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School management is responsible and accountable for implementing educational policies into practice effectively and efficiently to provide quality education. Simultaneously, school management can grasp the core features of the whole school process and identify the relationship among three variables: quality management practices, school culture, and student performance. The current study aims to explore the school principals' perception about quality management practices and its relationship with school culture and student performance in the public secondary schools of Punjab province, Pakistan. In order to achieve the objectives of the study, the study adopted an exploratory sequential mix-methods research design. The researcher conducted a systematic literature review of sixty-three previous studies and interviews with eleven school principals for the qualitative data. Based on results obtained from the qualitative phase, a questionnaire was prepared and dispatched to 150 school principals to get quantitative data. Successively 120 valid responses were received. SEM analysis was performed to get quantitative results. The study's preliminary conclusion demonstrated a positive connection between quality management and student performance in public secondary schools, and quality management was also a significant predictor of school culture. Further, school culture served as a complete mediator between quality management and student performance.
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Rash is one of the commonly observed adverse events with brentuximab vedotin (BV), a CD30-targeted antibody-drug conjugate used to treat cutaneous T-cell lymphoma (CTCL). However, clinical and histopathologic characterization of BV-associated rash (BVAR) is limited. Distinguishing BVAR from a patient's underlying CTCL can be challenging and can lead to treatment interruptions or even premature drug discontinuation. We performed a thorough clinical and histopathologic retrospective characterization of BVAR from a single institution. Utilizing polymerase chain reaction (PCR) and T-cell receptor high-throughput sequencing (TCR-HTS), we were able to isolate skin biopsy specimens from rash clinically suggestive of BVAR that also lacked a dominant TCR clone. A retrospective evaluation was performed of 26 biopsy specimens from 14 patients. Clinical features of BVAR included predominantly morbilliform or maculopapular morphology, delayed onset, and the trend toward moderate to severe classification, often requiring oral steroids. Most histopathologic specimens (25/26) showed spongiotic dermatitis as the primary reaction pattern. Many cases showed subtle findings to support a background interface or lichenoid eruption. Langerhans cell microabscesses were seen in one-fourth of specimens, and eosinophils were present in over one-half of the specimens. There were focal features mimicking CTCL, but these were not prominent. In 17 specimens with immunohistochemistry, the CD4:CD8 ratio in intraepidermal lymphocytes was relatively normal (1-6:1) in 65% (11/17) and 1:1 in 35% (6/17), demonstrating a trend toward increased CD8-positive cells compared with baseline CTCL. We have identified features that can help distinguish BVAR from a patient's CTCL, which can, in turn, help guide appropriate clinical management.
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Brentuximab Vedotin , Toxidermias , Exantema , Linfoma Cutâneo de Células T , Humanos , Brentuximab Vedotin/efeitos adversos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Toxidermias/patologia , Toxidermias/etiologia , Toxidermias/diagnóstico , Idoso , Exantema/induzido quimicamente , Exantema/patologia , Adulto , Linfoma Cutâneo de Células T/patologia , Linfoma Cutâneo de Células T/tratamento farmacológico , Imunoconjugados/efeitos adversos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/tratamento farmacológico , Antineoplásicos Imunológicos/efeitos adversos , Biópsia , Sequenciamento de Nucleotídeos em Larga Escala , Idoso de 80 Anos ou mais , Pele/patologia , Pele/efeitos dos fármacos , Pele/imunologia , Diagnóstico DiferencialRESUMO
Epstein Barr Virus-positive mucocutaneous ulcer (EBVMCU) can be difficult to distinguish from EBV-positive diffuse large B cell lymphoma (DLBCL). We used targeted next-generation sequencing (NGS) to explore genetic alterations in EBVMCU to aid in this diagnostic challenge. Ten cases of EBVMCU were evaluated by a targeted NGS panel of 164 genes. Targeted NGS identified 18 variants in 15 genes in eight cases of EBVMCU. Loss of function TET2 variants were most frequently identified (3 of 10 cases, 30 %). One TET2 variant occurred at low variant allele frequency (VAF) of 3 %, which may be suggestive of clonal hematopoiesis of indeterminate potential. One case harbored a loss of function DNMT3A variant at low VAF. Two cases demonstrated missense variants in the IRF8 gene. Both variants occurred at a VAF close to 50 % and with an estimated high burden of disease (75 %). Two cases of mucosal gastrointestinal involvement had no reportable variants. Mutational profiling of EBVMCU identified TET2 loss of function variants at an elevated frequency in our cohort; however, the findings are not specific and its clinical significance cannot be completely elucidated. Further studies are needed to confirm the findings in an independent and larger cohort of EBVMCU, to determine the cell of origin of the variants, and to further assess their significance in the pathogenesis of this disorder.
