Problem-based learning (PBL) is one of medical education’s most effective student-centered learning modalities. However, a lack of experience has led to several gaps in this useful learning modality, prohibiting it from achieving the desired goals. This study aimed to find gaps in our institution’s PBL strategy, take measures to fill these gaps, and then assess the effect of these measures. This interventional study was conducted in a Bachelor of Medicine and Surgery (MBBS) program after receiving ethical approval. The study consisted of three phases: gap identification, intervention, and evaluation. Faculty and student training sessions were conducted to provide insight into PBL processes, followed by a Quality Assessment Questionnaire (QAQ) to assess PBL design and delivery gaps. A PBL revision committee then used the 3C3R model to redesign 136 PBLs, improving alignment with learning outcomes. Pre- and post-intervention scores from the QAQ and formative assessments were analyzed using Wilcoxon signed-rank and paired t-tests. Pre-intervention QAQ scores averaged 2.7 out of 5, reflecting issues PBL problems and conduction. Post-intervention scores improved to 4.0 (p <.001), indicating a 48.1

Purpose: Coronary artery disease (CAD), clinically manifested as coronary syndrome (CS), is the leading cause of death and a significant contributor to morbidity worldwide. Elevated serum homocysteine levels have been associated with an increased risk of cardiovascular diseases, including CAD. Despite extensive research, the relationship between serum homocysteine and coronary syndromes with related short-term mortality is still under-studied. The main objective of this study is to evaluate the correlation between serum homocysteine levels and various types of CS, as well as in-hospital mortality in these patients. Patients and Methods: This multicenter study included 381 CS patients from Afghanistan, Egypt, and Pakistan tertiary care hospitals. The relation of serum homocysteine levels with different types of CS as well as with in-hospital mortality was measured and analyzed using inferential statistics (ANOVA, Kruskal-Wallis test, Tukey's post-hoc, Pearson correlation, etc.) and regression analysis (Binary regression). Results: Among 381 patients from both genders, 160 were from Pakistan, 130 from Egypt, and 91 from Afghanistan. There was no significant difference in baseline characteristics, like age, gender, homocysteine level, CS type, and mortality, among the three countries (p > 0.05). The one-way ANOVA, the Kruskal Wallis Test, and Tukey's post hoc test showed a significant difference among different CS groups based on serum homocysteine levels, and Pearson correlation showed a strong correlation between serum homocysteine and CS (r = 0.4). Binary regression analysis showed a 10.5% increase in in-hospital mortality for each 1 mu mol/L increase in homocysteine levels. Conclusion: Serum homocysteine could serve as a valuable biomarker and mortality predictor in CS patients.

The power output of a turbine blade is proportional to its size. As the size of a blade increases, its power output increases. However, larger size of a blade also makes it more susceptible to deflection and stress, resulting in a significant reduction in its load-carrying capacity. In order to efficiently evaluate the structural integrity and stability of large blades, we propose an improved finite element (FE) based methodology of a 53-meter-long composite wind turbine blade. 3D non-linear FE simulations, employing the composite failure criterion, are performed to examine the deformations of blades under extreme wind gusts and normal operational conditions. The results obtained from simulations revels that high compressive stresses are experienced by the suction side (SS) of the blade, leading to localized skin buckling and de-bonding at the skin-spar interface. Under normal operating conditions, gravity loads dominate the aerodynamic loads, and an edgewise bending is observed from the leading to the trailing edge of the blade. Under extreme loading condition, the maximum load-carrying capacity of the blade is governed by a coupled local buckling and de-bonding phenomenon. The analysis methodology proposed in our current work can make a basis for the development of reliable and cost-effective computational procedures to investigate the structural strength of large turbine blades under extreme and normal loadings, potentially reducing expensive experimental testing.

