤ 0.05 was considered as statistically significant. Results: The overall mean age of nurses was 37.07±10.72 years old. The mean year of practice for nurses was 15.85± 11.72 years. Majority 65.0%, 78.0% and 64.0% of nurses were male, married and from urban area. Majority 61.0% of nurses completed high school; meanwhile, only 35.0% of nurses had the position head of nurses.There were significant mean differences of nurses' years of practice by nurses' socio-demographic characteristics except the work shift. Meanwhile, there were significant mean differences of nurses' years of practice by nurses' knowledge about DM. There were significant mean differences of nurses' years of practice by the questions: While giving insulin, did you check expired day, While giving insulin, which angle did you use and While giving insulin, did you use alcohol wipes prior to injection.Conclusion: This study has explored several aspects of diabetes and or insulin-related knowledge and practice among nurses in General Hospitals of Al-Hillah City. It has identified the need for improvement in their knowledge and practices for educating and treating diabetic patients attending hospitals.

Key words: Diabetes Mellitus (DM), Nurses, Years of Practice, Knowledge, Insulin Injection Technique

[1]. Shu AD, Myers MG, Shoelson SE. Pharmacology of endocrine pancreas. In: Golan DE, TashjianJr AH, Armstrong EJ, Armstrong AW, editors. Principles of pharmacology the pathophysiologic basis of drug therapy. 2nd ed. New Delhi: Wolters Kluwer (India); 2008.
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[5]. Gersten B. 2007, Diabetes in the Eastern Mediterranean and Gulf Regions. Available from: http://memrieconomicblog.org/bin/content.cgi? article=59 [Last Accessed on 2010 Sep 12].

Abstract: Anatomy forms one of the basic sciences to cultivate academic knowledge and clinical experience. A multidisciplinary approach is used to teach anatomy using both classical and modern approach. Such integration of various methods of teaching enhances the student's knowledge of anatomy and their clinical experience. Also teachers should be sensitive to various problems faced by students relating to their experience with cadaver, improving their conceptual knowledge and making anatomy learning a enjoyable experience

[1]. Salient features of regulations on graduate medical education. Available at http://mciindia .org\know\rules_mbbs.htm( accessed on 8 august 2014)
[2]. Team based learning methods in teaching topographical anatomy by dissection. Burqess AW, Ramsey Stewart G, May J and Mellis C. Anz J Surg 2012; 82(6); 457-60[pubmed]
[3]. Digital report in an anatomy laboratory : a new method for team based dissection, reporting and evaluation. Oh CS, Kim KJ, Ching E and Choi HJ. Surg RadiolAnat 2014( accessed on 24 Aug 2014)[pubmed]
[4]. Psychosocial aspects of donation and dissection course. An extra curricular program with the objective of assisting students confront issues surrounding gross anatomy lab. Weyers S, Noack T and Rekhamper. GMS Z Med Ausbild 2014 [pubmed] ( free PMC article)
[5]. Perceptions of cadaveric dissection in anatomy teaching. Naz S,Nazir G, IramS, Mohammad M,Umair, Qari IH,Mohammad S. J Ayub Med Coll Abottabad 2011;23(3);145-8

Abstract: Background: Delivery modalities are importantobstetrical issues. Joint hypermobility (JHM) is a common clinical condition with striking female predominance. The aim of the study was to assess JHM in women with cesarean section (CS). Methods: This case control study included 100 women with CS and 100 women with normal vaginal delivery (NVD) matched in age and BMI. Joint mobility was measured by a blinded observer according to Beighton score. Women with joint mobility score ≥ 4 were hypermobile. Results: JHM was significantly less in women with CS than NVD group [8 (24.2%) vs 25 (75.8%), OR (95% CI), P=0.002].Total joint mobility score was significantly less in CS group (111) than in NVD group (197) (p=0.002).Joint mobility score at cut off ≤ 3 had accuracy of 59 %, with positive predictive value 55 % , sensitivity (92%), and specificity (25%). Conclusions: Joint mobility was reduced in women with CS. Joint mobility score at cut off ≤ 3 had moderate accuracy and high sensitivity to diagnose women who may need CS. This may suggest that women with more hypermobile joints may be a prognostic and facilitating factorof spontaneous vaginal birth.