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Epstein-Barr virus (EBV) is responsible for many B cell lymphoproliferative disorders (LPD) spanning subclinical infection to immunodeficiency-related neoplasms. EBV establishes a latent infection in the host B cell as defined histologically by the expression of EBV latent membrane proteins and nuclear antigens. Herein, we characterize the latency patterns of immunodeficiency-related neoplasms including post-transplant lymphoproliferative disorders (PTLD) and therapy-related LPD (formerly iatrogenic) with latent membrane protein-1 (LMP-1) and EBV nuclear antigen-2 (EBNA-2) immunohistochemistry. The latency pattern was correlated with immunodeficiency and dysregulation (IDD) status and time from transplant procedure. 38 cases of EBV+ PTLD in comparison to 27 cases of classic Hodgkin lymphoma (CHL) and diffuse large B cell lymphoma (DLBCL) arising in either the therapy-related immunodeficiency setting (n = 12) or without an identified immunodeficiency (n = 15) were evaluated for EBV-encoded small RNAs by in situ hybridization (EBER-ISH) and for LMP-1 and EBNA-2 by immunohistochemistry. A full spectrum of EBV latency patterns was observed across PTLD in contrast to CHL and DLBCL arising in the therapy-related immunodeficiency setting. Polymorphic-PTLD (12 of 16 cases, 75 %) and DLBCL-PTLD (9 of 11 cases, 82 %) showed the greatest proportion of cases with latency III pattern. Whereas, EBV+ CHL in an immunocompetent patient showed exclusively latency II pattern (13 of 13 cases, 100 %). The majority of EBV+ PTLD occurred by three years of transplant procedure date and were enriched for latency III pattern (21 of 22 cases, 95 %). Immunohistochemical identification of EBV latency by LMP-1 and EBNA-2 can help classify PTLD in comparison to other EBV+ B cell LPD and lymphomas arising in therapy-related immunodeficiency and non-immunodeficiency settings.
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Infecções por Vírus Epstein-Barr , Antígenos Nucleares do Vírus Epstein-Barr , Herpesvirus Humano 4 , Doença de Hodgkin , Linfoma Difuso de Grandes Células B , Transtornos Linfoproliferativos , Proteínas da Matriz Viral , Proteínas Virais , Latência Viral , Humanos , Transtornos Linfoproliferativos/virologia , Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/diagnóstico , Herpesvirus Humano 4/isolamento & purificação , Infecções por Vírus Epstein-Barr/virologia , Infecções por Vírus Epstein-Barr/complicações , Masculino , Antígenos Nucleares do Vírus Epstein-Barr/metabolismo , Feminino , Adulto , Pessoa de Meia-Idade , Proteínas da Matriz Viral/metabolismo , Doença de Hodgkin/virologia , Doença de Hodgkin/patologia , Linfoma Difuso de Grandes Células B/virologia , Linfoma Difuso de Grandes Células B/patologia , Idoso , Adulto Jovem , Adolescente , Imuno-Histoquímica , Criança , Linfoma/virologia , Linfoma/patologia , Hibridização In SituAssuntos
Anticorpos Monoclonais , Compostos Bicíclicos Heterocíclicos com Pontes , Neoplasias Hematológicas , Neoplasias , Proteínas Recombinantes de Fusão , Neoplasias Cutâneas , Sulfonamidas , Humanos , Subunidade alfa de Receptor de Interleucina-3 , Células Dendríticas , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Neoplasias Hematológicas/terapiaRESUMO
Introduction: Prolonged length of stay (LOS) in emergency departments (ED) is a widespread problem in every hospital around the globe. Multiple factors cause it and can have a negative impact on the quality of care provided to the patients and the patient satisfaction rates. This project aimed to ensure that the average LOS of patients in a tertiary care cancer hospital stays below 3 hours. Materials and Methods: The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) approach was followed. Results: The average LOS was 166 minutes before implementing interventions. The two primary reasons for the increased length of stay were delays secondary to physician assessment and diagnostic lab reports. Strategies were defined to control these factors, which helped reduce the average length of stay to 142 minutes, a 30% reduction. Conclusion: A process improvement model similar to this project is recommended to enhance the quality of hospital services. It will provide valuable insights into the process flow and assist in gathering precise data on the various steps involved. The data collected can then be analyzed to identify potential causes and make informed decisions that can significantly improve hospital processes.
