Juvenile Nasopharyngeal Fibroma (J.N.A) is a rare nasopharyngeal tumor that affects male adolescents; it is a benign but locally aggressive vascular tumor due to invasion of adjacent structures. The symptomatology is not very specific; but predominated by epistaxis. His treatment is essentially surgery; however, the use of other therapeutic means: radiotherapy, interventional arteriography, chemotherapy and hormone therapy are of value in the case of locally unresectable advanced tumors. Through our observation of a case of nasopharyngeal fibroma, we discuss the clinical, radiological and histological aspects as well as the therapeutic management of these tumors.

The role of this study was to explain the relationship between religious cultures and student retention in Chartered Christian Universities in Kenya. The study was based on Students’ Integration Theory by Tinto [1] and Cultural Model of Educational Management by Bush [2]. Descriptive survey research design was adopted. The targeted population was 604 year four students, 12 Academic Deans, 5 chaplains, 5 Finance Managers, and 5 Deans of students in Chartered Christian Universities. Census method was used to sample the respondents. Questionnaires which were piloted and tested for reliability using test-retest method and validated by experts were used together with interviews to collect data. Qualitative data was later analysed and presented. Quantitative data was analysed using descriptive statistics. SPSS version 22 was employed for data analysis. Pearson Product Moment Correlations Co-efficient and regression analysis were computed to establish relationships between the two variables. Embedded Design for mixed methods was used to integrate and present the findings. It was established that religious cultures were related to student retention (r=0.437; p=0.000) and thus, the null hypothesis was rejected, and the alternate hypotheses adopted. The study recommends that chartered Christian universities in Kenya should take advantage of their religious cultures and find policies that strengthen the existing cultures as tahey develop new ones. It also recommends that the Ministry of Education should develop policies that could facilitate student retention and review the existing policies on students’ retention in institutions of higher learning in Kenya and beyond. Moreover, further research should be carried out.

As pharmaceutical industries now a days concerns with the safety and continuously enhance the quality of the drug products. The development of pharmaceutical industries is based on the innovation of the product as well as the manufacturing process by keeping quality in the mind. In earlier times, the development of pharmaceutical products shows the failure in the quality and hence alters the therapeutic effect of the product. Quality by test (QbT) was the only way to maintain the quality of the drug product before the FDA launches the current Good Manufacturing Practices (cGMP), which was an approach without understanding the processes. So FDA decided to applied the several Design of Experiments (DoE) in the pharmaceutical fields. QbD (Quality by design) was one of the design experiment approved by the FDA to maintain the quality of the drug products before reaching to the market. In pharmaceutical industry, QbD brings cost-efficiency and simplicity of manufacturing process into reality. QbD is a systematic risk-based, proactive approach to pharmaceutical development that begins with predefined objectives and emphasizes product and process understanding and process control based on sound science and quality risk management. The main aim of this review is to discuss the concept of pharmaceutical Quality by Design and describe how it can be helpful to ensure pharmaceutical quality & drug development.

Inclusive education may be understood in the way that allows students with special needs to be placed to receive instruction in the mainstream classes and to be taught by mainstream teachers. Novice teachers or teachers with differential levels of teaching experience, belonging to urban-rural background may have a differential attitude towards inclusive education set up. Keeping this in mind, the present study was conducted to study the attitudinal dispositions of elementary school teachers towards inclusive education with reference to gender, teaching experience and locality. Descriptive research design was followed for carrying out the study. The data was collected from the 120 elementary school teachers of Choudwar block and Cuttack city of Odisha. The sample was selected through stratified random sampling technique. A self-developed five-point attitude scale was used for collection of data. The findings of the study revealed that, gender, teaching experience and locality were the factors for developing differential attitudes among the teachers as there were significant differences in the mean attitude scores of elementary school teachers towards various aspects of inclusive education with reference to gender, teaching experience and locality.