BACKGROUND Chronic liver disease is a growing global health problem, leading to hepatic decompensation characterized by an array of clinical and biochemical complications. Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score, model of end-stage liver disease (MELD) score, and MELD-Na score. Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes. Although studies have explored anemia in liver disease, few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation. AIM To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh, MELD, and MELD-Na scores. METHODS This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study. Data was collected on demographics, clinical history, and laboratory findings, including hemoglobin levels, bilirubin, albumin, prothrombin time (international normalized ratio), sodium, and creatinine. The Child-Pugh, MELD, and MELD-Na scores were calculated. Statistical analysis was performed using Statistical Package for the Social Sciences version 26, and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient. RESULTS The study included 405 males (62.1%) and 247 females (37.9%) with an average age of 58.8 years. Significant inverse correlations were found between hemoglobin levels and Child-Pugh, MELD, and MELD-Na scores (P < 0.01), with the MELD scoring system being the strongest correlator among all. One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system (P = 0.001). Tukey's post hoc analysis confirmed significant internal differences among each severity group. CONCLUSION Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.

It has been rediscovered in the last fifteen years that B-cells play an active role in autoimmune etiology rather than just being spectators. The clinical success of B-cell depletion therapies (BCDTs) has contributed to this. BCDTs, including those that target CD20, CD19, and BAFF, were first developed to eradicate malignant B-cells. These days, they treat autoimmune conditions like multiple sclerosis and systemic lupus erythematosus. Particular surprises have resulted from the use of BCDTs in autoimmune diseases. For example, even in cases where BCDT is used to treat the condition, its effects on antibody-secreting plasma cells and antibody levels are restricted, even though these cells are regarded to play a detrimental pathogenic role in autoimmune diseases. In this Review, we provide an update on our knowledge of the biology of B-cells, examine the outcomes of clinical studies employing BCDT for autoimmune reasons, talk about potential explanations for the drug's mode of action, and make predictions about future approaches to targeting B-cells other than depletion.

ObjectiveThe main aim of this study is to know the loopholes in the feedback system, strategies to remove these loopholes, and to measure the effects of an efficient feedback system in an institution.MethodsThis research has three stages. In the first stage, we tried to find out the flaws in the feedback system of the institution based on published benchmarks. Then we tried to remove these flaws with the collaboration of different stakeholders. In the last stage of the study, we tried to measure the effectiveness of these corrective procedures by certain key performance indicators (KPIs).ResultsAfter improvement strategies, there was a significant improvement in the KPIs like, the knowledge and attitude toward the feedback improved from 3.1 to 4.23 in students, and from 3.46 to 4.34 in faculty members, on a five-point scale, and the teaching standards improved as measured by students' performance in different courses in terms of learning objectives achievement, for example in internal medicine from 70.8% to 75.3%. Similar improvement was recorded in other KPIs as well.ConclusionAn efficient feedback system is the backbone of education and by adopting effective feedback, individuals and institutions can excel in the field of medical education.

Medical education is constantly evolving worldwide and facing various challenges. To cope with these, continuous and fruitful evaluation of an educational program is the need of the day. This study aims to know the purpose of evaluation, various theories related to program evaluation, and different models of curriculum and program evaluation. This will help educationists evaluate their programs fruitfully and effectively according to their needs and objectives. Different search engines including Medline’s PubMed interface, Google Scholar, and Cochrane Review databases using keywords, curriculum evaluation, evaluation models, and evaluation strategies in education, were searched without any date restrictions, and 20 full-text articles were selected for review and data extraction. While reviewing the literature it was found that most of the modern educational program and curriculum evaluation models are based on the reductionist, system, and complexity theories of evaluation. The experimental/quasi-experimental model is based majorly on the linear approach and reductionism, but its drawback is that it is impractical for the whole curriculum and sometimes ethically unfavorable. Kirkpatrick’s model, Philips’ model, the CIPP model, and the logic model are based on the system and complexity theory and are more practical in medical education. Each of these models has its advantages and limitations. In this review, the authors discussed the important distinctive features of these evaluation theories and models and their applicability and usefulness in evaluating different programs and curricula.