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Iron (Fe) oxide nanoparticles (NPs) improve crop growth. However, the comparative effect of root and foliar-applied different sources of Fe oxide NPs on plant performance at morphological and physiological levels still needs to be discovered. In this study, we characterized the growth and physiological responses of hydroponic-cultured maize seedlings to four sources of Fe (i.e., α-Fe2O3, γ-Fe2O3, Fe3O4 NPs, and bulk Fe3O4) and two application methods (root vs. foliar). Results showed that Fe concentration in root and shoot increased by elevating the level of NPs from 100 mg L-1 to 500 mg L-1. Overall, the responses of maize seedlings to different sources of Fe oxide NPs were as follows: Fe3O4 > γ-Fe2O3 > α-Fe2O3 > bulk Fe3O4. The application of Fe at concentrations ranging from 100 mg L-1 to 500 mg L-1 had no significant effects on various growth parameters of maize, including biomass, chlorophyll content, and root length. Iron oxide NPs increased the plant biomass by 23-37% by root application, whereas it was 5-9% by foliar application. Chlorophyll contents were increased by 29-34% and 18-22% by foliar and root applications, respectively. The non-significant response of reactive oxygen species (i.e., superoxide dismutase, catalase, and peroxidase) suggested optimum maize performance for supplementing Fe oxide NPs. A confocal laser scanning microscope suggested that Fe oxide NPs entered through the epidermis and from the cortex to the endodermis. Our results provide a scientific basis that the root application of Fe3O4 at the rate of 100 mg L-1 is a promising approach to obtain higher maize performance and reduce the quantity of fertilizer used in agriculture to minimize environmental effects while improving crop productivity and quality. These findings demonstrated the tremendous potential of Fe NPs as an environmentally friendly and sustainable crop approach.
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Cutaneous larva migrans (CLM) is a dermo-epidermal parasitic infection with a disproportionate incidence in developing countries, particularly in, and near tropical areas. It is characterized by erythematous, twisting, and linear plaques that can migrate to adjacent skin. Herein, we present an otherwise healthy 45-year-old woman who acquired a pruritic, erythematous, and serpiginous rash localized to her right medial ankle during a trip to New England. Oral ivermectin, the preferred first-line treatment for cutaneous larva migrans, was administered in combination with triamcinolone. This was followed by removal of the papular area via punch biopsy; treatment was successful with a one-week recovery. Although cutaneous larva migrans has traditionally been considered a tropical disease, clinicians should be cognizant of its expanding geographic spread.
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Exantema , Larva Migrans , Humanos , Feminino , Pessoa de Meia-Idade , Larva Migrans/diagnóstico , Larva Migrans/tratamento farmacológico , Larva Migrans/epidemiologia , Ivermectina/uso terapêutico , Pele/patologia , Epiderme , Exantema/patologiaRESUMO
Introduction: English argumentative writing (EAW) is a 'problem-solving' cognitive process, and its relationship with critical thinking has drawn attention in China. This is because fostering EAW proficiency is a crucial element but a challenging task for Chinese high school English teaching and learning. The present study examined how critical thinking is related to Chinese high school students' EAW performance. The study identified eight critical thinking disposition (CTD) subscales and aims to determine whether EAW and CTD are correlated. Methods: A questionnaire modified from the Chinese Version Critical Thinking Disposition Inventory (CTDI-CV) and the Evaluation Criteria for English Argumentative Writing (ECEAW) were employed in this study. Both instruments were administered to 156 students from Grade 12. A purposive sampling of high school students was used in this study. Student EAW performance was scored by two experts based on the Evaluation Criteria for English Argumentative Writing. Results: A significant relationship was found between students' CTD and EAW abilities. Furthermore, among the eight CTD subdispositions, cognitive maturity, truth-seeking, analyticity, and justice were found to be positively correlated with EAW, and they all were found to be the main predictors of EAW proficiency among high school students. Conclusion: Zhangzhou high school students' CTDs were overall positive, and students' EAW performance correlated significantly with the overall CTD and its four subdispositions of cognitive maturity, truth-seeking, analyticity, and justice. These four subdispositions showed a significantly predictive validity on EAW performance as well.
