#lowbackpain on TikTok: A New Frontier for Orthopaedic Medical Education.

INTRODUCTION: Low back pain has become a substantial health problem in all developed countries. Many healthcare professionals and content creators have begun sharing their treatment methods and opinions through social media, especially the video-based platform TikTok. TikTok has been downloaded more than 2.6 billion times with over a billion daily users. Its influence on public health makes it imperative that information be accurate and safe. This study aims to analyze TikTok's most popular content on lower back pain and how orthopaedic surgeons contribute on this growing platform. OBJECTIVES: To analyze TikTok's most popular content on lower back pain and how orthopaedic surgeons are and can contribute on this growing platform. METHODS: A TikTok search conducted on April 22, 2023, using the terms '#lowerbackpain'and '#lowbackpainrelief,' resulted in numerous videos, 100 of which met inclusion criteria. Videos were included if they were related to the content, had more than 1000 views, were in English, and were not duplicates. Video characteristics were recorded and evaluated for quality by two reviewers using DISCERN. A two-sample t-test was used to assess differences. RESULTS: Overall, the top videos on lower back pain had an average of 2,061,396 views, with a mean DISCERN score of 34. The mean total DISCERN score was 36 and 34 for physicians and nonphysicians, respectively, while the video by the orthopaedic surgeon (n = 1) scored 31. The most recommended treatments included at-home exercises (n = 75) and visiting a chiropractor (n = 4). CONCLUSION: We find that the information presented by nonphysicians offered quick, at-home fixes to medical problems without offering any research or proven data to support their claims. We cannot overlook Tiktok's immense influence in the realm of orthopaedic health as it has become a sphere of information dissemination and education. Thus, we suggest that there is not necessarily a need for a greater number of surgeons and/or resident physicians to involve themselves on the platform, but rather the involvement of governing bodies and spine societies to put out position statements for our patients.

Plant cultural indicators of forest resources from the Himalayan high mountains: implications for improving agricultural resilience, subsistence, and forest restoration.

AIM: Biocultural legacy practices are intricately tied to forestry resources, ethnic identity, and social cohesiveness. This study aims to determine the plant cultural values of forest resources and identify plant cultural indicators in each ethnic group, which can aid in long-term natural resource management plans in the current debate on socio-environmental and ecological transitions. METHODS: Semi-structured interviews, focus group discussions, and field observations were employed to collect data for a comprehensive and systematic ethnobotanical survey from February 2018 to October 2022. RESULTS: A total of 330 informants reported 154 plant species from 65 families. Asteraceae was the most prominent botanical family, with herbaceous plant groups outnumbering trees and shrubs. The Gujjar and Pahari groups exhibited the highest level of overlap, followed by significant overlaps between the Gujjar and Kashmiri communities. The close affinity observed between the Gujjar and Pahari groups suggests the horizontal pattern of local plant knowledge between these communities, influenced by their sociocultural interactions and intermarriages. Notably, the Pahari community displayed a rich understanding of medicinal plants and shared unique uses for the reported taxa. This study affirms that both ecological factors and sociocultural influences have played significant roles in shaping local plant knowledge. A total of 31 plant species have been identified as plant cultural markers among all four ethnic groups. We observed a positive correlation between plant cultural values and plant use with the Gujjar and Kashmiri ethnic groups. Artemisia absinthium reported the highest use value of (0.57) with use reports of (189). Adonis aestivalis, Cynoglossum nervosum, Geum elatum, Geranium himalayense, Juncus inflexus, Oxalis acetosella, Polygonatum biflorum, and Salvia hians from the Himalayan region are among the plant taxa whose ethnomedicinal applications are described here for the first time. CONCLUSION: Our data show that local and indigenous forest knowledge and practices could significantly contribute to forest conservation and ecological transition. This may happen if stakeholders generate clear frameworks and biocultural conservation strategies aimed at both dynamically preserve natural habitats and ways of traditional management of local natural resources.

Folk Knowledge and Perceptions about the Use of Wild Fruits and Vegetables-Cross-Cultural Knowledge in the Pipli Pahar Reserved Forest of Okara, Pakistan.

