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Abstract We report a case of a 65‐year‐old female with 1‐year history of dental pain and oral ulcers. A diagnosis of Langerhans cell histiocytosis (LCH) was made by oral biopsy and CD207 (Langerin) stain, and BRAF V600E mutation was identified. PET/CT revealed an enhancing lesion in the hard palate with extension into the maxillary sinus. Chemotherapy with cytarabine failed, and LCH progressed to affect additional organ systems. Treatment with vemurafenib was started, resulting in a dramatic improvement of painful mucocutaneous ulcers since the first month of treatment. Vemurafenib is effective in children with refractory BRAF V600E‐mutated LCH, and recent data support the use of vemurafenib in adults with refractory multisystem LCH harbouring the same mutation.

Reading is unquestionably a crucial component of any educational system because it not only underlies it but also permeates its aspects. Therefore, reading should be appropriately assessed. This mixed-methods developmental study developed a test package for assessing the reading competency of Grade 7 learners. The researcher used a variety of scales for validation, attribute assessment, assessment adherence principles, and indicators of a good reading diagnostic test. Analysis methods included mean, weighted mean, difficulty-discrimination indices, and Cronbach's Alpha. It was revealed that the comprehension test has a strong reliability score for a classroom test (a=.700). In contrast, the vocabulary test has a somewhat low-reliability score (a=.600). The validity results indicated that the fluency test was extremely valid (4.535), while both vocabulary and comprehension tests were very valid (4.322, 4.486). It was described as very good (4.33), and the experts concurred that it adheres to the indicators of a good reading diagnostic test (fluency: 1.00; vocabulary: 0.97; and comprehension: 0.97). Generally, the reading diagnostic test is a valid and reliable instrument for assessing students' reading competence levels, particularly in terms of fluency, vocabulary, and comprehension, but further validation is required.

IntroductionThe link between cannabis use and erectile dysfunction remains unclear. Moreover, the effect of cannabis in tandem with current Western dietary habits is an area in male sexual health that has yet to be explored. This study seeks to investigate the impact of diet and cannabis on penile health in an animal model.AimTo determine the effects of diet and oral cannabis extract on fibrosis and oxidative stress within the corpora cavernosa of mice.MethodsThis is a pilot animal study in which groups of 2-month old C57BL/6J male mice were fed a normal chow diet (NCD) or high-fat diet (HFD) daily and treated with or without either MJ or THC extract for 2 months. After euthanization, mouse penises were isolated and processed for immunohistochemical studies to determine: (i) smooth muscle cell to collagen content, (ii) myofibroblast proliferation, and (iii) anti-oxidative activity.Main outcome measuresQuantitative assessment of immunohistochemical markers of fibrosis and oxidative stress within the corpora cavernosa of mice fed a high-fat diet in combination with either oral marijuana (MJ) or Δ-9-tetrahydrocannabinol extract (THC).ResultsThe combination of HFD with MJ resulted in: (i) a decrease in the smooth/collagen ratio in the corpora cavernosa, (ii) an increase in alpha-smooth muscle actin expression in the tunica albuginea compatible with myofibroblast proliferation, and (iii) a decrease in heme oxygenase 1 expression indicating an increase in oxidative stress. Significant histological changes were not observed in the HFD + THC group.ConclusionsHFD combined with oral MJ extract led to structural alterations in erectile tissue that are associated with accelerated corporal fibrosis. However, the addition of THC to the diet did not exacerbate histological changes within the corpora. Further studies are warranted to elucidate the discrepant effects between MJ and THC in order to optimize the therapeutic potential of cannabis and minimize its adverse effects on penile health. S Nguyen, M Mangubat, S Eleswarapu, et al. The Combination of High-Fat Diet and Oral Marijuana Promotes the Development of Fibrosis in the Mouse Corpora Cavernosa. Sex Med 2021;9:100312.

