Collaboration among teachers in inclusive special education program classrooms

Collaboration between teachers and special education teachers is a vital factor in ensuring the success of the implementation of the Inclusive Education Programs especially in the teaching and learning aspects. Until 2016, there is no detailed document or information regarding how the collaboration is conducted or implemented in the inclusive classrooms. Therefore, this study is aimed to explore how collaboration is conducted and implemented in the Inclusive Special Education Program classrooms, particularly identifying the stage of collaboration the school are at and approach used in the inclusive classrooms. To achieve this, a survey questionnaire was used as an instrument for this study and it is conducted on 53 schools and 441 participants including headmasters, senior assistant principals for special education teachers, subject teachers and special education teacher. Results showed that most of the participants are at the “Starting a partnership” stage (mean score = 4.165, SD = 0.797). The type of collaboration approach that are usually being used is the “collaboration-consultation” approach (mean score = 4.10, SD = 0.721). This suggests that more action is needed to ensure the successful implementation of an inclusive program. This is because without done the recommended steps of collaboration, the inclusive may not carried out effectively. A successful inclusive classroom also can be achieved through multiple approaches of collaboration are implemented. Therefore, knowledge about steps and approaches of collaboration should be knowledgeable to general, special education teacher and also school administrators

Response of Imitanib Meysylate in patients with gastrointestinal stromal cell tumour

In this study, the response of Imitanib Mesylate in patients with Gastro-intestinal stromal cell tumour (GIST) was assessed. GIST results from a mutation in one of the receptor protein tyrosine kinases. Imitanib Mesylate, a tyrosine kinase inhibitor, has emerged as a promising new treatment for GISTs. Total 16 cases were reviewed. Diagnosis was based on biopsy and immunohistochemistry. Response assessment was done using CT scans, at a median duration of 4 months. The median age of the patients was 52 years, Majority were male (n=14). Most common presenting complaint was abdominal pain (n=7). Commonest primary site was stomach (n=7), Liver was the most common organ involved in metastasis (n=8). All patients received Imitanib 400 mg orally, once a day. No mortality was reported during median follow up time of 28 months on Imitanib. There was also either radiological remission (n=5) or response (n=5), in about half of the patients without any serious side effects

Pleural effusion as a manifestation of multiple myeloma

Multiple myeloma is a clonal B-cell malignancy, characterised by proliferation of plasma cells and secretion of paraproteins. These plasma cells accumulate predominantly in the bone marrow; rarely, they invade other areas, especially the thorax. Myeloma presenting with a pleural effusion is rare and reported in only 6% of patients with myeloma. Such patients generally present late and have a poor prognosis. Here, we describe a patient presenting with a lung mass, renal failure and a massive unilateral pleural effusion due to multiple myeloma who was treated successfully

Compliance of hand written transfusion requisition form and improvement after online request - A clinical audit

Objective: To assess the compliance of healthcare personnel with regard to sending completely filled transfusion requisition forms.Methods: The audit was conducted at Aga Khan University Hospital, Karachi, and comprised requisition slips received at the hospital blood bank from September 2014 to February 2015. The British Committee for Standards in Haematology guidelines was used as the standard. Percentage of each variable on the proforma was analsyed. Rating \u3c50% for each form was defined as needs improvement , 51-99% as good compliance and 100% as excellent compliance . After implementing strategies to increase awareness and the launching of an online transfusion requisition form, a re-audit of physician compliance was done from February to April 2016 and the results were compared with the initial audit.. Data was analysed using SPSS 21.Results: The audit and the re-audit both comprised 1000 transfusion requisition forms each. In the audit, The sum of total scores of all the transfusion requisition forms was 4911, indicating a compliance rate of 46.9%, while the corresponding numbers in the re-audit were 10000 and 100%.Conclusions: The implementation of online blood transfusion requisition system had a positive impact on compliance rate

Autologous hematopoietic stem cell transplantation-10 years of data from a developing country

