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.

Background: Drug utilization studies conducted at regular intervals help to guide the physician in prescribing drugs rationally. Methods: This is prospective, observational study was conducted in the outpatient of department of general medicine of Indian Institute of Medical Science & Research a tertiary care teaching hospital. Data was collected from patients who have been diagnosed with hypertension as per JNC-8 guidelines and patients receiving or prescribed with antihypertensive medications were included. Frequency and proportions of utilization of antihypertensive medications in were figured. Results: A total of 170 prescriptions were analysed during the 6 month study period. The patients 93 (46.5%) were on Mono therapy significantly higher than dual therapy, triple therapy and poly therapy, 64 (32 %), 27 (13.5%), 16 (8 %) respectively. Calcium channel blocker was the frequently used class of drug for monotherapy (19.5 %). In dual drug therapies were CCB+ARB accounting for 18.5 %, and 5.8% of patients were on triple drug therapy with CCB+ARB+Diuretic. 30.2% patients were on ACE inhibitors. 25.5 % patients receiving Calcium channel blocker reported side effect. Conclusion: This type of studies gives the base line idea of prescription pattern and ADRs of antihypertensive drugs. These helps to design policy for rational use of drugs and motivation of physician for rational use of drugs. The study emphasizes that need for effective continuing medical education and also preventive measures in hypertensive individuals.

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.

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.

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

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: 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.

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

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.

The starch synthase 4 (SS4) is a key enzyme for initiation of starch granules and regulation of the starch granule number in chloroplasts of higher plants. These enzymes transfer glucosyl residue from ADPglucose to the non-reducing end of a preexisting glucan chain. The presence of a coiled-coil motive in the N-terminus of Arabidopsis SS4 has been involved in mediating some of the protein-protein interactions. Thus, it was also shown that AtSS4 directly interacts with the plastidial phosphorylase (AtPHS1). However, phosphorylase enzymes are widespread in animals, microorganism, and plants. So far, it was unclear if the observed protein-protein interaction is specific for plant origin phosphorylase enzymes. Therefore, we tested whether or not an animal type phosphorylase, the rabbit muscle phosphorylase a (Pho a), also interacts with AtSS4. Our results show that the protein-protein interaction of AtPHS1 and AtSS4 is specific and cannot archived by Pho a. Furthermore, also a functional interaction between AtSS4 and the Pho a was not detected.

meconium aspiration syndrome (MAS) in relation to outcome in terms of need for ventilation and mortality. Methodology: This study is a prospective observational study of late preterm>34 – 36 6/7 weeks and term neonates with moderate and severe meconium aspiration syndrome (MAS) admitted in Dr B C Roy Postgraduate Institute of Pediatric Sciences, Kolkata. Study was done by application of surfactant within 24 hrs and 25 to 48 hrs of birth. Requirement for supplemental oxygen and ventilation were recorded in predesigned proformas. Results: The outcome in terms of death between within 24 hrs and 25-48 hrs of birth application of surfactant in MAS is mortality in the former was 3/20(15%) as compared to 2/10(20%) in the latter though it was not statistically significant (p =0.301) .Mean duration of ventilation,( p=0.026)supplemental oxygen requirement(p=0.039) and the length of hospital stay(p=0.045) were significantly lower in those who received surfactant within 24 hrs of birth in comparison to who received within 25-48 hrs of birth.(alpha value for p=0.05). Conclusion: Surfactant in a form of bolus therapy within 24 hrs of birth has no role in decreasing the percentage of mortality or morbidity in MAS but however has shown benefit in terms of decreasing the mean duration of ventilation, O2 requirement and hospitalization.

The purpose of this study was to examine and analyze whether there were significant positive influences between the variables of Personality Type, Effectiveness of Principal Leadership, and Decision Making against Teacher Job Satisfaction in Provincial High Schools. The study has ten problem formulations that analyze the direct effect, indirect effect and simultaneous influence between each variable studied. The research approach used is a quantitative approach with a survey method conducted on selected research samples based on probability sampling with the Slovin method totaling 141 Jambi State High School teachers. Data collection techniques using observation and using a questionnaire (questionnaire) as a primary data collection tool. Data analysis using path analysis (part analysis) with data processing tools manually Microsoft Office Excel program and SPSS version 22. The results of the analysis of the path coefficient and coefficient of determination, there is a direct effect and a significant positive simultaneous effect between variables Personality Type (X1), Leadership Effectiveness (X2) and Decision Making (X3) on Teacher Job Satisfaction (X4). The indirect effect between personality type variables (X1) and Leadership Effectiveness on teacher job satisfaction (X4) through decision-making variables (X3) has no significant effect. The research results imply that efforts to increase teacher job satisfaction in-state high schools in Jambi Province can be done by paying attention to personality types, the effectiveness of school principals' leadership and increasing teacher participation in decision making. Future research to obtain more comprehensive and representative research results in a wider population.

Objective: To assess the iron status in children with sickle cell disease (SCD) and trait (SCT). Design: Prospective, observational, descriptive study. Setting: Referral tertiary hospital in the state of Jharkhand. Methods: 108 consecutive patients of SCD and trait were enrolled and complete hemogram, serum iron and serum ferritin were measured. Results: Patients with SCT were more at risk of having iron deficiency (ID) than SCD.ID was present in patients who had not received or received <5 units of blood transfusion (BT).High iron level was found in all the patients who had received more than 10 units of BT. Serum Ferritin level had linear relationship with units of BT. Conclusion: Patients with SCT were more in number than that of homozygous SCD (2.6:1). Patients with SCT had more chances to have ID than homozygous SCD.