Carbon and glass fabric reinforced polymer (C/GFRP) composites are extensively used in aerospace and sports industry because of their exceptional properties. However, during service, static and dynamic bending loads can ensue damage in composites affecting their strength, stiffness and energy absorption. Carbon fiber composites, being inherently brittle, are prone to sudden catastrophic fracture without ductile-like behavior of metals. This study investigates mechanical behavior and damage mechanisms of woven C/GFRP composites in on- and off-axis orientations during bending. Initially, bending tests with quasi-static loading were performed, followed by dynamic ones using an Izod impact testing apparatus. Results showed distinct behavior in on-axis CFRP laminates with brittle fracture. Off-axis CFRP samples and both on- and off-axis GFRP laminates showed signs of damage and non-linear behavior, yet they retained their ability to bear loads. Significantly, off-axis specimens of both types and on-axis GFRP laminates exhibited enhanced energy absorption capabilities without experiencing fracture, undergoing pseudo-ductile deformation. CFRP specimens were analyzed with micro-computed tomography (micro-CT), provided insights into prevalent damage modes such as matrix mircocracking, debonding of tows, delamination and breakage of fabric. While on-axis CFRP laminates experienced brittle fracture, off-axis specimens exhibited a ductile-like response attributed to matrix plasticity, cracking and fiber trellising before eventual failure.

Selective laser melting (SLM) of titanium (Ti) alloys has been a focus of research in aerospace industries recently, due to ease of production, producing complex geometries and shorter production time as compared to conventional machining. Although some basic research on mechanical properties at room temperature is found in literature, the need for high-temperature applications, correlated with material characterization is inevitable. This work provides a benchmark for high-temperature mechanical and thermal properties of SLM manufactured Ti6Al4V alloy, formulated as a result of extensive experimentation in the form various mechanical and thermal tests. The Ultimate Tensile Strength (UTS) and Yield Strength (YS) of test specimens at 600 degrees C reduced to approximately 64% of those at room temperature (RT), whereas an increase in the percentage elongation from 9.6% to 15% at 600 degrees C, which is the usual trend in materials at elevated temperatures. Fracture toughness of 89.44 MPa m(1/2) was calculated from 3-point bend test. Hardness value of 37 HRC was measured on the Rockwell-C scale. Thermal conductivity and coefficient of thermal expansion increased from 2.11 W/m. K at RT to 3.73 W/m. K at 300 degrees C and 8 mu m\m-0C at RT to 10 mu m\m-0C at 600 degrees C respectively. Specific heat capacity values increased from 760 J/kg 0C to 925 J/kg 0C up to 200 degrees C, but decreased at higher temperatures from 200 degrees C to 600 degrees C. To the author's knowledge, for the first time comprehensive mechanical testing characterized the behavior of the developed material for its application in structures subjected to elevated temperatures.

Most fiber-reinforced composites are inherently brittle and fail suddenly at low strains without yielding and energy-absorbing capability. Still, under some conditions, they can demonstrate ductile like response known as pseudo-ductility. To investigate such a response, experimental analysis of carbon- and glass-fabric reinforced thermoplastic polymer (C/GFRP) composites was performed in on- and off-axis orientations under service loading conditions of tension and bending. Tensile tests of off-axis specimens were conducted with a full-field strain-measurement digital image correlation (DIC) technique. Cyclic bending tests of on- and off-axis C/GFRP specimens were performed to assess their ductility and damage behavior. The tests revealed that on-axis CFRP laminates failed due to fracture of brittle carbon fibers under tension, monotonic and cyclic bending. The on-axis GFRP samples demonstrated a linear-elastic brittle response under tension but a visco-elasto-plastic nonlinear behavior under monotonic and cyclic bending with hysteresis and energy absorption. The off-axis C/GFRP specimens exhibited ductile behavior akin to metals, enduring high strains with permanent deformation before ultimate failure, and absorbing substantial amounts of energy. The pseudo-ductile response of off-axis CFRP specimens under bending can be attributed to plasticity and damage of matrix as well as fiber trellising, whereas in the on-axis GFRP specimens, it is primarily due to visco-elasto-plastic behavior of glass fibers and the TPU matrix. It is concluded that material's response can be tailored for stiffness, strength and ductility for specific applications.