Calcium, obtained from various sources, is essential to fulfil the dietary requirements of birds. Oyster shells are excellent sources of calcium and are widely used in bird diets. Calcium is a critical factor in eggshell deterioration, affecting its absorption. Consequently, this study aimed to determine the combined effects of powdered oyster shell and lemongrass on the growth, development, and egg quality of birds, specifically using 5, 10, and 15 grams of oyster shell powder as a calcium source. A completely randomised design was used to assess the efficacy of varying amounts of powdered oyster shell. Results revealed that there was no significant change in growth development at different inclusion levels of oyster shell powder and lemongrass solution. However, egg quality exhibited a significant variance at different inclusion levels of oyster shell powder. Similarly, lemongrass solution as a supplement for laying quails demonstrated a significant difference. Therefore, supplementing the calcium source with a blend of 15 g of oyster shell powder and 300 ml lemongrass solution enhanced egg performance and eggshell quality of laying quail by 5%.

Background: HIV-associated nephropathy (HIVAN) is a renal parenchymal disease that occurs exclusively in people living with HIV. It is a serious kidney condition that may possibly lead to end-stage kidney disease, particularly in the HIV-1 seropositive patients. Summary: The African-American population has increased susceptibility to this comorbidity due to a strong association found in the APOL1 gene, specifically two missense mutations in the G1 allele and a frameshift deletion in the G2 allele, although a “second-hit” event is postulated to have a role in the development of HIVAN. HIVAN presents with proteinuria, particularly in the nephrotic range, as with other kidney diseases. The diagnosis requires biopsy and typically presents with collapsing subtype focal segmental glomerulosclerosis and microcyst formation in the tubulointerstitial region. Gaps still exist in the definitive treatment of HIVAN – concurrent use of antiretroviral therapy and adjunctive management with like renal-angiotensin-aldosterone system inhibitors, steroids, or renal replacement therapy showed benefits. Key Message: This study reviews the current understanding of HIVAN including its epidemiology, mechanism of disease, related genetic factors, clinical profile, and pathophysiologic effects of management options for patients.

The COVID-19 pandemic had an impact on schools all over the world. The new norm in academia was a reduction in teaching and learning activities. Teachers around the world were challenged to come up with innovative ways to help students during the COVID-19 pandemic. This phenomenological study aimed to understand the challenges faced by newly hired teachers during the limited face-to-face classes for the school year 2022-2023. Data gathered from participants may provide useful insight on how educators navigate the phenomenon despite being unprepared. The study utilized a qualitative research design using a phenomenological approach with twenty (20) purposefully selected newly hired teachers who experienced the limited face-to-face class. Moreover, the newly hired teachers were from public schools, both in the elementary and high school departments. They underwent in-depth interviews and focus group discussions (FGD) using the validated research instrument. The results of the study were recorded based on the experiences of the teachers, including the challenges they encountered. Emergent themes were formulated: Rejoicing in the Reopening of Classes, Anticipating Challenges, Collaborating with Iniatives, Adhering the Protocol, Meticulous in Tasking and Efficient Communication. On the coping mechanisms, teachers showed strength guided by mission and focus on purpose. Themes were formulated, such as Requesting for Assistance, Receiving Compliments, Sharing of Commitment, Emanating Positivity and Growth, Open Communication and Developing Success. Finally, as to their insights, notable emergent themes were formulated as follows: Receptive to Feedback, Valuing Responsibilities, Accepting Imperfections, Proficiency in Decision Making, Possessing Empathy and Kindness, Enhancing Instructional Methods. The teachers were remarkable in that they aimed to transform the work environment and transfer effective learning to the students, especially here in the Philippines. [ABSTRACT FROM AUTHOR]

This study explored the relationship between parental involvement and the self-help skills of kindergarten learners. Using a descriptive-correlational research design, the study aimed to determine whether parental involvement significantly impacted the development of children's self-help skills. Data were collected from parents through two adapted surveys: the Parental Involvement Survey and the Self-Help Skills Survey, which measured various indicators related to participation in school activities and children's proficiency in daily tasks. The findings indicated no significant relationship between parental involvement and the self-help skills of the learners, suggesting a negligible positive correlation. This result contrasts with previous studies that demonstrated a strong link between parental involvement and children's skill development. Despite the lack of statistical significance, the study underscores the continued importance of parental engagement and the need for collaboration between educators and parents to support the holistic growth of children, including the development of essential self-help skills. [ABSTRACT FROM AUTHOR]

