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The removal of titanium plates after maxillofacial trauma is influenced by various patient- and plate-related factors. Understanding these factors can help improve surgical outcomes and minimize complications associated with plate retention or removal. The study employed a prospective cohort design and was conducted over a period of 16 months, from June 2023 to October 2024 included 420 patients who underwent titanium plate removal following maxillofacial trauma. Patients were followed up at intervals of 1 week, 1 month, and 3 months postoperatively to evaluate surgical outcomes, functional recovery, and any long-term complications. Data on demographics, trauma characteristics, plate type, anatomical location, and postoperative outcomes were statistically evaluated using chi-square tests. Persistent pain (70%), infection (91%), and plate exposure (28%) were the most common reasons for plate removal. Gender ( p  < 0.001), occupation ( p  < 0.001), and trauma etiology ( p  < 0.001) significantly influenced outcomes. Mandibular plates (63%) and titanium alloy plates (70%) exhibited higher complication rates. Postoperative satisfaction was reported by 56% of patients, though 84% required additional surgeries ( p  < 0.001). This study identifies key factors influencing titanium plate removal and highlights the need for individualized treatment strategies to optimize patient outcomes and satisfaction.

Plant growth and development can be greatly impacted by drought stress. Suitable plant growth promoting rhizobacteria (PGPR) or biochar (BC) application has been shown to alleviate drought stress for plants. However, their co-application has not been extensively explored in this regard. We isolated bacterial strains from rhizospheric soils of plants from arid soils and characterized them for plant growth promoting characteristics like IAA production and phosphate solubilization as well as for drought tolerance. Three bacterial strains or so called PGPRs, identified as , , and based on their 16S rRNA, were screened for further experiments. Wheat was grown on normal, where soil moisture was maintained at 75% of water holding capacity (WHC), and induced-drought (25% WHC) stressed soil in pots. PGPRs were applied alone or in combination with a biochar derived from pyrolysis of tree wood. Drought stress substantially inhibited wheat growth. However, biochar addition under stressed conditions significantly improved the wheat growth and productivity. Briefly, it increased straw yield by 25%, 100-grain weight by 15% and grain yield by 10% compared to the control. Moreover, co-application of biochar with PGPRs , and further enhanced straw yield by 37-41%, 100-grain weight by 30-36%, and grain yield by 22-22.57%, respectively. The co-application also enhanced soil quality by increasing plant-available phosphorus by 4-31%, microbial biomass by 33-45%, and soil K /Na ratio by 41-44%. Co-application of PGPRs and biochar alleviated plant drought stress by improving nutrient availability and absorption. Acting as a nutrient reservoir, biochar worked alongside PGPRs, who solubilized nutrients from the former and promoted wheat growth. We recommend that the co-application of suitable PGPRs and biochar is a better technology to produce wheat under drought conditions than using these enhancers separately.

BackgroundThe coronavirus disease (COVID-19) pandemic has put an excessive strain on healthcare systems across the globe, causing a shortage of personal protective equipment (PPE). PPE is a precious commodity for health personnel to protect them against infections. We investigated the availability of PPE among doctors in the United States (US) and Pakistan.MethodsA cross-sectional study, including doctors from the US and Pakistan, was carried out from April 8 to May 5, 2020. An online self-administered questionnaire was distributed to doctors working in hospitals in the US and Pakistan after a small pilot study. All analysis was done using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY).ResultsAfter informed consent, 574 doctors (60.6% from Pakistan and 39.4% from the US) were included in the analysis. The majority of the participants were females (53.3%), and the mean age of the participants was 35.3 ± 10.3 years. Most doctors (47.7%) were from medicine and allied fields. Among the participants, 87.6% of doctors from the US reported having access to masks/N95 respirators, 79.6% to gloves, 77.9% to face-shields or goggles, and 50.4% to full-suit/gown. Whereas, doctors in Pakistan reported to have poor availability of PPE with only 37.4% having access to masks/N95 respirator, 34.5% to gloves, 13.8% to face-shields or goggles, and 12.9% to full-suit/gown. The reuse of PPE was reported by 80.5% and 60.3% physicians from the US and Pakistan, respectively. More doctors from Pakistan (50.6%) reported that they had been forced to work without PPE compared to doctors in the US (7.1%).ConclusionThere is a lack of different forms of PPE in the US and Pakistan. Doctors from both countries reported that they had been forced to work without PPE. Compared to the US, more doctors from Pakistan reported having faced discrimination in receiving PPE.