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Resolução de Problemas , Pensamento , Humanos , Aprendizagem , Estudantes , RedaçãoRESUMO
Contamination of water sources by toxic antimony Sb(III) ions poses a threat to clean water supplies. In this regard, we have prepared a mesoporous silica nanoparticle (MSN)-derived adsorbent by reverse microemulsion polymerization, using cetyltrimethylammonium chloride (CTAC) and triethanolamine (TEA) as co-templates. The physical and chemical properties were characterized using advanced tools. The MSN exhibits a higher surface area of up to 713.72 m2·g-1, a pore volume of 1.02 cm3·g-1, and a well-ordered mesoporous nanostructure with an average pore size of 4.02 nm. The MSN has a high adsorption capacity for toxic Sb(III) of 27.96 mg·g-1 at pH 6.0 and 298 K. The adsorption data followed the Langmuir isotherm, while the kinetics of adsorption followed the pseudo-second-order model. Interestingly, the effect of coexisting iron showed a promoting effect on Sb(III) uptake, while the presence of manganese slightly inhibited the adsorption process. The recyclability of the MSN adsorbent was achieved using a 0.5 M HCl eluent and reused consecutively for three cycles with a more than 50% removal efficiency. Moreover, the characterization data and batch adsorption study indicated physical adsorption of Sb(III) by mesopores and chemical adsorption due to silicon hydroxyl groups.
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This work is a combination of two studies, Study I and Study II, which aimed to examine the impact of animated movies on the aggression and behavioral performance of primary school students, as well as their control using the CBACT program. In Study I, the influence of animated movies on 300 students from ten primary schools in Pakistan with gender differences (50% male), family systems, and viewing time duration was examined. This study was performed on 7- to 9-year-old children on four subscales of the Buss-Perry aggression questionnaire (BPAQ), three subscales of the child behavior questionnaire (CBQ), and toy selection. Following that, in Study II the CBACT intervention was applied to aggressive students (n = 46) selected from Study I. Students were randomly divided into CBACT treatment (50%) and control groups. The results of Study I indicated that violent animated movies had a greater impact on the aggressive behavior of male students than on that of females, while girls were more affected by watching nonviolent movies. Furthermore, male viewers from nuclear families and females from joint families showed more aggressive problems. It was also observed that aggression in students significantly increased (p < 0.001) with increasing viewing animation time duration (10 to 30 min). The results of Study II showed that aggression in the treatment group was significantly reduced (p = 0.000) with the CBACT program but remained constant for the control group. The findings of Study I showed that violent animation is strongly linked with aggression and behavioral performance in primary school students. The CBACT program in Study II indicates that students may not be completely eliminated from watching violent movies, but their aggression levels were reduced when they watched animated movies. Therefore, the CBACT program opens a new window into behavioral problem treatment, which is casually influenced by violent media.
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BACKGROUND: SARS-CoV2 is a highly contagious virus causing COVID-19 (Corona virus disease 2019), which has resulted in more than 6 million deaths worldwide as of June 2022. Mortality in COVID-19 has mainly been attributed to respiratory failure. Previous studies showed that the presence of cancer did not adversely affect the outcome of COVID-19. However, in our clinical practice, it was noted that in cancer patients with pulmonary involvement, COVID-19-related morbidity, and morbidity were high. Therefore, this study was designed to assess the impact of cancerous pulmonary involvement on COVID-19 outcomes and to compare clinical outcomes of COVID-19 in cancer and non-cancer population, with further discretion between cancers with and without pulmonary involvement. METHODS: We performed a retrospective study from April 2020 until June 2020 with a sample size of 117 patients with a confirmed diagnosis of SARS-CoV2 on nasal swab PCR. Data was extracted from HIS (Hospital Information System). Hospitalization, supplemental oxygen, ventilatory support, and death were compared between non-cancer and cancer patients with a particular focus on pulmonary involvement. RESULTS: Admissions, supplemental oxygen requirement, and mortality were significantly higher in cancer patients with pulmonary involvement (63.3%, 36.4%, and 45%, respectively) compared to cancer patients without pulmonary involvement (22.1%, 14.7%, and 8.8% respectively) (p-values: 0.00003, 0.003, and 0.00003 respectively). In the non-cancer group, there was no mortality, only 2% required admission, and none needed supplemental oxygen. CONCLUSION: We conclude that the cancer patient with pulmonary involvement was significantly at higher risk of complications and death from COVID when compared with the non-pulmonary cancer group and the general population.