Corticosteroids have proved to be extremely effective in the treatment of acute inflammation and chronic inflammatory diseases. Drug utilization review (DUR) is an on-going, systematic, criteria-based program of medicine evaluations that will help ensure appropriate medicine use. The present study aim was to evaluate the drug utilization of Corticosteroids in the various department of a tertiary care teaching hospital, Khammam. A prospective observational study was conducted to evaluate drug utilization pattern of corticosteroids. Total 249 corticosteroids were prescribed Prednisolone was prescribed in 39.5% prescription followed by hydrocortisone in 27%, budesonide in 19%, methylprednisolone in 15.5%, Dexamethasone in 9.5%, Deltazacort in 7.5%, Prednisone in 4.5% and Fluhydrocortisone in 2% respectively. 34 ADRs were detected in the study due to corticosteroid use, facial puffiness was detected in 12.50%, headache in 14.70%, Hypernatremia in 14.70%, Hyperglycemia in 17.64%, hypertension in 26.47% and osteoporosis in 14.70%. 72.6% of the drugs were prescribed from the NELM list. Clinical pharmacists interact directly with patients in several different ways. Hence, the clinical pharmacist can perform potential role in health care system in assisting physician in altering the number of medications taken, the number of doses taken, improving the patient medication adherence, detect the adverse drug reactions, drug interactions, in patient counselling, improve the health related quality of life and decreasing the health care cost of the patient.

Introduction: Low level laser therapy (LLLT) also known as photobiomodulation, is a treatment that uses low-level lasers or light-emitting diodes (LEDs) to change cellular function and is a clinically well accepted tool in shortening the duration of Orthodontic treatment which is beneficial to the orthodontists as long treatment duration is associated with increased risks of white spot lesions, gingival inflammation, decalcification and root resorption. Low-level laser therapy (LLLT) is reported to accelerate orthodontic tooth movement. Both pulsed (PW) and continuous wave (CW) modes are available in LLLT devices, which provide with a wide range of therapeutic options. The relative influence of CW and PW on Orthodontic tooth movement has not been fully studied. So the purpose of this study was to determine the effects of CW & PW on the effect of OTM. Materials & Methods: This split-mouth design study was carried on 20 patients requiring extraction of first premolars in maxillary arch. Upper Left quadrant canine was irradiated to Continous wavelength (CW) LLLT and upper right quadrant canine was irradiated with Pulsed wavelength (PW) LLLT. Gallium Aluminum Arsenide (GaAlAs) semiconductor diode laser with a wave length of 810 nm was used in two different modes. Laser Irradiation and the Traction Force of 150gm was applied on reaching 19x25 stainless steel wire at various intervals T0, T3, T6.Digital vernier caliper was used on study models as well as direct intraorally to measure the rate of canine retraction at each interval. Results: Data was subjected to various statistical tests- Kolmogorov Smirnov test, student t-test, one way ANOVA test. The rate of canine retraction was 6.58 mm at T0 (starting point) to 4.61 at T6 (6 weeks interval) in continuous wave(CW) group ( p=0.0001) while in Pulsed wave (PW) group it was 6.56mm at T0 to 2.94 mm at T6 (p=0.0001). Conclusion: The rate of canine retraction was greater in the quadrant which was irradiated with pulsed wavelength (PW) as compared to continuous wavelength (CW). More rapid tooth movement was seen between 3-6 week intervals.

Introduction: The term “hysterectomy” though means removal of uterus, in practice it has a much wider classification depending upon the indication. At times, it is done without removal of cervix (Supracervical hysterectomy) or with removal of adnexa (Hysterectomy with salpingooopherectomy). It can also be a part of staging laparotomy or radical hysterectomy. Hysterectomy can be performed abdominally, vaginally or through abdominal ports with the help of laparoscope. Materials and Methods: This is a Prospective and Comparative Study conducted in the Department of Obstetrics and Gynaecology, Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre over a period of 1 year. Total 100 patients undergoing hysterectomy for benign uterine pathology meeting the inclusion and exclusion criterion will be included in the study. 50-Laparoscopic assisted vaginal hysterectomy and 50-Total abdominal hysterectomy. Results: 95% of women of TAH group needed spinal anaesthesia and only 5% needed general anaesthesia. On the other hand, all the women of LAVH group needed general anaesthesia. Duration of surgery was little more in patients who underwent LAVH when compared to patients who underwent TAH. The average duration of surgery in TAH group is 50 minutes and it is 75 minutes in LAVH group. Only 2 patients in LAVH group needed conversion into laparotomy because of adhesions and uncontrollable haemorrhage. Fever and wound infection was more with TAH group 11.6% compared to LAVH group 5% and 3.3%. UTI was also comparatively more with TAH group., which was the reason for longer hospital stay in TAH group. RTI was observed in 3 patients of LAVH group. Conclusion: LAVH is associated with less blood loss and decreased intra operative complications when compared to TAH. Length of hospital stay is significantly less for LAVH when compared to TAH. Post-operative pain, complications and blood transfusions are more with TAH group, because of which patient had longer hospital stay and took longer time for recovery and return to work.