Wild fruits and vegetables (WFVs) have been vital to local communities for centuries and make an important contribution to daily life and income. However, traditional knowledge of the use of wild fruits is at risk of being lost due to inadequate documentation. This study aimed to secure this knowledge through intermittent field visits and a semi-structured questionnaire. Using various ethnobotanical data analysis tools and SPSS (IBM 25), this study identified 65 WFV species (52 genera and 29 families). These species, mostly consumed as vegetables (49%) or fruits (43%), were predominantly herbaceous (48%) in wild and semi-wild habitats (67%). 20 WFVs were known to local communities (highest RFC), Phoenix sylvestris stood out as the most utilized species (highest UV). Surprisingly, only 23% of the WFVs were sold at markets. The survey identified 21 unique WFVs that are rarely documented for human consumption in Pakistan (e.g., Ehretia obtusifolia, Euploca strigosa, Brassica juncea, Cleome brachycarpa, Gymnosporia royleana, Cucumis maderaspatanus, Croton bonplandianus, Euphorbia prostrata, Vachellia nilotica, Pongamia pinnata, Grewia asiatica, Malvastrum coromandelianum, Morus serrata, Argemone mexicana, Bambusa vulgaris, Echinochloa colonum, Solanum virginianum, Physalis angulata, Withania somnifera, Zygophyllum creticum, and Peganum harmala), as well as 14 novel uses and five novel edible parts. Despite their ecological importance, the use of WFVs has declined because local people are unaware of their cultural and economic value. Preservation of traditional knowledge through education on conservation and utilization could boost economies and livelihoods in this and similar areas worldwide.

Unmasking the long-term effects: unravelling neuropsychiatric and neurological consequences of COVID-19.

The COVID-19 pandemic has not only burdened healthcare systems but has also led to a new emerging medical enigma that is post-COVID-19 syndrome or "long COVID." Characterized by persistent symptoms that extend beyond the acute phase of the illness, long COVID has rapidly become a public health concern with ambiguous neurological and neuropsychiatric dimensions. This narrative review aims at synthesizing available research to decode the long-term impacts of COVID-19 on neurological and mental health. Drawing from a multitude of studies, this review synthesizes evidence on various neuropsychiatric and neurological symptoms, including cognitive deficits, mood disorders, and more. The narrative delves into potential pathogenic mechanisms, hoping to fill existing research gaps and offering directions for future inquiry. The objective is not just academic; it has immediate real-world implications. Understanding these long-term effects is crucial for developing effective treatments and interventions, thereby better serving the millions of individuals living with these lingering symptoms. As healthcare systems continue to grapple with the fallout from the pandemic, this review provides much-needed context and insights into an area that demands urgent research and action.

Early coronary angioplasty fails to lower all-cause mortality in patients with out-of-hospital cardiac arrest without ST-segment elevation: A systematic review and meta-analysis.

Introduction: Out-of-hospital cardiac arrest (OHCA) is defined as the loss of functional mechanical activity of the heart in association with an absence of systemic circulation, occurring outside of a hospital. Immediate coronary angiography (CAG) with percutaneous coronary intervention is recommended for OHCA with ST-elevation. We aimed to evaluate the effect of early CAG on mortality and neurological outcomes in OHCA patients without ST-elevation. Methods: This meta-analysis and systemic review was conducted as per principles of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) group. A protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, Ref No. = CRD42022327833). A total of 674 studies were retrieved after scanning several databases (PubMed Central, EMBASE, Medline, and Cochrane Central Register of Controlled Trials). Results: A total of 18 studies were selected for the final analysis, including 6 randomized control trials and 12 observational studies. Statistically, there was no significant difference in primary outcome, i.e., mortality, between early and delayed CAG. In terms of the grade of neurological recovery as a secondary outcome, early and delayed CAG groups also showed no statistically significant difference. Conclusion: Early CAG has no survival benefits in patients with no ST elevations on ECG after OHCA.

Durability Properties of Macro-Polypropylene Fiber Reinforced Self-Compacting Concrete.

Concrete is one of the most commonly used construction materials; however, its durability plays a pivotal role in areas where the concrete is exposed to severe environmental conditions, which initiate cracks inside and disintegrate it. Randomly distributed short fibers arrest the initiation and propagation of micro-cracks in the concrete and maintain its integrity. Traditional polypropylene fibers are thin and encounter the problem of balling effects during concrete mixing, leading to uneven fiber distribution. Thus, a new polypropylene fiber is developed by gluing thin ones together, forming macro-polypropylene fibers. Thus, different amounts of fibers, 0-1.5% v/f with an increment of 0.5% v/f, are used in different grades of concrete to study their impact on durability properties, including resistance to freezing and thawing cycles, sulfate, and acid attacks. A total of 432 cube samples were tested at 28, 56, and 92 days. The results reveal that the maximum durability, in terms of compressive strength loss, is noted with a fiber content of 1% with improved resistance of 72%, 54%, and 24% against freeze-thaw cycles, sulfate attack, and hydrochloric acid attack, respectively, at 92 days. Thus, the resulting fiber-reinforced concrete may be effective in areas where these extreme exposure conditions are expected.