Purpose: Katipuneros RPG--Bisperas ng Himagsikan (Katipuneros RPG: The Eve of the Revolution) is an immersive and gamified theater that engages its "audiences" in the initiation rites of a secret revolutionary movement in the Philippines in 1896. This descriptive qualitative research evaluates such experiential approach to learning history by investigating the experiences and insights of a group of students from the University of the Philippines Los Baños (UPLB), who participated in Katipuneros RPG. Design/methodology/approach: Textual data obtained from the participants' reflection papers and focus group discussion transcripts were analyzed using open and axial coding. Findings: Three key themes summarized the participants' learning experiences as they went through the play, as follows--(1) Katipuneros RPG as an immersive, interactive and intrinsically motivating medium for learning history; (2) the knowledge, values and skills that served as facilitating factors for their learning and (3) the insights the participants gained about history and life in general. Practical implications: The research argues that in Katipuneros RPG, learners take on a more active role in studying history as the "teacher" vanishes in lieu of a learning system the allows students to think critically, reflect and collaborate. The approach integrates elements of development theater, immersive play and gamified learning, as well as the principles of constructivist, play-based and multi-sensorial learning. Social implications: As an innovative learning tool, it is a viable medium to teach history in the current socio-political context of the Philippines. Originality/value: The study hopes to contribute to literature on pedagogical approaches for teaching and learning history through immersive environments.

We previously reported on the lack of utility of the 1 mg overnight dexamethasone (DEX) test in mild and/or periodic Cushing's syndrome, as most patients with the condition suppressed to 1 mg DEX. It is possible that a lower dose of DEX as part of an overnight DEX test might be able to distinguish between mild and/or periodic Cushing's syndrome and those without the condition. The objective of the current study is to determine the sensitivity and specificity of a 0.25 mg overnight DEX suppression test, the standard 1 mg overnight DEX suppression test, and the two-day low-dose (Liddle test) DEX suppression test with and without correction for DEX levels in patients evaluated for mild and/or periodic Cushing's syndrome. Thirty patients determined to have Cushing's syndrome by biochemical testing and 14 patients determined not to have the condition had the 0.25 mg and standard 1 mg overnight DEX suppression test and the two-day low-dose DEX suppression tests. Our results show that morning serum cortisol and cortisol/DEX ratios following an overnight dexamethasone suppression test were similar in patients with Cushing's syndrome and those not having Cushing's syndrome. However, a morning cortisol value above 7.6 μg/dl following a dose of DEX of 0.25 mg was found in 12 patients with Cushing's syndrome and none in those not having Cushing's syndrome, suggesting that a high cortisol value after this low dose of dexamethasone can indicate that further testing for Cushing's syndrome is warranted. Our data suggest that the traditional 1 mg overnight or the 2 mg/2 day DEX suppression testing should no longer be used as a screening test in patients who could have mild and/or periodic Cushing's syndrome, while the 0.25 mg dose of DEX may pick up some patients with mild Cushing's syndrome.

Patients with acromegaly carry a high risk of developing cardiovascular diseases (CVD). In fact, CVD is the leading cause of mortality among this group of patients. The most frequent cardiovascular complications are heart failure (HF), valvular disease, hypertension, arrhythmias, and coronary artery disease (CAD). The pathophysiology centers on the family of growth hormone (GH). These hormones are involved in normal cardiac development and function; however, excess of insulin-like growth factor-1 (IGF-1), the principally active hormone, can also cause negative effects on the cardiovascular system. HF in acromegaly usually presents with biventricular enlargement and diastolic dysfunction and is strongly associated with the duration of GH excess rather than the degree of hormone elevation. There is a high prevalence of valvular disease affecting aortic and mitral valves among patients with longer disease duration. The development of hypertension in acromegaly may be attributed to the effects of chronic GH/IGF-1 excess on different organ systems, which act via several mechanisms. The aspect of arrhythmia and CAD complicating acromegaly are currently not fully understood.