Background and AimsThe prevalence and extent of liver damage in coronavirus disease 2019 (COVID-19) patients remain poorly understood, primarily due to small-sized epidemiological studies with varying definitions of “liver injury”. We conducted a meta-analysis to derive generalizable, well-powered estimates of liver injury prevalence in COVID-19 patients. We also aimed to assess whether liver injury prevalence is significantly greater than the baseline prevalence of chronic liver disease (CLD). Our secondary aim was to study whether the degree of liver injury was associated with the severity of COVID-19.Materials and MethodsElectronic databases (PubMed and Scopus) were systematically searched in June 2020 for studies reporting the prevalence of baseline CLD and current liver injury in hospitalized COVID-19 patients. Liver injury was defined as an elevation in transaminases >3 times above the upper limit of normal. For the secondary analysis, all studies reporting mean liver enzyme levels in severe versus non-severe COVID-19 patients were included. A random-effects model was used for meta-analysis. Proportions were subjected to arcsine transformation and pooled to derive pooled proportions and corresponding 95% confidence intervals (CIs). Subgroup differences were tested for using the chi-square test and associated p-value. Means and their standard errors were pooled to derive weighted mean differences (WMDs) and corresponding 95% CIs.ResultsElectronic search yielded a total of 521 articles. After removal of duplicates and reviewing the full-texts of potential studies, a total of 27 studies met the inclusion criteria. Among a cohort of 8,817 patients, the prevalence of current liver injury was 15.7% (9.5%-23.0%), and this was significantly higher than the proportion of patients with a history of CLD (4.9% [2.2%-8.6%]; p < 0.001). A total of 2,900 patients in our population had severe COVID-19, and 7,184 patients had non-severe COVID-19. Serum ALT (WMD: 7.19 [4.90, 9.48]; p < 0.001; I2 = 69%), AST (WMD: 9.02 [6.89, 11.15]; p < 0.001; I2 = 73%) and bilirubin levels (WMD: 1.78 [0.86, 2.70]; p < 0.001; I2 = 82%) were significantly higher in patients with severe COVID-19 when compared to patients with non-severe disease. Albumin levels were significantly lower in patients with severe COVID-19 (WMD: -4.16 [-5.97, -2.35]; p < 0.001; I2 = 95%).ConclusionsPatients with COVID-19 have a higher than expected prevalence of liver injury, and the extent of the injury is associated with the severity of the disease. Further studies are required to assess whether hepatic damage is caused by the virus, medications, or both.

Background and objectivesIn high-risk populations, the efficacy of mesh placement in incisional hernia (IH) prevention after elective abdominal surgeries has been supported by many published studies. This meta-analysis aimed at providing comprehensive and updated clinical implications of prophylactic mesh placement (PMP) for the prevention of IH as compared to primary suture closure (PSC).Materials and methodsPubMed, Science Direct, Cochrane, and Google Scholar were systematically searched until March 3, 2020, for studies comparing the efficacy of PMP to PSC in abdominal surgeries. The main outcome of interest was the incidence of IH at different follow-up durations. All statistical analyses were carried out using Review Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and Stata 11.0 (Stata Corporation LP, College Station, TX). The data were pooled using the random-effects model, and odds ratio (OR) and weighted mean differences (WMD) were calculated with the corresponding 95% confidence interval (CI).ResultsA total of 3,330 were identified initially and after duplicate removal and exclusion based on title and abstract, 26 studies comprising 3,000 patients, were included. The incidence of IH was significantly reduced for PMP at follow-up periods of one year (OR= 0.16 [0.05, 0.51]; p=0.002; I2=77%), two years (OR= 0.23 [0.12, 0.45]; p<0.0001; I2=68%), three years (OR= 0.30 [0.16, 0.59]; p=0.0004; I2= 52%), and five years (OR=0.15 [0.03, 0.85]; p=0.03; I2=87%). However, PMP was associated with an increased risk of seroma (OR=1.67 [1.10, 2.55]; p= 0.02; I2=19%) and chronic wound pain (OR=1.71 [1.03, 2.83]; p= 0.04; I2= 0%). No significant difference between the PMP and PSC groups was noted for postoperative hematoma (OR= 1.04 [0.43, 2.50]; p=0.92; I2=0%), surgical site infection (OR=1.09 [0.78, 1.52]; p= 0.62; I2=12%), wound dehiscence (OR=0.69 [0.30, 1.62]; p=0.40; I2= 0%), gastrointestinal complications (OR= 1.40 [0.76, 2.58]; p=0.28; I2= 0%), length of hospital stay (WMD= -0.49 [-1.45, 0.48]; p=0.32; I2=0%), and operating time (WMD=9.18 [-7.17, 25.54]; p= 0.27; I2=80%).ConclusionsPMP has been effective in reducing the rate of IH in the high-risk population at all time intervals, but it is associated with an increased risk of seroma and chronic wound pain. The benefits of mesh largely outweigh the risk, and it is linked with positive outcomes in high-risk patients.