Objective Hypertension (HTN) is among the most common causes of chronic disease burden, along with dyslipidemia. It is a prominent risk factor for cardiovascular and cerebrovascular morbidity and mortality. More often than not, HTN coexists with dyslipidemia. This study aimed to see the antihypertensive effect of statins (atorvastatin), as certain animal models have shown that statins have a voltage-gated calcium channel -blocking effect. Material and methods This was a randomized controlled trial done at the Ayub Hospital Complex in Abbottabad, Pakistan. After ethical approval, 120 patients with newly diagnosed hypertension belonging to either gender and aged 35 and above were enrolled in the trial. They were randomly divided into two groups, with each group comprising 60 patients. One group was administered amlodipine 5 mg per oral (PO) once a day, while the other group was given 5 mg of amlodipine PO plus 10 mg of atorvastatin PO. The patients were examined on a follow-up visit 14 days later, and blood pressure was recorded as per protocols. Results A total of 120 newly diagnosed patients were studied in this trial. The mean age was 51.07 years, with a standard deviation of +/- 6.15 years and a range of 41-60 years. There were 64 (53.3%) males and 56 (46.7%) females in the study. The mean systolic blood pressures (SBPs) and diastolic blood pressures (DBPs) in Group 2 (amlodipine 5 mg + atorvastatin 10 mg) were significantly lower than the patients in Group 1 (only amlodipine 5 mg) in the follow-up visit, which was 14 days after starting the medication (p <= 0.05). Conclusion The addition of a lipid-lowering drug to an antihypertensive regimen results in a better lowering of blood pressure in hypertensive individuals.

Background:Several precipitating factors of hepatic encephalopathy have been recognized and studied. Hepatic encephalopathy which is a frequent and grave complication of liver failure, is associated with multiple biochemical changes like high serum ammonia, mercaptan and phenol levels, low albumin levels and derangements in electrolytes. It is characterized by a range of neuronal and psychological aberrations mainly due to the inability of liver to metabolize different neurotoxic chemicals produced in the body. Hypokalemia is one of the most important findings in hepatic encephalopathy and postulated as a precipitating factor of the condition. The authors aimed to know the frequency of hypokalemia and its relation to the severity of hepatic encephalopathy. Methods:After taking approval from the hospital ethical review committee, a total of 5000 patients with hepatic encephalopathy were recruited by consecutive sampling. They were interviewed, examined and investigated for serum potassium levels and other precipitating factors of hepatic encephalopathy. Results:Total of 5000 patients including 3070 (61.4%) males and 1930 (38.6%) females, aging 13 years and above were studied. The frequency of hypokalemia was 78% (3900 patients). Relating the serum potassium level with the severity of hepatic encephalopathy, 1200 (60%) out of 2000 patients with serum potassium below 2.5 mEq/l were in grade 4 (40%) and 800 out of 2000 were in grade 3 encephalopathy. On the other hand, only 700 patients (6.4%) out 1100 with serum potassium above 3.4 mEq/l were in grade 4 encephalopathy. Conclusion:Hypokalemia is a frequent finding in patients with hepatic encephalopathy and found to be directly related to its severity.

The large size composite wind turbine blades for higher power output are subjected to extreme aerodynamic loads such as wind gusts during service life of 20 years. The loading conditions can induce large deformation and high stresses leading to progressive adhesive debonding between spar and skin and damage of composite skin; thus challenging structural integrity of the blade. These interactive damage modes of interface and skin are simulated by carrying out finite element (FE) analysis with Ansys software. In the FE analysis, cohesive zone model (CZM) using bilinear type law of traction-separation is employed to model adhesive debonding between spar and skin. Continuum damage mechanics (CDM) based approach is used for progressive damage analysis of the composite skin. Both these techniques are described by user through material subroutines. The simulation results indicated that high compressive stresses caused buckling of skin locally leading to debonding of adhesive interface between skin and spar on the suction side of the blade with subsequent progressive damage of the composite skin. Resultantly, the eventual load carrying-ability of the blade is dictated by coupling of adhesive debonding at the interface and skin failure. The simulation procedure implemented in this work can be used for development of reliable and economical computational models for investigating coupled damage modes and predicting failure response of the blade than costly experimental qualification testing.