Keywords: Joint hypermobility, Cesarean section, Beighton score

[1]. Festin MR, Laopaiboon M, Pattanittum P, et al. Caesareansection in fourSouthEastAsiancountries: reasons for, rates, associatedcarepractices and healthoutcomes.BMC Pregnancy Childbirth. 2009 May 9;9:17.
[2]. Charoenboon C, Srisupundit K, TongsongT.Rise in cesareansectionrateover a 20-yearperiod in a publicsectorhospital in northernThailand. Arch Gynecol Obstet. 2013 Jan;287(1):47-52
[3]. Niino Y. The increasing cesarean rate globally and what we can do about it. Biosci Trends 2011; 5(4):139–150
[4]. Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol 2007; 34:804–9
[5]. Aydeniz A, Dikensoy E, Cebesoy B, et al. The relation between genitourinary prolapse and joint hypermobility in Turkish women. Arch Gynecol Obstet. 2010; 281:301–4.
[6]. Calguneri M, Bird HA, Wright V. Changes in joint laxity occurring during pregnancy. Ann Rheum Dis. 1982; 41(2):126–128. [PubMed: 7073339]

Abstract: Background: Testicular torsion occurs when a testicle torts on the spermatic cord resulting in the cutting off of blood supply. The most common symptom is acute testicular pain and the most common underlying cause, a bell-clapper deformity. Testicular torsion implies obstruction of first venous, and later, arterial flow. The extent of testicular ischemia will depend on the degree of twisting (180°-720°) and the duration of the torsion. Testicular salvage is more likely in patients treated within 4-6 hours after the onset of torsion. Case Presentation: We came across an unusual case of testicular torsion in a 75 years old man,who presented to our emergency department with a 7 days history of right-sided testicular pain with no pyrexia,urinary symptoms and negative urine routine ,initially treated with antibiotics elsewhere as torsion amongst the elderly population is rarely described. This case presents the oldest surgically confirmed case of testicular torsion, in a 75-year-old male, documented in a journal so far .There was no pyrexia or urinary symptoms and negative urine routine. In adults above the age of 40, likely diagnoses include epididymo-orchitis, epididymitis, neoplasm or hydrocele. Clinical differentiation with epididymo-orchitis can be difficult in any age range. Clinical signs such as fever, elevated C-reactive protein and positive urine test are suggestive of epididymo-orchitis/orchitis. Conclusion: This case study demonstrates that testicular torsion can occur at any age, and clinical suspicion should always be high in patients presenting with testicular pain and a negative urine tests, regardless of age. Although risk in this subgroup is low, the identification of a potentially reversible testicular abnormality should be of high priority.

Key words: Testicular torsion, bell-clapper deformity,testicular ischemia, twisting degree (180 – 720 ),testicular salvage, old age (75 yrs ),epididymo-orchitis,epididymitis,neoplasm, hydrocele.

[1]. Alfert HJ, Canning DA. Testicular torsion in a 62 year old man. J Urol 1987;138:149–50.
[2]. Edelsberg JS, Surh YS. The acute scrotum. Emerg Med Clin North Am 1988;6:521–46.
[3]. Arce JD, Cortes M, Vargas JC. Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis. Pediatr Radiol 2002;32:485–91.
[4]. Chiang MC, Chen HW, Fu RH, Lien R, Wang TM, Hsu JF. Clinical features of testicular torsion and epididymo-orchitis in infants younger than 3 months. J Pediatr Surg 2007;42:1574–7.
[5]. Dunne P, O'Loughlin B. Testicular torsion: time is the enemy. ANZ J Surg 2000;70:441–2.
[6]. Jaison A, Mitra B, Cameron P, Sengupta S. Use of ultrasound and surgery in adults with acute scrotal pain. ANZ J Surg 2011;81:366–70.

Abstract: Ectopic thyroid gland is characterized by the presence of thyroid tissue outside its normal position resulting from a defect of the thyroid diverticulum migration from the base of the tongue until its final pre-tracheal position. The incidence of lingual thyroid is very less which varies from 1:3000 and 1:10,000. Lingual thyroid may sometimes present with symptoms of respiratory obstruction or feeding difficulties. It may lead to serious problem ranging from asymptomatic swelling to lethal condition. The authors present a 40−years−old man with an ectopic thyroid gland in the base of the tongue, found accidentally during the laryngeal intubation. Keywords: Ectopic gland, Lingual thyroid, Lingual thyroid nodule, Thyroglossal duct

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Abstract: Background: In India 30% of doctors working in rural areas where 68.84% of the population is residing. India may not achieve health related millennium development goals, as required investments yet to be made in health sector, although a beginning has been made by the NRHM, which is facing several constraints, notable among these constraints is the insufficient deployment of human resources, especially doctors in the health institutions located in the rural areas.. Objectives: 1) To know the socio-demographic profile of study population 2) To study the attitudes towards rural health service in study population Methods: A Cross sectional study was conducted among 100 randomly selected postgraduate medical students of Andhra Medical College, Visakhapatnam with self-administered pretested questionnaire& Informed consent was taken from the study subjects.The data was analyzed with the help of MS EXCEL. Results: Among study population 53% male, 47 % female, 27% are in-service postgraduates. 52% from urban 46% rural & 2% from tribal areas and17% of the study population said that health care services are sufficient 83% disagreed,interestingly 56% are interested to work in rural areas. Conclusion: About56% of Postgraduates are interested to work in rural areas provided sufficient infrastructure is present.

