By comparing Problem-Based Learning(PBL) with Case-Based Learning(CBL) between University of California at Los Angeles(UCLA) and the University of California at Davis(UCD),the writers find that CBL was preferred by students(89%) and faculty(84%) across schools and learner levelsThe conclusion is that learners and faculty at two major academic medical centers overwhelmingly prefer CBL(guided inquiry) to PBL(open inquiry)

Comparing Problem-Based Learning with Case-Based Learning: Effects of a Major Curricular Shift at Two Institutions

https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(15)00320-4.pdf

Variability in mortality following caesarean delivery, appendectomy, and groin hernia repair in low-income and middle-income countries: a systematic review and analysis of published data

Excess Surgical Mortality: Strategies for Improving Quality of Care

Much has since been done to investigate these issues. The WHO has provided guidance for measuring surgical services and capacity through a set of standardized metrics for surgical surveillance (Weiser and others 2009). In addition, a situational analysis tool has been constructed and deployed in a number of countries to help assess surgical capacity (WHO 2010). Yet the logistics of performing surgery are complex and demand standardization. Surgical services must also continuously measure patient outcomes to identify shortcomings, inform improvements, and maintain high levels of quality care. Mortality Following Surgery

Excess Surgical Mortality: Strategies for Improving Quality of Care -- Essential Surgery: Disease Control Priorities, Third Edition (Volume 1)

Introduction: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has had a disastrous effect worldwide during the previous three years due to widespread infections with SARS-CoV-2 and its emerging variations. More than 674 million confirmed cases and over 6.7 million deaths have been attributed to successive waves of SARS-CoV-2 infections as of 29th January 2023. Similar to other RNA viruses, SARS-CoV-2 is more susceptible to genetic evolution and spontaneous mutations over time, resulting in the continual emergence of variants with distinct characteristics. Spontaneous mutations of SARS-CoV-2 variants increase its transmissibility, virulence, and disease severity and diminish the efficacy of therapeutics and vaccines, resulting in vaccine-breakthrough infections and re-infection, leading to high mortality and morbidity rates. Materials and methods: In this study, we evaluated 10,531 whole genome sequences of all reported variants globally through a computational approach to assess the spread and emergence of the mutations in the SARS-CoV-2 genome. The available data sources of NextCladeCLI 2.3.0 (https://clades.nextstrain.org/) and NextStrain (https://nextstrain.org/) were searched for tracking SARS-CoV-2 mutations, analysed using the PROVEAN, Polyphen-2, and Predict SNP mutational analysis tools and validated by Machine Learning models. Result: Compared to the Wuhan-Hu-1 reference strain NC 045512.2, genome-wide annotations showed 16,954 mutations in the SARS-CoV-2 genome. We determined that the Omicron variant had 6,307 mutations (retrieved sequence:1947), including 67.8% unique mutations, more than any other variant evaluated in this study. The spike protein of the Omicron variant harboured 876 mutations, including 443 deleterious mutations. Among these deleterious mutations, 187 were common and 256 were unique non-synonymous mutations. In contrast, after analysing 1,884 sequences of the Delta variant, we discovered 4,468 mutations, of which 66% were unique, and not previously reported in other variants. Mutations affecting spike proteins are mostly found in RBD regions for Omicron, whereas most of the Delta variant mutations drawn to focus on amino acid regions ranging from 911 to 924 in the context of epitope prediction (B cell & T cell) and mutational stability impact analysis protruding that Omicron is more transmissible. Discussion: The pathogenesis of the Omicron variant could be prevented if the deleterious and persistent unique immunosuppressive mutations can be targeted for vaccination or small-molecule inhibitor designing. Thus, our findings will help researchers monitor and track the continuously evolving nature of SARS-CoV-2 strains, the associated genetic variants, and their implications for developing effective control and prophylaxis strategies.

/pdf/variant-specific-deleterious-mutations-in-the-sars-cov-2-13c5lzkl.pdf

Variant-specific deleterious mutations in the SARS-CoV-2 genome reveal immune responses and potentials for prophylactic vaccine development

Chimeric antigen receptor (CAR) T therapy has shown remarkable success in discovering novel CAR-T cell products for treating malignancies. Despite of successful results from clinical trials, CAR-T cell therapy is ineffective for long-term disease progression. Numerous challenges of CAR-T cell immunotherapy such as cell dysfunction, cytokine-related toxicities, TGF-β resistance, GvHD risks, antigen escape, restricted trafficking, and tumor cell infiltration still exist that hamper the safety and efficacy of CAR-T cells for malignancies. The accumulated data revealed that these challenges could be overcome with the advanced CRISPR genome editing technology, which is the most promising tool to knockout TRAC and HLA genes, inhibiting the effects of dominant negative receptors (PD-1, TGF-β, and B2M), lowering the risks of cytokine release syndrome (CRS), and regulating CAR-T cell function in the tumor microenvironment (TME). CRISPR technology employs DSB-free genome editing methods that robustly allow efficient and controllable genetic modification. The present review explored the innovative aspects of CRISPR/Cas9 technology for developing next-generation/universal allogeneic CAR-T cells. The present manuscript addressed the ongoing status of clinical trials of CRISPR/Cas9-engineered CAR-T cells against cancer and pointed out the off-target effects associated with CRISPR/Cas9 genome editing. It is concluded that CAR-T cells modified by CRISPR/Cas9 significantly improved antitumor efficacy in a cost-effective manner that provides opportunities for novel cancer immunotherapies. 

Explorations of CRISPR/Cas9 for improving the long-term efficacy of universal CAR-T cells in cancer immunotherapy.