Aim: To know the relation between serum hs CRP levels and IHD. Methods: This study was done in the Department of cardiology Hayatabad Medical Complex, Peshawar after approval from the hospital ethical committee. It was a cross-sectional descriptive study. The duration of the study was one and a half years, with a sample of 160 IHD patients.The sample size was calculated based on a universally validated calculator with a 95% confidence interval and a 5% margin of error. Results: Among the total 160 IHD patients included in this study, 102(63.7%) were male and 58(36.3%) females. Mean±SD age was 57.8±13.7. Among 160 patients, 32(20%) patients were having hs CRP below 1 mg/L, 45(28.1%) patients having between 1 to 3mg/L, and 83(51.9%) patients >3 mg/L. Mean±SD hs CRP level was 4.52±3.2mg/L. Conclusion: High sensitivity C-reactive proteins (hs CRP) is one of the important risk factors of IHD and its level is directly related to the frequency of IHD Keywords: Ischemic Heart Disease (IHD), cardiovascular disease (CVD), hs CRP

Background: COVID-19 is a global pandemic and the most serious health issue worldwide now a day. There is a lot of research going on regarding this issue. Many sectors of the community are focussed but some are still not properly approached like those with poor socioeconomic status, with high exposure to the community. This study was aimed at one of such group i.e., labourers, maintenance and sanitary workers. Methodology: It was a questionnaire-based cross-sectional study. The questionnaire contained multiple choice questions based on simple laymen knowledge regarding covid-19. The sampling technique was non-probability consecutive sampling. The sample size (169) and the questionnaire were filled in by the one health professional in face-to-face interview. Results: Total 169 participants, all males, were included in this study. The age range was 18-60 years (median 36 years). Most of the participants were sanitary workers (89.9%) with a major chunk from Bangladesh (82.8%) followed by India (15.4%). The level of awareness was considered good, average and poor with more than 20 (80%), 15 to 20 (58- 79%), and less than 15 (54%) correct replies, respectively. Only 35 participants (20.7%) ranked as good while 110(65.1%) had average and 24(14.2%) had poor knowledge. Conclusion: The level of awareness among labour class of the society is quite low. Educating them regarding COVID-19 is very important in order to control this pandemic. Keywords: SARS-CoV-2, COVID-19, Awareness, Prevention

Aim: Responsible factors in patients with portosystemic encephalopathy and their relation with the severity of encephalopathy using “west haven scoring”. Methods: This cross-sectional study was done in the Gastroenterology Department, Hayatabad Medical Complex Peshawar. After ethical approval, a sample of 500 patients was calculated by universally accepted sample calculators. 95% confidence intervals and 5%margin of error. The sample was taken by a non-probability consecutive sampling technique. Results: Out of 500 patients, 307 were male and 193 females. The mean age was 57.36(±17.65 SD). Electrolyte imbalance (79.2%) was the most prevalent responsible factor, followed by infection (47.4%) and dehydration (24.4%). The number of patients with Grade 1, 2, 3 and 4 encephalopathy were 48, 187, 223, 42 respectively. In the majority of patients with encephalopathy, more than one responsible factor was present. Conclusion: Portosystemic encephalopathy is one of the most serious and life-threatening complications of liver failure and cirrhosis. Keywords: Portosystemic encephalopathy, responsible factors, gastrointestinal bleeding.