Background: Aortic stenosis (AS) is the world’s most prevalent heart valve disease. Transcatheter aortic valve replacement (TAVR) or Implantation (TAVI) is widely available yet adopting this procedure in Asia has been slow due to high device cost, the need for specific training programs, and the lack of specialized heart teams and dedicated infrastructures. The limited number of randomized controlled trials describing TAVI outcomes among the Asian population hampered the approval for medical reimbursements as well as acceptance among surgeons and operators in some Asian countries. Methods: A comprehensive medical literature search on TAVI and/or TAVR performed in Asian countries published between January 2015 and June 2022 was done through MEDLINE and manual searches of bibliographies. The full text of eligible articles was obtained and evaluated for final analysis. The event rates for key efficacy and safety outcomes were calculated using the data from the registries and randomized controlled trials. Results: A total of 15,297 patients were included from 20 eligible studies. The mean patient age was 82.88 ± 9.94 years, with over half being females (62.01%). All but one study reported Society of Thoracic Surgeons (STS) scores averaging an intermediate risk score of 6.28 ± 1.06%. The mean logistic European Systems for Cardiac Operations Risk Evaluation (EuroSCORE) was 14.85. The mean baseline transaortic gradient and mean aortic valve area were 50.93 ± 3.70 mmHg and 0.64 ± 0.07 cm2, respectively. The mean procedural success rate was 95.28 ± 1.51%. The weighted mean 30-day and 1-year all-cause mortality rate was 1.66 ± 1.21% and 8.79 ± 2.3%, respectively. The mean average for stroke was 1.98 ± 1.49%. The acute kidney injury (AKI) rate was 6.88 ± 5.71%. The overall major vascular complication rate was 2.58 ± 2.54%; the overall major bleeding rate was 3.88 ± 3.74%. Paravalvular aortic regurgitation rate was 15.07 ± 9.58%. The overall rate of pacemaker insertion was 7.76 ± 4.6%. Conclusions: Compared to Americans and Europeans, Asian patients who underwent TAVI had lower all-cause mortality, bleeding, and vascular complications, however, had a higher rate of postprocedural aortic regurgitation. More studies with greater sample sizes are needed among Asian patients for a more robust comparison.

Purpose – Katipuneros RPG: Bisperas ng Himagsikan (Katipuneros RPG: The Eve of the Revolution) is an immersive and gamified theater that engages its “audiences” in the initiation rites of a secret revolutionary movement in the Philippines in 1896. This descriptive qualitative research evaluates such experiential approach to learning history by investigating the experiences and insights of a group of students from the University of the Philippines Los Baños (UPLB), who participated in Katipuneros RPG. Design/methodology/approach – Textual data obtained from the participants' reflection papers and focus group discussion transcripts were analyzed using open and axial coding. Findings – Three key themes summarized the participants' learning experiences as they went through the play, as follows: (1) Katipuneros RPG as an immersive, interactive and intrinsically motivating medium for learning history; (2) the knowledge, values and skills that served as facilitating factors for their learning and (3) the insights the participants gained about history and life in general. Practical implications – The research argues that in Katipuneros RPG, learners take on a more active role in studying history as the “teacher” vanishes in lieu of a learning system the allows students to think critically, reflect and collaborate. The approach integrates elements of development theater, immersive play and gamified learning, as well as the principles of constructivist, play-based and multi-sensorial learning. Social implications – As an innovative learning tool, it is a viable medium to teach history in the current socio-political context of the Philippines. Originality/value – The study hopes to contribute to literature on pedagogical approaches for teaching and learning history through immersive environments.

Abstract: Atovaquone, a US Food and Drug Administration–approved antiparasitic drug previously shown to reduce interleukin-6/STAT3 signaling in myeloma cells, is well tolerated, and plasma concentrations of 40 to 80 µM have been achieved with pediatric and adult dosing. We conducted preclinical testing of atovaquone with acute myeloid leukemia (AML) cell lines and pediatric patient samples. Atovaquone induced apoptosis with an EC50

