Unlocking the potential of biofilm-forming plant growth-promoting rhizobacteria for growth and yield enhancement in wheat (Triticum aestivum L.).

Plant growth-promoting rhizobacteria (PGPR) boost crop yields and reduce environmental pressures through biofilm formation in natural climates. Recently, biofilm-based root colonization by these microorganisms has emerged as a promising strategy for agricultural enhancement. The current work aims to characterize biofilm-forming rhizobacteria for wheat growth and yield enhancement. For this, native rhizobacteria were isolated from the wheat rhizosphere and ten isolates were characterized for plant growth promoting traits and biofilm production under axenic conditions. Among these ten isolates, five were identified as potential biofilm-producing PGPR based on in vitro assays for plant growth-promoting traits. These were further evaluated under controlled and field conditions for their impact on wheat growth and yield attributes. Surface-enhanced Raman spectroscopy analysis further indicated that the biochemical composition of the biofilm produced by the selected bacterial strains includes proteins, carbohydrates, lipids, amino acids, and nucleic acids (DNA/RNA). Inoculated plants in growth chamber resulted in larger roots, shoots, and increase in fresh biomass than controls. Similarly, significant increases in plant height (13.3, 16.7%), grain yield (29.6, 17.5%), number of tillers (18.7, 34.8%), nitrogen content (58.8, 48.1%), and phosphorus content (63.0, 51.0%) in grains were observed in both pot and field trials, respectively. The two most promising biofilm-producing isolates were identified through 16 s rRNA partial gene sequencing as Brucella sp. (BF10), Lysinibacillus macroides (BF15). Moreover, leaf pigmentation and relative water contents were significantly increased in all treated plants. Taken together, our results revealed that biofilm forming PGPR can boost crop productivity by enhancing growth and physiological responses and thus aid in sustainable agriculture.

Who should get a right colectomy in low-grade appendiceal adenocarcinomas? Association of lymphovascular invasion and nodal metastases.

BACKGROUND: There is variation in the probability of nodal metastases from low-grade appendiceal adenocarcinomas, and the role of right colectomy is unclear. We aimed to define the prevalence and utility of lymphovascular invasion in predicting the risk of nodal metastases to help stratify patients who may benefit from right hemicolectomy. METHODS: Patients with nonmetastatic low-grade appendiceal adenocarcinomas were identified from the National Cancer Database (2010-2017). The primary outcome was probability of nodal metastases. Logistic regression was used to identify independent predictors of nodal metastases. A 4-tier risk model-the COH Composite Score-was calculated by assigning 1 point each for a high-risk feature (lymphovascular invasion, T3/T4 T stage, or nonmucinous histology). Survival analysis was performed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify independent predictors of survival. RESULTS: A total of 1,303 patients with nonmetastatic low-grade appendiceal adenocarcinomas (64.2% mucinous) were identified. Of the 1,133 patients with known lymphovascular invasion status, 78 (6.9%) were lymphovascular invasion positive. In multivariate analysis, lymphovascular invasion was independently associated with nodal metastases (odds ratio, 8.68; P < .001). Overall accuracy of lymphovascular invasion in predicting nodal metastases was 86%. The COH Composite Score stratified patients in 4 categories with increasing risk of nodal metastases and incrementally worse survival. For patients with the COH Composite Score of 0 (12%), the nodal metastasis rate was 3.1%, and a right hemicolectomy in this group did not improve survival. CONCLUSION: The presence of lymphovascular invasion is strongly predictive of nodal metastases. Lymphovascular invasion as part of the COH Composite Score may help guide the extent of surgery in low-grade appendiceal adenocarcinomas.

Effect of SGLT2 inhibitors on kidney function of type 2 diabetes patients during Ramadan: A systematic review.

Background: SGLT2 inhibitors are known for their osmotic diuretic effect, and their use by Muslim patients with type 2 diabetes during the fasting month of Ramadan may pose an increased risk of volume depletion, potentially impacting renal function. Methods: We conducted a systematic review registered on PROSPERO (registration number CRD42020204582) of studies published between 2013 and January 2023, sourced from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The study selection criteria included controlled studies that reported the use of SGLT2 inhibitors (SGLT2i) by fasting adult type 2 diabetes patients and provided data on creatinine or estimated glomerular filtration rate (eGFR) as outcomes. Results: Two prospective observational studies, encompassing a total of 359 participants, of which 197 utilized SGLT2 inhibitors, were identified. Our findings indicated that the use of SGLT2 inhibitors during Ramadan did not result in a significant alteration in eGFR. In one study by Hassanein et al., the mean changes in eGFR for the SGLT2i group, as compared to the non-SGLT2i group, were -1.2 ± 19.4 and 3.1 ± 14.8, respectively (p = 0.06). In a study by Shao et al., the least squares mean changes for eGFR in the SGLT2i group, compared to the non-SGLT2i group, were -6.0 ± 1.5 (95% CI, -8.9 to -3.1) and -4.2 ± 1.6 (95% CI, -7.3 to -1.1), respectively (p = 0.39). Conclusion: Despite the limited number of observational studies available, our analysis suggests that the use of SGLT2 inhibitors by type 2 diabetes patients during Ramadan does not appear to significantly impact kidney function.

Effect of SGLT2 inhibitors on kidney function of type 2 diabetes patients during Ramadan: A systematic review.