Assessment of Qatar's Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study.

BACKGROUND: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization. OBJECTIVE: This study aims to comprehensively examine the community call center's operations and their significant role during the COVID-19 pandemic. METHODS: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations. RESULTS: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19-related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls. CONCLUSIONS: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises.

Seroconversion and safety of Covid-19 vaccines in pa-tients with chronic liver disease and liver transplant: A systematic review.

BACKGROUND AND AIMS: As part of the COVID-19 control strategy, a growing number of vaccine portfolios evolved and got fast-tracked through regulatory agencies, with a limited examination of their efficacy and safety in vulnerable populations, such as patients with chronic conditions and immunocompromised states. Patients with chronic liver disease (CLD), and cohorts post liver transplant (LT) in particular, were underrepresented in the determinant trials of vaccine development, hence the paucity of data on their efficacy and safety in published literature. This systematic review aims to examine the available evidence and ascertain the effectiveness and safety of Covid-19 vaccination in patients with CLD and those with LT. METHODS: A systematic review of PubMed (Medline), Google Scholar, Cochrane Library, and ScienceDirect from inception until 1st March 2022 was conducted. We included observational studies and assessed vaccine efficacy regarding seroconversion or immunological rate, whereas serious or significant adverse effects have been considered safety outcomes when reported. RESULTS: Studies comprised 45275 patients, performed in 11 different countries. Seroconversion or immunological rate after Covid-19 vaccination was mostly the primary endpoint, whereas other endpoints like covid-19 related adverse effects were also reported. Twenty-four of the final analyzed studies are prospective cohort studies, while four are retrospective cohort studies. Twenty-one studies included patients who underwent LT and received the Covid vaccine; nine included patients who had CLD due to various etiologies. The median age range of all included patients varied from 43-69 years. All patients with LT who received at least two doses of Covid vaccine had a seroconversion rate of around 60%. Patients with CLD had a seroconversion rate of about 92% post two doses of Covid vaccination. The average seroconversion rate in post-transplant recipients was around 45% after two doses of the significant Covid vaccines: Pfizer, AstraZeneca, Moderna, and Jansen. Only two studies have reported a higher seroconversion rate of 75% and 73% after the third dose of Covid vaccine. No significant adverse effects were reported in all studies; the most commonly reported negative effect was local injection site pain. CONCLUSION: The present systematic review, comprising real-world observational data studies, concludes that Covid-19 vaccination was associated with 92% and 60% seroconversion rates in patients with CLD and LT, respectively. No significant side effects were reported in all studies. This finding helps to resolve the uncertainty associated with Covid-19 vaccination in this cohort of patients.

A Typical Aortic Intramural Hematoma With an Atypical Neurological Presentation.

Aortic intramural hematoma (IMH) is characterized by blood spilling through the intimal layer of the aortic wall without any tear within the aortic wall. The condition has been troublesome to analyze until of late. A 55-year-old gentleman with hypertension presented with epigastric pain radiating to the back, he later developed back pain as well as bilateral lower limb numbness and was found to have IMH when a CT angiogram was conducted. Due to the severity of the illness, the patient expired on the 10th day of the admission. It is important for physicians to be aware of atypical presentations of this life-threatening aortic disease.

A universal hydro-mechanical coupled behavior model for clay-bearing strata-Molecular-level simulation approach.

Clay minerals in soils and rocks exhibit large volume change upon interaction with water and this behavior becomes even more complex when the strata are being stressed by the engineering and environmental loads. Therefore, a realistic prediction of the hydro-mechanical behavior of the clay-bearing strata is always a challenge due to their coupled swelling-mechanical response in the cases of geotechnical and geoenvironmental engineering problems, nuclear waste storage in clay-bearing rock repositories, shale gas extraction, and other uses of clay in the manufacturing industry. All the existing behavior models have restricted applications in the engineering and other fields of practice mainly due to the partial consideration of the structure and fabric of clay-bearing strata in the model formulation. In this study, a hydro-mechanical behavior model has been formulated using the parameters acquired from the molecular-level simulations and modeling of the volume change and stress-strain behavior of the clay-bearing structure. The Molecular Mechanics and Molecular Dynamic simulations were performed on the natural structure of the clay-bearing strata formulated using Monte Carlo technique. The mathematical model, developed from the simulation results, can predict the overall hydro-mechanical behavior of clay-bearing strata for all possible combinations of clay minerals, non-clay minerals, salts causing cementation of the soil/rock structure, confining pressures, and the induced strain levels. The developed model has successfully been validated through laboratory and field testing on the clay-bearing strata in both the elastic and elasto-plastic regions of the stress-strain behavior and also from the data of two (02) swelling clays (MX-80 and FEBEX Bentonite) from the existing literature, supporting the universal nature of the developed behavior model.