Intensive chemotherapy followed by autologous stem cell transplantation is the treatment of choice for patients with hematological malignancies. The objective of the present study was to evaluate the outcomes of patients with mainly lymphoma and multiple myeloma after autologous stem cell transplant. The pretransplant workup consisted of the complete blood count, an evaluation of the liver, kidney, lung, and infectious profile, chest radiographs, and a dental review. For lymphoma, all patients who achieved at least a 25% reduction in the disease after salvage therapy were included in the study. Mobilization was done with cyclophosphamide, followed by granulocyte colony-stimulating factor, 300 g twice daily. The conditioning regimens included BEAM (carmustine, etoposide, cytarabine, melphalan) and high-dose melphalan. A total of 206 transplants were performed from April 2004 to December 2014. Of these, 137 were allogeneic transplants and 69 were autologous. Of the patients receiving an autologous transplant, 49 were male and 20 were female. Of the 69 patients, 26 underwent transplantation for Hodgkin\u27s lymphoma, 23 for non-Hodgkin\u27s lymphoma, and 15 for multiple myeloma and 4 and 1 for Ewing\u27s sarcoma and neuroblastoma, respectively. The median age ± SD was 34 ± 13.1 years (range, 4-64). A mean of 4.7 * 10⁸ ± 1.7 mononuclear cells per kilogram were infused. The median time to white blood cell recovery was 18.2 ± 5.34 days. Transplant-related mortality occurred in 10 patients. After a median follow-up period of 104 months, the overall survival rate was 86%. High-dose chemotherapy, followed by autologous stem cell transplant, is an effective treatment option for patients with hematological malignancies, allowing further consolidation of response

Chromosomal abnormalities in primary myelodysplastic syndrome

Objective: To determine the frequency of cytogenetic abnormalities in patients diagnosed as primary myelodysplastic syndrome (MDS) using conventional karyotyping. Study Design: Case series. Place and Duration of Study: The Clinical Laboratory, The Aga Khan University Hospital, Karachi, between January 2006 - June 2012. Methodology: Patients of all ages and either gender who fulfilled WHO criteria for MDS were included. Cytogenetic analysis was conducted at the time of diagnosis. Patients who had secondary MDS were excluded from analysis. Chromosome identification and karyotype description was done according to the International System for Chromosome Nomenclature (ISCN, 1995) and described as frequency percentage. Results: Out of the 122 cases of MDS, 71 patients had their karyotype done at the time of diagnosis, including 42 males (59.2%) and 29 females (40.8%) with median age of 60 years. Forty one (57.7%) showed normal karyotype and 30 (42.3%) showed clonal karyotypic abnormalities at diagnosis. Out of which 14 (19.7%) had single, 11 (15.5%) had complex and 6 (8.5%) had double cytogenetic abnormalities. The common abnormalities found were: trisomy 8 in 7 cases (9.9%), -7/del (7q) in 3 cases (4.2%), -Y and complex 5q in 2 cases (2.8%) each, complex trisomy 8, del 11q , inversion 9, trisomy 19 and del 20q were found in 1 case (1.4%) each. Other abnormalities were found in 11 cases (15.5%). Conclusion: Trisomy 8 was the most common disorder/abnormality found in this study population followed by the complex cytogenetics

Clinico-pathological profile and outcomes of patients with polycythaemia vera, essential thrombocythaemia and idiopathic myelofibrosis: a tertiary care center experience from southern Pakistan

Background: The “Philadelphia Negative Classic Myeloproliferative Neoplasms” include polycythaemia vera (PV), essential thrombocythaemia (ET) andidiopathic myelofibrosis (IMF). These three disorders share several clinical and laboratory features including JAK2 V617F mutation. Our objectives were to determine the clinicoat hological profile and outcomes of Pakistani patients with polycythaemia vera (PV), essential thrombocythaemia (ET) and idiopathic myelofibrosis (IMF) in order to have an insight regarding behaviour of these conditions. Methods: A retrospective analysis of all the cases of PV, ET and IMF diagnosed at our institute from January 1995 to December 2013 was performed.Age, gender, clinical presentation, laboratory investigations, treatment provided and duration of follow up were included for analysis. Appropriatestatistics were utilized for calculation of data. Results: A total of 58 patients were diagnosed as PV, ET or IMF during the study period. Male to female ratio was 1.1:1Forty five percent (n=2) patients came to medical attention due to abnormal laboratory results, 3 had cerebrovascular events, 3 had pruritus, and 1 patient each with gangrene and BuddChiari syndrome. Haemorrhag was not seen in any patient. Sixty percent (n=35) patients were treated with phlebotomy, hydroxyurea and aspirin alone or in combination. None of the patients transformed to myelofibrosis (MF) ormyelodysplasia (MDS) during the mean (±SD) followupperiod of 57.2±50 months.One patient with ET transformed to acute myeloid leukaemia9 yearsafter the diagnosis. Conclusions: This study demonstrated a relatively more benign form of PV, ET and IMF with lesser frequency of symptoms, good response to treatment andless likelihood of transformation to MF, MDS or AM