Sepsis is a major health problem, that significantly increases the mortality and morbidity of patients. The prognostic value of Platelet indices in septic shock has not been established. Our study aims to know the importance of platelet indices in sepsis and their value in prognosis. Details of sepsis patients from September 2018 to August 2019 were taken from case sheets and Hospital Information Management System (HIMS) in GEMS medical college and hospital, Srikakulam. Platelet (PLT) indices were recorded on the day of admission and the fifth day in hospital. The data were compared between revived and succumbed patients. A total of 100 septic shock patients were studied, of them, 55 were revived and 45 succumbed. Mean Platelet Volume (MPV) in the succumbed group was significantly higher than that of the revived group. Platelet Distribution Width (PDW) and Platelet Large Cell Ratio (PLCR) were increased, while Plateletcrit (PCT) and PLT count decreased in the succumbed group. A statistically significant difference was seen between revived and succumbed patients for PLT count and MPV which make them useful prognostic markers for patients in septic shock.

A performance evaluation is a regular analysis of the job performance of an employee and the overall contribution to an organization. It evaluates employees’ skills, achievements and lacking. The performance assessment process of employees is essential for organizations to boost the productivity of employees and improve their results. Employees are less motivated in government and private hospitals. Employees and organization did not meet each other expectations. Victor Vroom develops theory of expectancy in 1964 which applied in this scenario. Vroom stated that three major factors determine the person motivation: expectancy, instrumentality and valence. Performance appraisal used as motivational tool and it is necessary for staff sustainability. Organization should do performance evaluation of employees and give feedback according to their work. Motivation is very important to enhance employee organizational commitment, resulting in higher productivity levels. Rewards are also some of the key strategies to strengthen the motivation of employees to use their best capabilities to develop innovative ideas that could improve organizational performance.

In the scope of this research, the direct liquefaction (DL) of microalgae (Spirulina, Spartina alterniflora) and soy protein was performed in a co-solvent system consisted of water and ethanol (EWCS). We investigated the effect of reaction time, reaction temperature, an alkaline catalyst (Na2CO3), and the Ethanol-Water Co-Solvent system on the liquefaction yields and bio-oil properties. The outcome of the experiments elucidated a bio-oil yield of 49.4 %, 50.2 % and 42.7 % for Spirulina, Spartina alterniflora and Soy protein respectively in which it is much higher than the HTL runs with pure water indicating the positive effect of co-solvent on the liquefaction, and for catalytic runs the bio-oil yields were 53.7%, 50.2%, and 31.6% respectively. When compared to non-catalytic DL, Na2CO3 relatively increased the bio-oil yield of the algae samples and decreased it for the Soy protein samples. The GC-MS and FT-IR analyses displayed that there are some differences in the chemical composition and the content of compounds among the bio-oils, where the significant components were esters, ketones, amides, acids, and nitrogen-containing heterocycles. Apart from its influence on the product yield, the usage of Na2CO3 showed no significant impact on the properties of the bio-oil.

Ethical decision-making in an organization is an important process. Decision-making requires careful assessment and analysis of all possible alternatives. It is the management executives ' duty at all levels. In this case study, patient suffered due to medical harm and ethical committee did not provide justice to patient. Ethical decision-making model apply on this scenario. James Rest (1994) developed theoretical framework for understanding the process of ethical decision making. His model has four components: moral awareness, moral motivation, moral judgement and moral action. Thomas Jones gave moral intensity model in 1991. Jones concluded that the moral features, which he collectively called moral strength, affect ethical decision-making. Jones conceptualized his model so that moral strength could impact each of the Rest's Four Component Model components. Organization leaders faces moral complex situation, their consciousness of the moral conflict, their decisions on choices and consequences, and their ability to act are significantly affected by the particular aspects of the moral situation. The priniciple of ethical decision making must be followed while taking a decision.

Hypothyroidism is a common endocrine disorder associated with increase in peripheral vascular resistance and decreased cardiac output. The increase in peripheral resistance can predispose to alteration in renal hemodynamics including reduced renal blood flow associated with diminution of glomerular filtration. The study was taken up to determine the influence of thyroid hormones on serum cystatin C, creatine kinase and creatinine level in hypothyroids and to determine the extent of renal involvement in these cases. Serum T3, T4, TSH, Total creatine kinase, Cystatin C and creatinine levels were estimated. Creatinine clearance was calculated using Cockcroft Gault formula and eGFR by using MDRD formula. The elevation of serum creatinine levels in hypothyroids in the study may be due to increase in total creatine kinase level either due to myopathy or due to decreased clearance by kidney. In the study there is paradoxical relation of elevation of serum creatinine and decrease in serum cystatin C in hypothyroidism.