Efficacy and Outcome Measurement of iFactor/ABM/P-15 in Lumbar Spine Surgery: A Systematic Review.

STUDY DESIGN: Systematic Review. OBJECTIVES: To determine the efficacy and overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. METHODS: We performed a search of the Cochrane Library, Medline Ovid, PubMed, and SCOPUS databases from inception until August 2023. Eligible studies included outcomes of patients receiving iFactor following lumbar spine surgery. The primary outcomes of interest were fusion rates and iFactor efficacy after lumbar surgery in patients who received iFactor. Secondary outcomes included patient-reported outcomes and complication rates. RESULTS: A total of 766 titles were initially screened. After inclusion criteria were applied, 5 studies (388 patients) were included, which measured overall outcomes of iFactor/ABM/P-15 following lumbar spine surgery. These studies showed acceptable reliability for inclusion based on the Methodical Index for Non-Randomized studies and Critical Appraisal Skills Programme assessment tools. iFactor/ABM/P-15 facilitated significantly faster bone development in various procedures while maintaining favorable clinical outcomes compared to traditional grafts. CONCLUSIONS: This systematic review found that iFactor/ABM/P-15 use for lumbar spine surgery maintains similar managing patient-reported outcomes relative to other grafting methods. In regard to rates of fusion, iFactor/ABM/P-15 showed a significantly faster rate of fusion when compared to traditional grafts including allograft, autograft, demineralized bone matrix (DBM), and recombinant human bone morphogenetic protein-2 (rhBMP-2). Future multicenter randomized control trials with larger sample sizes are recommended to further assess iFactor/ABM/P-15 efficacy in lumbar spine surgery.

Transforming Orthopedic Joint Surgeries: The Role of Artificial Intelligence (AI) and Robotics.

The landscape of orthopedic joint surgeries, specifically total hip arthroplasty (THA) and total knee arthroplasty (TKA), is rapidly changing, and artificial intelligence (AI) along with robotics is at the helm of this transformation. These technologies, working synergistically, have introduced unprecedented levels of precision and personalization to surgical procedures, thereby significantly enhancing patient outcomes. In this editorial, we explore the changing perspectives of orthopedic surgeons toward AI and robotics and dissect the incorporation of these technologies in surgeries, their associated advantages, their inherent limitations, and potential future prospects. We draw from a host of recent studies to provide a comprehensive understanding of how these transformative technologies can augment surgical performance and patient care.

Mentorship in a Surgical Residency: A Comprehensive Review of the Literature.

Mentorship in surgical training is an experience that extends beyond the teacher-student interaction. Effective mentorship is crucial in surgical training and requires ongoing support at all stages of graduate surgical education, particularly in the context of busy surgical residency programs. It is important to recognize that mentors and mentees may have different styles of learning and teaching, making it essential to discuss and review these approaches to ensure effective mentorship. By acknowledging these differences and developing a supportive mentorship program that addresses them, surgical residents can receive the guidance they need to progress successfully through their training and prepare for independent practice. This review provides a comprehensive analysis of mentorship styles in various surgical training residencies. By including 30 publications, this study highlights different mentorship approaches and their contributions to education in surgical residency programs. Moreover, this study summarizes the 10 stages of mentorship, offering a clearer understanding of the mentorship model in the context of graduate surgical education. Finally, the review provides insight into the common challenges and pitfalls among mentorship programs. The findings of this study aim to provide valuable guidance for developing effective mentorship programs in surgical residency programs, contributing to better support and outcomes for surgical trainees.

Genome-wide association study of soybean (Glycine max [L.] Merr.) germplasm for dissecting the quantitative trait nucleotides and candidate genes underlying yield-related traits.

