Facial nerve schwannoma is an uncommon benign tumor, which is rarely encountered in the parotid gland, and mimicking the tumors of this gland. It’s a neurogenic lesion that arises from Schwann cells of peripheral nerve sheath. Most of cases, it is localized in the intratemporal segment of the facial nerve, only 9% that occur in the extratemporal segment. Intraparotid facial nerve schwannoma was firstly described by Ibarz in 1927. Even if the tumor arises from the nerve itself, the function of the facial nerve is generally unaffected. If there is facial paralysis, it is interfered with malignant parotid tumors. Because of the heterogeneity of imaging features, it is difficult to diagnosis and differentiate preoperatively the intraparotid facial nerve schwannoma from other parotid tumors, so the definitive diagnosis is made by histological examination of resected tumor. The management of intraparotid facial nerve schwannoma is a very contested issue within the literature. Because the benignity and low evolutionary potential of the tumor, some authors advocating a conservative attitude with clinical surveillance for patients without facial nerve dysfunction or for tumor localized in the parotid gland. However, if a severe or a sudden facial nerve dysfunction, or extension into the mastoid was founded, the surgical resection of the tumor is indicated without delay. We report a case of a 24-year-old young female, complaining of a slow-growing and painless mass in the left parotid area, associated with grade V facial paralysis on left side since 10 years. No lymphadenopathy was founded in the neck. The computed tomography scan was revealed a heterogeneous tumor, involving in superficial and deep lobes of the left parotid gland, and extending into the parapharyngeal space. On surgical exploration, the dissection of facial nerve and isolation of the mass was impossible. Because the patient had a facial paralysis preoperatively, we had to sacrifice the facial nerve to remove

Background: Gestational Diabetes Mellitus is considered to be a significant problem among pregnant women in Egypt. Aim: To evaluate the effect of educational protocol to improve pregnant women practices about gestational diabetes mellitus. Design: A quasi-experimental design was used. Setting: The outpatient diabetic clinic at Zagazig university hospital. Sample: A purposive sample of eighty pregnant diabetic women. Tools: Two tools were used in the study, Tool (1): Contained two parts; (1) demographic characteristics, (2) History about reproductive profile during pregnancy, Tool (2): Included two parts, assessment of knowledge of pregnant women about DM, and assessment of practice of pregnant women about DM. Results: The mean age of the pregnant women were 32.04 ± 9.36 years, also it was revealed that the total knowledge scores improved from 31.35% to 58.20%, with a highly significant difference (p=0.0044) for the participants, additionally, the overall increase in adequate practices improved from 56 to 78.5% after the implementation of the protocol sessions, with a significant difference (p=0.0106). Conclusion: The implementation of educational protocol for pregnant women was effective and enhanced their practices, and knowledge regarding the gestational diabetes mellitus. Recommendation: The study recommended that further studies for pregnant women with gestational diabetes mellitus should be applied in all health care centers.

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.

Background: Peak expiratory flow rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR is recorded in Mini Wrights Peak Flow Meter and it is commonly used for screening the individuals who are asthmatics. PEFR shows hour to hour variation that follows a specific pattern in asthmatics and healthy individuals. Circardian oscillations in the sympathetic activity may have impact on the airway smooth muscles. Materials and Methods: Peak expiratory flow rate was recorded in 60 young healthy females in the age group of 18-25years in Sri Ramachandra Institue of Higher Education and Reasearch. Mini Wright’s peak flow meter was used to measure the peak expiratory flow rate. PEFR was recorded at 6-7am, 9-10am, 1-2pm, 5-6pm, 10-11pm in a single day. Results: Our results showed PEFR values were low in the morning, followed by progressive rise peaking in the afternoon and evening and a small fall at night time. Highest PEFR is seen around afternoon. Conclusion: Comparing the PEFR readings there ia diurnal variation there is a diurnal variation in healthy young females showing a overall dip in the morning PEFR at 6 A.M, peaking in the evening PEFR at 6P.M, eventually decrease in night PEFR at 10P.M. But there is no significant in the afternoon (2P.M) and night (10.P.M).

The proliferation of slum residential areas in cities in Sub Saharan Africa adversely affects the inhabitants through overcrowding and congestion, sub-standard housing development, disease prevalence, inadequate socio-economic infrastructures such as potable water supply, hygiene and sanitation facilities, wastes disposal schemes and drainage channels, the prevalence of crime and violence and environmental hazards such as floods and landslides. In Cameroon, slums continue to appear in cities and towns because of poor urban governance which fails to ensure effective and comprehensive city management strategy in order to prevent new slum neighbourhoods from emerging in the urban landscape and make existing ones more livable and sustainable. This study makes an appraisal of slum upgrading in Cameroonian cities and proffers a twin-track planning solution that will ensure an effective and comprehensive city management for urban sustainability. To do this, on-the-spot appraisals, field surveys and participatory appraisals were undertaken with individual slum households, quarter heads, municipal authorities, CIGs and NGOs working with slum dwellers and government ministries in charge with urban development for a period of twelve months. Analysis was done using descriptive techniques. Findings showed that the Participatory Slum Upgrading Programmes (PSUP) launched in 2008 and implemented by UN-Habitat which aims to improve the living conditions of slum dwellers is the current slum upgrading approach used in Cameroon. But an appraisal of the problems plaguing this approach shows that much still need to be done to assure adequate and decent affordable housing. Tenure security, financial difficulties, displacement/forced evictions, coordination of actors, follow-ups, determination of slum sites and their full coverage, the non-respect of building/construction norms during resettlement, trivial help from international donors, lack of technical expertise, government neglect and

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.

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.