A study of maternal mortality in 8 principal hospitals in Pakistan in 2009.

Objective: To explore the perceptions of final year medical students about efficacy of traditional teaching methods and Case based learning (CBL) and to evaluate the effect of CBL on students’ performance and satisfaction level during their clinical rotation in Obstetrics and Gynaecology Department. Study Design: Sequential mixed method study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Holy Family Hospital, Rawalpindi from January 2013 to June 2013. Participants and Methods: Students expressed their perceptions on a Likert scale in a questionnaire. It was triangulated with data collected from 4 focus group discussions (FGD). Students for FGD were selected using purposive sampling. Students’ performance in OSPE and long case was compared with another group who was taught with traditional methods. Quantitative data was analyzed by SPSS version 17. For qualitative data, themes and patterns were identified using content analysis technique. Results: Of 141 students, 134 returned completed forms giving a response rate of 95%.Gender distribution was similar in both the groups. There was no statistically significant difference in performance assessment. Strong preference for CBL was expressed by 97% as it improved their confidence (83%), clinical and presentation skills (91& 80%), attitude and student teacher relationship (68 & 77%), strengthened link between theory and practice (90%), and integrated basic and clinical knowledge (92%). Seventy six percent stated that all teaching should be CBL. Qualitative data from SGD strongly supported these views. Conclusion: Although test performance was similar in both the groups, students expressed strong preference for CBL as compared to traditional methods

Case based learning and traditional teaching strategies: where lies the future

Abstract. Asghar A, Qadeer O, Mushtaq S, Maalik S, Majeed W, Bano N, Nargis S. 2022. Assessment of insects diversity with the influence of industrial pollutants in agricultural zones of District Sialkot, Pakistan. Biodiversitas 23: 2047-2053. Insects are the most important creatures on earth due to their multifunctional role in the environment by providing different services such as biological indicators, decomposers, pollinators, scavengers, pests, and predators agroecosystem. However, with time due to anthropogenic activities such as environmental pollution, industrial waste, and the use of effluents for agriculture, insect fauna has been facing a dramatic threat to their diversity, particularly in most polluted areas. The present study was designed to find insects diversity variation under polluted environments (heavy metals) in agriculture fields having brassica and Rice crops. Two different sites, the tannery and non-tannery areas were selected to sample insects. The total number of insects found in tannery area fields were 2195 and 3753 from the non-tannery area. The abundance of Melanoplus bivittatus (Say, 1825) was highest in the non-tannery area, and Acrida exaltata (Walker, 1859) was highest in tannery area fields. From the tannery area and non-tannery area, the maximum abundance of 32% and 37% were found for order orthoptera. The cadmium concentration in tannery rice crops was 0.626 ppm, and brassica concentration was 0.315 ppm. The cadmium concentration in non-tannery area samples was 0.115 ppm for rice and 0.101 ppm for brassica plants, while 0.1231 ppm for rice and 0.104 ppm for brassica insects. The lead concentration in tannery areas of rice crops was 0.637 ppm, and brassica concentration was 0.672 ppm. The lead concentration in non-tannery area samples was 0.324 ppm for rice and 0.267 ppm for brassica plants, while 0.214 ppm for rice and 0.266 ppm for brassica insects. The diversity and richness were recorded at 3.11 and 3.525 for rice and 3.124 and 3.913 for brassica fields. The species maximum was seen in the non-tannery area, and less abundance was recorded in the tannery area. It is further suggested that preventive measures should be taken to protect insect diversity from balancing nature's ecological balance.

/pdf/assessment-of-insects-diversity-with-the-influence-of-1716v2kl.pdf

Assessment of insects diversity with the influence of industrial pollutants in agricultural zones of District Sialkot, Pakistan

The global outbreak of COVID-19 possesses serious challenges and adverse impacts for patients with progression of chronic liver disease and has become a major threat to public health. COVID-19 patients have a high risk of lung injury and multiorgan dysfunction that remains a major challenge to hepatology. COVID-19 patients and those with liver injury exhibit clinical manifestations, including elevation in ALT, AST, GGT, bilirubin, TNF-α, and IL-6 and reduction in the levels of CD4 and CD8. Liver injury in COVID-19 patients is induced through multiple factors, including a direct attack of SARS-CoV-2 on liver hepatocytes, hypoxia reperfusion dysfunction, cytokine release syndrome, drug-induced hepatotoxicity caused by lopinavir and ritonavir, immune-mediated inflammation, renin-angiotensin system, and coagulopathy. Cellular and molecular mechanisms underlying liver dysfunction are not fully understood in severe COVID-19 attacks. High mortality and the development of chronic liver diseases such as cirrhosis, alcoholic liver disease, autoimmune hepatitis, nonalcoholic fatty liver disease, and hepatocellular carcinoma are also associated with patients with liver damage. COVID-19 patients with preexisting or developing liver disease should be managed. They often need hospitalization and medication, especially in conjunction with liver transplants. In the present review, we highlight the attack of SARS-CoV-2 on liver hepatocytes by exploring the cellular and molecular events underlying the pathophysiological mechanisms in COVID-19 patients with liver injury. We also discuss the development of chronic liver diseases during the progression of SARS-CoV-2 replication. Lastly, we explore management principles in COVID-19 patients with liver injury and liver transplantation.

/pdf/pathogenetic-mechanisms-of-liver-associated-injuries-1kolhpzy.pdf

Pathogenetic Mechanisms of Liver-Associated Injuries, Management, and Current Challenges in COVID-19 Patients

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