Soybean (Glycine max [L.] Merr.) is one of the most significant crops in the world in terms of oil and protein. Owing to the rising demand for soybean products, there is an increasing need for improved varieties for more productive farming. However, complex correlation patterns among quantitative traits along with genetic interactions pose a challenge for soybean breeding. Association studies play an important role in the identification of accession with useful alleles by locating genomic sites associated with the phenotype in germplasm collections. In the present study, a genome-wide association study was carried out for seven agronomic and yield-related traits. A field experiment was conducted in 2015/2016 at two locations that include 155 diverse soybean germplasm. These germplasms were genotyped using SoySNP50K Illumina Infinium Bead-Chip. A total of 51 markers were identified for node number, plant height, pods per plant, seeds per plant, seed weight per plant, hundred-grain weight, and total yield using a multi-locus linear mixed model (MLMM) in FarmCPU. Among these significant SNPs, 18 were putative novel QTNs, while 33 co-localized with previously reported QTLs. A total of 2,356 genes were found in 250 kb upstream and downstream of significant SNPs, of which 17 genes were functional and the rest were hypothetical proteins. These 17 candidate genes were located in the region of 14 QTNs, of which ss715580365, ss715608427, ss715632502, and ss715620131 are novel QTNs for PH, PPP, SDPP, and TY respectively. Four candidate genes, Glyma.01g199200, Glyma.10g065700, Glyma.18g297900, and Glyma.14g009900, were identified in the vicinity of these novel QTNs, which encode lsd one like 1, Ergosterol biosynthesis ERG4/ERG24 family, HEAT repeat-containing protein, and RbcX2, respectively. Although further experimental validation of these candidate genes is required, several appear to be involved in growth and developmental processes related to the respective agronomic traits when compared with their homologs in Arabidopsis thaliana. This study supports the usefulness of association studies and provides valuable data for functional markers and investigating candidate genes within a diverse germplasm collection in future breeding programs.

Comparative study of five topological invariants of supramolecular chain of different complexes of N-salicylidene-L-valine.

L-valine is a crucial amino acid that has rising market demand and numerous uses. It can be used to make specific nutrients, animal feed additives, cosmetic ingredients, and other things in the medical and agricultural fields. N-salicylidene-L-valine (NsLv) is attracting a lot of attention due to its unusual structure and enhanced catalytic and cytotoxic activities. Topological index is a numerical value which is associated with the molecular structure. It is very helpful to predict physio-chemical properties and Quantitative structure-activity relationship and Quantitative structure-property relationship modeling. We study the supramolecular chain (Sc) in the dialkyl tin of complexes 2, 3 and 4 of NsLv to better understand this structure and its topological index-related characteristics. Additionally, we compare topological indices and analyze how these structures relate to one another using concrete examples.

Patient satisfaction with follow-up after spinal fusion.

Background: Postoperative follow-up visits (PFUs) allow providers to track patient recovery but can be costly to patients. With the advent of the novel coronavirus pandemic, virtual/phone visits have been utilized as an alternative to in-person PFUs. Patients were surveyed to elucidate patient satisfaction with postoperative care in the setting of increased virtual follow-up visits. A prospective survey with retrospective cohort analysis of chart data was conducted to better understand the factors influencing patient satisfaction related to their PFUs after spine fusion with the goal of improving the value of postoperative care. Methods: Adult patients at least 1 year postoperative from cervical or lumbar fusion surgery completed a telephone survey related to their postoperative clinic experience. Medical record data including complications, number of visits and length of follow-up, and presence of phone/virtual visits were abstracted and analyzed. Results: Fifty patients (54% female) were included. Univariate analysis demonstrated no association between satisfaction and patient demographics, rates of complication, mean length or number of PFUs, or incidence of phone/virtual visits. Patients "very satisfied" with their clinic experience were more likely to be "very satisfied" with their outcome (P<0.01), and to feel their concerns were "very well addressed" (P<0.01). Multivariate analysis additionally demonstrated that satisfaction was positively associated with how well patient concerns were addressed (P<0.01) and the incidence of virtual/phone visits (P=0.01), and negatively associated with age (P=0.01) and level of education (P=0.01). Conclusions: After spinal fusion, patient satisfaction is positively related to virtual/phone visits and to how well their concerns are addressed. As long as patient concerns remain adequately addressed, surgeons can eliminate excess PFUs which are not clinically beneficial without adversely impacting patients' postoperative experience.

Assessment of halotolerant bacterial and fungal consortia for augmentation of wheat in saline soils.