The study explored whether baseline individual differences in executive function (EF) affect the relation between elevations in internal states and subsequent likelihood of lapsing from a dietary prescription. Participants were 189 adults with overweight/obesity in a behavioral weight loss treatment who completed a neuropsychological EF task at intake and a 2-week EMA protocol measuring internal states and dietary lapses at start of treatment. Generalized estimating equations found relations between momentary elevations in tiredness (b = .06, p = .01) and deprivation (b = .06, p = .047) and subsequent likelihood of lapsing were more robust for participants with lower EF, whereas the relation between momentary elevations in boredom and subsequent likelihood of lapsing (b = .04, p = .03) was more robust for participants with higher EF. Results provide support for EF impacting the relation between elevations in internal states and likelihood of dietary lapse, informing the development of personalized behavioral weight loss treatments., Author(s): Rebecca J. Crochiere [sup.1] [sup.2] , Clare Jocelyn Mangubat [sup.1] , Stephanie M. Manasse [sup.1] , Evan M. Forman [sup.1] [sup.2] Author Affiliations: (1) grid.166341.7, 0000 0001 2181 3113, [...]

ABSTRACT Objective: To investigate the distribution and aerosolized particle counts generated during mastoidectomy, we utilized low-cost and locally available material and developed a plastic tent creating a barrier between the health care workers (HCW) and patient. Methods: The barrier tent is a clear plastic bag attached to the microscope lens. The tent is draped and tucked underneath the patient’s head and upper torso with surgeon’s arms also passed underneath and secured with clamps. We demonstrated the area of greater contamination by spread of droplet particles and bone dust after drilling using fluorescent dye. Particle counts inside and outside the barrier was determined and then comparison with and without the tent after drilling of cadaveric temporal bone were also done. Results: The area with highest concentration of contamination (“hot zone”) was noted opposite the surgeon’s hand drill which is dependent on the operator’s handedness. Other hot zones noted were opposite the operator and on the operator’s side. Particle determination of aerosol size 0.3 and 2.5µm inside the barrier tent were at peak levels after bone drilling procedure. Then a significant drop of particle counts was noted at 2 minutes after drilling was stopped with flattening observed at 8 minutes. Conclusion: Our experimental results suggest that the improvised barrier tent can be effective in mitigating aerosols generated during mastoid surgery and may serve as an added protection for the operating room team.

Introduction: The link between cannabis use and erectile dysfunction remains unclear. Moreover, the effect of cannabis in tandem with current Western dietary habits is an area in male sexual health that has yet to be explored. This study seeks to investigate the impact of diet and cannabis on penile health in an animal model. Aim: To determine the effects of diet and oral cannabis extract on fibrosis and oxidative stress within the corpora cavernosa of mice. Methods: This is a pilot animal study in which groups of 2-month old C57BL/6J male mice were fed a normal chow diet (NCD) or high-fat diet (HFD) daily and treated with or without either MJ or THC extract for 2 months. After euthanization, mouse penises were isolated and processed for immunohistochemical studies to determine: (i) smooth muscle cell to collagen content, (ii) myofibroblast proliferation, and (iii) anti-oxidative activity. Main Outcome Measures: Quantitative assessment of immunohistochemical markers of fibrosis and oxidative stress within the corpora cavernosa of mice fed a high-fat diet in combination with either oral marijuana (MJ) or Δ-9-tetrahydrocannabinol extract (THC). Results: The combination of HFD with MJ resulted in: (i) a decrease in the smooth/collagen ratio in the corpora cavernosa, (ii) an increase in alpha-smooth muscle actin expression in the tunica albuginea compatible with myofibroblast proliferation, and (iii) a decrease in heme oxygenase 1 expression indicating an increase in oxidative stress. Significant histological changes were not observed in the HFD + THC group. Conclusions: HFD combined with oral MJ extract led to structural alterations in erectile tissue that are associated with accelerated corporal fibrosis. However, the addition of THC to the diet did not exacerbate histological changes within the corpora. Further studies are warranted to elucidate the discrepant effects between MJ and THC in order to optimize the therapeutic potential of cannabis and minimize its adverse effects on penile health.S Nguyen, M Mangubat, S Eleswarapu, et al. The Combination of High-Fat Diet and Oral Marijuana Promotes the Development of Fibrosis in the Mouse Corpora Cavernosa. Sex Med 2021;9:100312.