Introduction: In India, the number of people with diabetes is increasing day-by-day. Due to a sole “Asian Indian Phenotype,” Indians develop diabetes an era earlier and have an earlier onset of complications. Hence, it is essential to evaluate earlier stage of disease progression. Prediabetes, typically defined as blood glucose levels above normal but below the thresholds of diagnosis of diabetes, is a risk state that defines a high chance of developing diabetes. Methods: The present study was Prospective, open label, comparative, randomized, parallel group, single center study conducted at Department of General Medicine, Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre, Hyderabad. Comparison of two active treatment groups over a period of six months. Sixty patients of either sex in the age of more than 40 years with prediabetes, with HbAlc in the range of 5.7 to 6.4 % at screening as per ADA. The effect of metformin and pioglitazone were observed on various parameters i.e. Serum Insulin, FBG, HbA1c, HOMA-IR. Results: In metformin group the mean change in HOMA-IR from baseline to 6 months was 3.44 to 2.21 (-1.23); on the other hand, in Pioglitazone group from baseline to 6 months was 3.30 to 1.91 (-1.39). Whereas, serum insulin from 37.65 to 28.75 (-8.9) in metformin group; in Pioglitazone group from 37.43 to 23.75 (-13.68). Pioglitazone statistically highly significant than metformin group in improving glycemic indices. Conclusions: Though metformin and pioglitazone were equally effective in improving glycemic indices yet pioglitazone showed better results in improving Serum Insulin, FBG, HbA1c, HOMA-IR as compared with Metformin. Pioglitazone had minimal side effects as compared to Metformin

Carpenter syndrome is a condition characterized by the premature fusion of certain skull bones (craniosynostosis), abnormalities of the fingers and toes, and other developmental problems. Craniosynostosis prevents the skull from growing normally, frequently giving the head a pointed appearance (acrocephaly). Mutated genes cause Carpenter syndrome, and they are passed from parent to child during fetal development. These genes cause the coronal (from ear to ear) and sagittal (top of head, front to back) sutures to fuse together prematurely (craniosynostosis). Treatment of Carpenter syndrome depends on the symptoms the individual has and the severity of the condition. Surgery may be needed if a life-threatening heart defect is present. Surgery may also be used to correct craniosynostosis by separating the abnormally fused skull bones to allow for growth of the head. Craniosynostosis prevents the skull from growing normally, frequently giving the head a pointed appearance (acrocephaly). In severely affected individuals, the abnormal fusion of the skull bones results in a deformity called a cloverleaf skull. Craniosynostosis can cause differences between the two sides of the head and face (craniofacial asymmetry). Early fusion of the skull bones can affect the development of the brain and lead to increased pressure within the skull (intracranial pressure). Premature fusion of the skull bones can cause several characteristic facial features in people with Carpenter syndrome. Distinctive facial features may include a flat nasal bridge, outside corners of the eyes that point downward (down-slanting palpebral fissures), low-set and abnormally shaped ears, underdeveloped upper and lower jaws, and abnormal eye shape. Some affected individuals also have dental abnormalities including small primary (baby) teeth. Vision problems also frequently occur.Abnormalities of the fingers and toes include fusion of the skin between two or more fingers or toes (cutaneous syndactyly), unusua

Introduction: The neuroendocrine neoplasms (NENs) are comparatively infrequent and mixed tumors which comprise 2% of all malignancies, with an incidence of <200,000 population. Gastrointestinal neuroendocrine carcinomas are diagnosed rarely. While gastric carcinoma is third principal reason of death in men and fifth in women especially in Eastern Asia. Case Report: We, herein, present a patient of 30 years and male who was presented to OPD having complaints of diarrhea, hot flushes, dizziness, dyspepsia and anorexia. A Core Biopsy of left par aortic region was made. The findings showed that patient was suffering from neuroendocrine neoplasm/paraganglioma. Initially, lesions can be managed by endoscopic excision of accessible tumors and endoscopic monitor. Discussion: Abdominal neuroendocrine carcinomas are also rare and accounting for less than 10% of gastric neoplasms and such rareness has made it tough to accurately recognize their organic nature and to identify ideal treatment choices. Conclusion: As we described a patient of intermittent gastric neuroendocrine carcinoma, a well-managed description of these cancers/tumors should be discussed globally and historically. Diagnostics and therapeutic managements must be evaluating in large clinical studies.