Adaptations of green technologies to counter abiotic stress, including salinity for crops like wheat by using halotolerant microbes, is a promising approach. The current study investigated 17 salt-affected agroecological zones from the Punjab and Sindh provinces of Pakistan to explore the potential of indigenous microbial flora, with their multiple biochemical characteristics in addition to plant growth promoting (PGP) traits, for enhanced wheat production in saline areas. Initially, 297 isolated pure bacterial colonies were screened for salt tolerance, biochemical, and PGP traits. Three bacterial strains belonging to Pantoea spp. and Erwinia rhaphontici with possession of multiple characteristics were selected for the development of the halotolerant bacterial consortium. Inoculation of two local wheat varieties, Faisalabad 2008 and Galaxy 2013, with the consortium for in vitro seed germination assay and sand microcosm experiments exhibited significant improvement of selected plant growth parameters like germination percentage and root structure. Two previously reported PGP fungal strains of Trichoderma harzianum and T. viridae were also used as fungal consortium separately for pot experiments and field trials. The pot experiments exhibited a positive correlation of consortia with metabolic viz. catalase, peroxidase, and proline and agronomical parameters including shoot length, dry weight, number of spikes, spike length, and 100 grain weight. To evaluate their performance under natural environmental conditions, field trials were conducted at three salt-affected sites. Agronomical attributes including days of flowering and maturity, flag leaf weight, length and width, shoot length, number of spikes, spike length, spike weight, number of seeds spike-1, 1,000 grain weight, and plot yield indicated the efficiency of these microbes to enhance wheat growth. Concisely, the bacterial consortium showed better performance and Faisalabad 2008 was a more resistant variety as compared to Galaxy 2013. Initial promising results indicate that further extensive research on indigenous microbes might lead to the development of Pakistan's first saline-specific biofertilizers and sustainable eco-friendly agriculture practices.

From forest floor to tree top: Partitioning of biomass and carbon stock in multiple strata of forest vegetation in Western Himalaya.

The foremost role of forest vegetation in storing biomass and carbon (C) stock constitutes one of the main nature-based solutions to mitigate climate change. In this study, we aimed to quantify biomass and C stock partitioning in multiple vegetation strata (tree, shrub, herb, and ground floor layers) of major forest types in Jammu and Kashmir, Western Himalaya, India. We used a stratified random cluster sampling strategy to collect field data in 96 forest stands of 12 forest types (altitudinal range: 350 to 3450 m) in the study region. We evaluated the degree to which the carbon stock of the entire ecosystem was dependent on the multiple vegetation strata using the Pearson method. Across all the forest types, the average total ecosystem-level biomass was estimated to be 181.95 Mgha-1 (range: 60.64-528.98). Forest strata-wise, the maximum biomass of 172.92 Mgha-1 (range: 50.64-514.97) was found in the tree vegetation, followed by 5.58 Mgha-1 (range: 2.59-8.93) in understory vegetation (shrubs and herbaceous), and 3.44 Mgha-1 (range: 0.97 and 9.14) in the forest floor. The total ecosystem-level biomass showed a peak at mid-elevation coniferous forest types, whereas the lowest was observed in low-elevation broad leaved forest types. At the ecosystem-level, on average, the understory contributed 3% and the forest floor 2% to the total C stock across the forest types. The shrub layer contributed up to 80% of total understory C, with the herbaceous layer accounting for the remaining 20%. The ordination analysis clearly shows that anthropogenic and environmental variables significantly (p ≤ 0.002) influence the forest types' C stock in the region. Our findings have significant implications for conserving natural forest ecosystems and restoring degraded forest  landscapes in this Himalayan region, which in turn can lead to better carbon sequestration and climate mitigation outcomes.

Barriers to Surgical Outcomes Research in Low- and Middle-Income Countries: A Scoping Review.

INTRODUCTION: Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical outcomes data from low- and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings. METHODS: We conducted a scoping review of all published literature on barriers to conducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and GoogleScholar. Keywords included 'surgery', 'outcomes research', 'registries', 'barriers', and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors. RESULTS: Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital platform for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors highlighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time. CONCLUSIONS: There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs.

A Rare Case of Chronic Liver Disease in a Patient Who Previously Presented With Hepatitis E.

Hepatitis E virus (HEV) is among the most common causes of acute viral hepatitis. It typically causes acute infection, but some cases of chronic infection have also been recorded. These cases were particularly seen in developed countries, in patients who were immunocompromised, organ transplant recipients, or those with underlying hematological malignancy. However, we encountered a case of hepatitis E presenting as a chronic liver disease in an immunocompetent patient from a developing country. Therefore, more underlying risk factors need to be studied, which may lead to such a rare presentation of hepatitis E.