Keywords: Attitude, infrastructure, living facilities, Post Graduate medical student, Rural Health Service

[1]. Getting doctors to the villages; will compulsion work? Editorial by SP Kalantri, Indian journal of medical ethics vol 3 no4 oct- dec 2007
[2]. Issues of creating a new cadre of doctors for rural India Cherumanalil Jeeja International Journal of Medicine and Public Health | Jan-Mar 2013 | Vol 3 | Issue 1
[3]. Revitalizing Rural Health Care Delivery: Can Rural Health Practitioners be the Answer? Kapil Yadav, Indian Journal of Community Medicine / Vol 34 / Issue 1 / January 2009
[4]. For more than love or money : Attitude of student and in-service health workers towards rural service in India Ramani et.al,Human Resources for Health 2013.
[5]. Attracting doctors to rural health services of India, Hemant Deepak Shewade,the national medical journal of India, vol 25,no 6, 2012.

Abstract: As a preliminary work the macroscopic and macroscopic study of thymus of pig was carried out. 2 male and 2 female pigs weighing 80±10 kgs were used. The thymus of these animals was procured in the slaughter house where it is sacrificed for edible purpose. It was a large bilobed structure situated in the superior mediastinum. Tissue from the thymus was processed and stained with H&E. Lobules were observed. Cortex and medulla could be differentiated. Two to three Hassall's corpuscles were observed and the distribution was uniform.

Key Word: Thymus, Hassall's corpuscles, cortex, medulla

[1]. Gail Pearse: Normal structure function and histology of thymus. Toxicologic Pathology 34: 504, 2006.
[2]. R K Ajitha, Th. Naranbabu Singh, Y. Ibochouba Singh, L. Chandramani Singh. An insite into the structure of the thymus in human fetus – a histological approach. J. Anat. Soc. India. 55 (1): 45, 2006.
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[4]. Tatsuya Irifune, Masakatsu Tamechika, Yasuhiro Adachi, Novuko Tokuda, Tomoo Sawada, Tetsuo Fukumoto. Morphological and immunohistochemical changes to thymic epithelial cells in the irritated and recovering rat thymus. Arch Histol Cytol, 2004, 67 (2); 149-158.
[5]. Krystyna Wyrzykowska & Zygmunt Wyrzykowski. Structure and topography of the thymus in the European Beaver. Acta Theriologica; 1949, vol 24, 29; 399-404.

Abstract: Solitary plasmacytoma of bone (SPB) is a rare disease, defined as clonal proliferation of plasma cells identical to those of plasma cell myeloma, which manifest as localised osseous growth with no evidence of disease dissemination. We report a case of solitary plasmacytoma of Right 6th rib in 28-year-old male. The patient underwent complete en-bloc resection of the chest wall harbouring the tumour, ribs, muscles, and parietal pleura with reconstruction of chest wall. Patient is asymptomatic and in regular follow up .

Key Words: Chest wall, plasmacytoma, ribs, solitary tumor

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[2]. Goel G, Rai S, Naik R, Gupta A, Baliga P, Sinha R. Cytodiagnosis of extramedullary plasmacytomas. ActaCytol. 2010;54:255–8. [3]. Bousnina S, Zendah I, Marniche K, Yalaoui S, El Mezni F, Megdiche ML, Chabbou A. Solitary plasmocytoma of the rib: A rare tumor not to miss. Rev Pneumol Clin. 2006;62:243–6.

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Abstract: 28years old female presented with cough, dysponea and recurrent pulmonary infection. The CT and MRI Chest revealed middle mediastinal mass with pericardial attachment. She underwent midline sternotomy with successful enblock removal of the mass, the biopsy confirmed benign mature teratoma arising from pericardium. She was discharged on the 6th post operative day, and is in regular follow up.

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Abstract: The success of prosthetic treatment is predicted not only on the dentist's manual dexterity but also on the ability to understand the patient needs. Patient with complete edentulism undergoes many esthetic consequences among which sunken appearance of cheek has a great psychological effect on the individual that can add ages to a patient age. Prosthetic rehabilitation of such patient not only confines to replacement of missing teeth but also restoring the lost cheek support. This article focuses on simple, effective and a noninvasive method for restoring the slumped facial musculature by incorporating cheek plumper in the dentures and an innovative technique for the fabrication of detachable cheek plumper through custom made attachment.

Keywords: Denture, Esthetics, Cheek plumper

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