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Bullous impetigo is a variant of epidermal infection by Staphylococcus aureus, representing 30% of impetigo cases. Its clinical appearance may mimic certain autoimmune blistering dermatoses and other cutaneous infections, sometimes necessitating careful evaluation. Herein we present a patient with bullous impetigo in a striking and characteristic appearance and briefly overview the approach to diagnosis, treatment, and prevention.
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Doenças Autoimunes , Impetigo , Dermatopatias , Infecções Estafilocócicas , Masculino , Humanos , Impetigo/diagnóstico , Vesícula , AbdomeAssuntos
Esclerose Múltipla , Micose Fungoide , Neoplasias Cutâneas , Humanos , Cloridrato de Fingolimode/efeitos adversos , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/genética , Micose Fungoide/tratamento farmacológico , Micose Fungoide/genética , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/genética , Sequenciamento de Nucleotídeos em Larga EscalaRESUMO
Contamination of water resources by toxic metals and opportunistic pathogens remains a serious challenge. The development of nano-adsorbents with desired features to tackle this problem is a continuously evolving field. Here, magnetic mesoporous carbon nanospheres grafted by antimicrobial polyhexamethylene biguanidine (PHMB) are reported. Detailed mechanistic investigations reveal that the electrostatic stabilizer modified magnetic nanocore interfaced mesoporous shell can be programmatically regulated to tune the size and related morphological properties. The core-shell nano-adsorbent shows tailorable shell thickness (≈20-55 nm), high surface area (363.47 m2 g-1 ), pore volume (0.426 cm3 g-1 ), radially gradient pores (11.26 nm), and abundant biguanidine functionality. Importantly, the nano-adsorbent has high adsorption capacity for toxic thallium (Tl(I) ions (≈559 mg g-1 ), excellent disinfection against Staphylococcus aureus and Escherichia coli (>99.99% at 2 and 2.5 µg mL-1 ), ultrafast disinfection kinetics rate (>99.99% within ≈4 min), and remarkable regeneration capability when exposed to polluted water matrices. The Tl(I) removal is attributed to surface complexation and physical adsorption owing to open ended mesopores, while disinfection relies on contact of terminal biguanidines with phospholipid head groups of membrane. The significance of this work lies in bringing up effective synchronic water purification technology to combat pathogenic microorganisms and toxic metal.
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Poluentes Químicos da Água , Água , Desinfecção , Carbono , Adsorção , Fenômenos Magnéticos , Cinética , Concentração de Íons de HidrogênioRESUMO
Cutaneous T-cell lymphomas (CTCL) are a clinically and molecularly heterogeneous class of lymphomas of the skin-homing T cell, and their genetic profiles are not fully characterized. Previously, rearrangements of the Lysine Methyltransferase 2A (KMT2A) gene have been identified as driver mutations only in acute leukemias. KMT2A plays a role in epigenetic regulation, and cancers with such rearrangements are responsive to epigenetic therapy including hypomethylating agents. Here, we report two cases of CTCL with novel genetic profiles. KMT2A rearrangements were identified in two aggressive cases of mycosis fungoides with large cell transformation. A KMT2A::DSCAML1 gene rearrangement was seen in Case 1, while a KMT2A::MAPRE1 fusion was identified in Case 2. These cases demonstrate that KMT2A rearrangements can be found in primary CTCLs rather than solely acute leukemias, illustrating the importance of correlating molecular findings with clinical and histologic features in diagnosis. Additionally, this finding suggests that the subset of CTCLs driven by aberrancy of the KMT2A pathway may be responsive to therapy with hypomethylating agents or menin inhibitors, as seen in acute leukemias.