Wind turbine blades are continuously upscaled in size to meet the increasing demand of low cost renewable energy. The larger and slender blades with reduced mass are susceptible to large-deflection bending and instability during extreme wind gusts. The loading can induce interactive damage modes such as adhesive bond failure and composite skin damage progressively degrading the blade structural performance. The structural deformation and instability as well as progressive damage in composite blade is analyzed by developing finite element (FE) models using ANSYS software. First, a geometric nonlinear FE analysis of the 3D blade is performed to predict its deflection and regions of high stresses. The results demonstrated that high compressive stresses in the blade suction side trigger local skin buckling; thus initiating debonding of weak adhesive interface joint between skin and spar combined with skin damage. Subsequently, the interactive buckling-driven skin-spar debonding and composite skin damage in the identified region are analyzed through a submodel using cohesive zone model (CZM) as well as continuum damage mechanics (CDM) based progressive failure analysis, respectively, through a user-defined material subroutine. The results indicated that buckling-driven debonding of adhesive interface between skin and spar was primary damage mode leading to progressive failure of the blade composite skin. Consequently, the blade ultimate load carrying-ability was governed by coupled adhesive debonding and progressive skin damage phenomena, which is in good agreement with published experimental results. The developed simulation approach is capable to efficiently analyze the interactive buckling-induced interface damage as well as progressive failure of composite blade structure. In this work, modelling of interaction between interface debonding and skin damage, based on the CZM and CDM scheme, is a novel methodology for progressive damage analysis of blade under extreme loading.

Aim: To determine the different risk factors for Ischemic Heart Disease.Study Design: Cross-sectional study.Place of study: Department of cardiology Hayatabad Medical Complex, PeshawarDuration of study: 6 monthsMethodology: A total of 160 patients with Ischemic Heart Disease were included by using the WHO calculator with a margin of error of 5% and a confidence interval of 95%. A detailed history regarding clinical features of IHD and the risk factors was rcorded. Ischemic heart disease was confirmed by angiography and echocardiography.Results: Out of 160 cases, 102 were males and 58 were females. 43 were between 18-40 years, 54 between 41-60 years, and 63 were above 60 years of age. Among these, 74 patients were having dyslipidemia, 34 were hypertensive, 42 were Diabetic, 68 were smokers and 117 patients were over-weight (BMI>27). 132 patients were having more than one risk factor.Conclusion: Different risk factors in descending order are higher BMI (above 27), dyslipidemia, smoking, diabetes, and hypertension. The majority of the patients were having more than one risk factor.

We propose an efficient formulation using the framework of Generalized Finite Element Method (GFEM) for the solutions of transient heat diffusion problems having multiple heat sources in the solution domain. The purpose here is to use minimal computational resources and rely on coarse mesh grids to capture the sharp variations of temperature field. We use Gaussian functions of global nature to enrich the GFEM approximation space which ensure efficient solution in the whole solution domain. To capture steep thermal gradients at multiple locations, a multiplicity of enrichment functions is used and the peaks of enrichment functions are centred at the cores of heat sources. The advantage of this approach is that no further degrees of freedom (DOFs) are added to capture the solution at multiple locations. Besides, the enrichment functions are time-independent; the temporal variation of temperature is embedded in the definition of the enrichment functions. This formulation requires the assembly of system matrix once and only the right-hand side of the system of equations is updated at subsequent time steps which results in a significant reduction in the overall computational time. We consider problems in two-dimensional (2D) and three-dimensional (3D) domains to show the effectiveness of the proposed approach. A reduction of more than 95% in DOFs and more than 80% in computational time is achieved as compared to the h -version of finite element method.

Wind energy has emerged as one of the cleanest and sustainable sources of energy and is a potential resource for meeting the future’s electricity demand. Evaluating the aerodynamic performance of the turbine blade in complex environmental conditions is vital for designing and developing energy-efficient wind turbines. This work aims to undertake aerodynamic analysis of a Horizontal Axis Wind Turbine i.e. NREL Phase IV. Computational fluid dynamics (CFD) models are presented using ANSYS-CFX software. Blade geometries were tested at different wind speeds ranging from 5 m/s to 30 m/s. The power output and pressure coefficients obtained from numerical simulations are compared with experimental data published on wind turbine.