Background: SGLT2 inhibitors are known for their osmotic diuretic effect, and their use by Muslim patients with type 2 diabetes during the fasting month of Ramadan may pose an increased risk of volume depletion, potentially impacting renal function. Methods: We conducted a systematic review registered on PROSPERO (registration number CRD42020204582) of studies published between 2013 and January 2023, sourced from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The study selection criteria included controlled studies that reported the use of SGLT2 inhibitors (SGLT2i) by fasting adult type 2 diabetes patients and provided data on creatinine or estimated glomerular filtration rate (eGFR) as outcomes. Results: Two prospective observational studies, encompassing a total of 359 participants, of which 197 utilized SGLT2 inhibitors, were identified. Our findings indicated that the use of SGLT2 inhibitors during Ramadan did not result in a significant alteration in eGFR. In one study by Hassanein et al., the mean changes in eGFR for the SGLT2i group, as compared to the non-SGLT2i group, were -1.2 ± 19.4 and 3.1 ± 14.8, respectively (p = 0.06). In a study by Shao et al., the least squares mean changes for eGFR in the SGLT2i group, compared to the non-SGLT2i group, were -6.0 ± 1.5 (95% CI, -8.9 to -3.1) and -4.2 ± 1.6 (95% CI, -7.3 to -1.1), respectively (p = 0.39). Conclusion: Despite the limited number of observational studies available, our analysis suggests that the use of SGLT2 inhibitors by type 2 diabetes patients during Ramadan does not appear to significantly impact kidney function.

Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak.

BACKGROUND: Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. METHODS: Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. RESULTS: Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. CONCLUSIONS: The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

Perceptions of Family Physicians About Applying AI in Primary Health Care: Case Study From a Premier Health Care Organization.

BACKGROUND: The COVID-19 pandemic has led to the rapid proliferation of artificial intelligence (AI), which was not previously anticipated; this is an unforeseen development. The use of AI in health care settings is increasing, as it proves to be a promising tool for transforming health care systems, improving operational and business processes, and efficiently simplifying health care tasks for family physicians and health care administrators. Therefore, it is necessary to assess the perspective of family physicians on AI and its impact on their job roles. OBJECTIVE: This study aims to determine the impact of AI on the management and practices of Qatar's Primary Health Care Corporation (PHCC) in improving health care tasks and service delivery. Furthermore, it seeks to evaluate the impact of AI on family physicians' job roles, including associated risks and ethical ramifications from their perspective. METHODS: We conducted a cross-sectional survey and sent a web-based questionnaire survey link to 724 practicing family physicians at the PHCC. In total, we received 102 eligible responses. RESULTS: Of the 102 respondents, 72 (70.6%) were men and 94 (92.2%) were aged between 35 and 54 years. In addition, 58 (56.9%) of the 102 respondents were consultants. The overall awareness of AI was 80 (78.4%) out of 102, with no difference between gender (P=.06) and age groups (P=.12). AI is perceived to play a positive role in improving health care practices at PHCC (P<.001), managing health care tasks (P<.001), and positively impacting health care service delivery (P<.001). Family physicians also perceived that their clinical, administrative, and opportunistic health care management roles were positively influenced by AI (P<.001). Furthermore, perceptions of family physicians indicate that AI improves operational and human resource management (P<.001), does not undermine patient-physician relationships (P<.001), and is not considered superior to human physicians in the clinical judgment process (P<.001). However, its inclusion is believed to decrease patient satisfaction (P<.001). AI decision-making and accountability were recognized as ethical risks, along with data protection and confidentiality. The optimism regarding using AI for future medical decisions was low among family physicians. CONCLUSIONS: This study indicated a positive perception among family physicians regarding AI integration into primary care settings. AI demonstrates significant potential for enhancing health care task management and overall service delivery at the PHCC. It augments family physicians' roles without replacing them and proves beneficial for operational efficiency, human resource management, and public health during pandemics. While the implementation of AI is anticipated to bring benefits, the careful consideration of ethical, privacy, confidentiality, and patient-centric concerns is essential. These insights provide valuable guidance for the strategic integration of AI into health care systems, with a focus on maintaining high-quality patient care and addressing the multifaceted challenges that arise during this transformative process.

Trends and socioeconomic inequality of the burden of congenital abnormalities of the kidney and urinary tract among children and adolescents.

BACKGROUND: Although congenital abnormalities of the kidney and urinary tract (CAKUT) is the leading cause of childhood onset chronic kidney disease (CKD) and kidney failure, comprehensive information on the disease burden among children and adolescents globally is lacking. We aim to report the trends and socioeconomic inequality of CAKUT burden for people aged 0-24 years from 1990 to 2019·. METHODS: We reported the prevalence, mortality and disability-adjusted life-years (DALYs) for CAKUT based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, quantified the association of disease burden and socio-demographic index (SDI), calculated the slope index of inequality (SII) the relative index of inequality (RII) and concentration index. RESULTS: In 2019, the global prevalence, mortality, and DALYs of CAKUT among individuals aged 0-24 years were 167.11 (95%Confident Interval 166.97, 167.25), 0.30 (0.29, 0.30), and 32.22 (32.16, 32.29) per 100 000 population. The greatest prevalence, mortality and DALYs were recorded in the 0-4 year age group. The greatest mortality and DALYs were recorded in low SDI countries and territories. During 1990 to 2019, the prevalence, mortality and DALYs decreased globally, while in low and low-middle countries and territories the reduction was much less slower. India, Nigeria and Pakistan had the highest DALYs. Saudi Arabia and China exhibited a markedly decrease of CAKUT burden. Globally for every 0.1 increase in SDI, there was a 20.53% reduction in mortality, a 16.31% decrease in DALYs, but a 0.38% rise in prevalence. CONCLUSIONS: Inequality for disease burden of varying SDI was increasing globally. Thus, specific preventive and health service measures are needed to reduce the global burden from CAKUT.

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.

#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.

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.

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.

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.