Giant juvenile fibroadenoma of the breast in a 13-year-old Pakistani girl with excellent cosmetic outcome after subareolar enucleation - A case report

Introduction: Fibroadenoma is the most common benign lesion of breast in young women, characterized by an aberrant proliferation of both epithelial and mesenchymal elements. It is termed giant fibroadenoma when it is larger than 5 cm or weighs more than 500 g with an incidence of 0.5-2% of all fibroadenomas.Presentation of case: In this report, we discuss a case of a 13-year-old Pakistani girl who presented with a giant juvenile fibroadenoma in left breast and was treated by a subareolar lump excision through a periareolar incision with excellent cosmetic outcome. To the best of our literature search, this is the first case of giant juvenile fibroadenoma in an adolescent being reported from Pakistan.Discussion: Surgical management of giant juvenile fibroadenoma in immature breast is challenging as it may either result in asymmetric defect or damage to developing breast tissue resulting in long term poor outcomes. Surgical decision should be carefully undertaken and reported for future reference in such cases.Conclusion: The diagnosis and management of giant juvenile fibroadenoma can be challenging because these tumors clinically and histologically mimic phyllodes tumor due to their rapid growth and large size. Excision through a periareolar approach for fibroadenomas located in subareolar region provides good cosmetic results in these patients with minimal scar visibility

Stock Market Dynamics in Pakistan: What Do Political Events and Budget Announcements Disclose?

The purpose of this study is to capture Pakistani stock market dynamics in response to political -and budget events. The study of political events and budget announcements together is quite reasonable in that: swift transformations of governments are likely to change annual budget policies, so both political -and budget events go side by side and influence the stock market performance. Moreover, we want to check: whether budget is one possible channel to off- set or somehow reduce the damage occurred due to political instability? We employ event study methodology over the sample period 1998-2016 of KSE-100 index daily returns to test the investor’s reaction to political -and budget news and, investigated whether stock market behaviour is consistent with efficient market hypothesis or over-and underreaction hypothesis or uncertain information hypothesis. We find evidence that Pakistani stock market exhibits weak form of the EMH for expected political -and budget events. The results of unexpected political events report that investors overreact to good political news while underreact to bad political news, indicate that results are consistent to UIH. The study may suggest that budget policies may not be very useful to offset the negative impact of political instability for a longer time period. So, the developing nations, especially, with more exposure towards political risk may use this suggestion as a strategic tool and, focus on some other channels to compensate the harmful effects of political instability on stock market performance. Keywords: Pakistan, KSE-100 index, Political events, Budget events, Event Stud

IMPACT OF R&D INVESTMENT ON FIRM PERFORMANCE AND FIRM VALUE: EVIDENCE FROM DEVELOPED NATIONS (G-7)

The purpose of the study is to evaluate the impact of R&D investment on firm performance and firm value among G-7 countries. To testify such relationship we use firm level and country level data collected from firms’ financial statement, countries stock exchanges and World Bank databases. Based on data structure (country level, industry level and firm level) we use HLM regression analysis technique along with robust standard error. By using diverse range of control variables (firm size, age, leverage, GDP growth, interest rate and financial crises dummy), results suggest that same year R&D investment has negative impact on firm performance and positive impact on firm value. However one year lagged period R&D investment has positive relationship with both firm performance and firm value. Nevertheless two year lagged period R&D investment has not effect on both firm performance and value