There is a paucity of literature on anesthetic drug shortages and their impact on patient safety in lower-middle-income countries. We sought to determine the magnitude of the problem, the effect on patient care and safety, and the adverse patient outcomes witnessed by anesthesiologists in Pakistan METHODS: We conducted a nationwide, multicentre, cross-sectional survey of a representative sample of anesthesiologists in Pakistan (January 2021 to June 2021). The survey questionnaire was adapted from the American Society of Anesthesiologists (ASA) survey on drug shortages and was modified based on the national essential medication list 2018 of Pakistan. It was distributed through Google Forms to anesthesiologists practicing in both the private and government sector. The names of hospitals or the identity of anesthesiologists was not required. The questionnaire consisted of 20 items and focused on the anesthesiologists' experience of drug shortages, the availability of drugs, and the impact of drug shortages on their individual practice. Two hundred and forty-six responses were received. Approximately 50% (122/246) of anesthesia practitioners in Pakistan reported anesthetic drug shortages. Fifty-seven percent of respondents mentioned using an inferior drug that may have significantly affected the delivery of anesthetic care. Four participants mentioned severe morbidity and another four mentioned observing a mortality associated with drug shortage. Anesthetic drug shortages are common in anesthetic practice in Pakistan and they appear to affect patient care and outcomes.

Abstract Disclosure: J.C. Lo: None. M. Chandra: None. M.M. Khan: None. L.D. Carbone: None. E.A. Garcia: None. G.H. Tabada: None. D. Low: None. R.L. Hui: None. Introduction: Bisphosphonate (BP) drugs remain one of the first line therapies for fracture prevention, but treatment patterns have changed since BPs were first approved for osteoporosis. This study examines trends among adults initiating oral BP in a large US healthcare system over a 25-year period (1988-2022) and in each successive 5-year period. Methods: The study cohort comprised adults aged 50-89y who initiated alendronate, risedronate or oral ibandronate during 1998-2022 in an integrated healthcare delivery system, excluding those with select bone disorders, multiple myeloma, secondary metastatic cancer, end stage renal disease, and receipt of intravenous BP. Covariates included age (proportion age <65y), sex, race and ethnicity, and prior fracture (diagnosed within 5 years) using electronic health record data. Demographic trends and fracture status were examined across time periods. The chi-squared test and Cochrane-Armitage test for trend were used to examine differences and trends. This report extends findings from an earlier report of women initiating oral BP during 2004-2012 in the same healthcare population. Results: Among 208,780 adults (86% women) who initiated BP, including 26,646 (1998-2002, 35% <65y), 44,726 (2003-2007, 35% <65y), 34,005 (2008-2012, 24% <65y), 35,248 (2013-2017, 19% <65y), and 38,743 (2018-2022, 17% <65y) women and 2348 (1998-2002, 28% <65y), 4895 (2003-2007, 26% <65y), 5172 (2008-2012, 17% <65y), 5331 (2013-2017, 13% <65y), and 11,666 (2018-2022, 5% <65y) men in each 5-year period. Over time, an increasing proportion were age ≥65y (p<0.001 for trend), with larger numbers of older adults in later years partly reflecting initiatives targeting secondary fracture prevention (since 2008 for women, 2015 for men) and BMD screening (since 2011 for women, 2017 for men). Among women initiating BP, the proportion with prior fracture increased from 24-30% (pre-2008) to 43-45% (post-2008), partly reflecting secondary fracture prevention initiatives for women. For men, this proportion increased from 33% (1998-2002) to 42% (2003-2007), 47% (2008-2012), and 54% (2013-2017), but fell to 36% (2018-2022) after BMD screening initiatives began in 2017 for older men (primary prevention efforts). Racial and ethnic diversity in treatment also increased, comparing 1988-2002 (75.2% White, 2.5% Black, 8.6% Hispanic, 12.7% Asian/Pacific Islander) to 2018-2022 (61.5% White, 2.9% Black, 12.2% Hispanic, 21.1% Asian/Pacific Islander, p<0.001 for overall differences and % non-White). Conclusions: In a primary care population of adults initiating oral BP, a larger proportion in later years were age >65y, including larger numbers both with and without fracture coinciding with initiatives for fracture prevention. Among those initiating BP, the relative proportions with prior fracture in each period were likely influenced by primary or secondary prevention efforts. Presentation: 6/2/2024

Purpose There is a paucity of literature on anesthetic drug shortages and their impact on patient safety in lower-middle-income countries. We sought to determine the magnitude of the problem, the effect on patient care and safety, and the adverse patient outcomes witnessed by anesthesiologists in Pakistan Methods We conducted a nationwide, multicentre, cross-sectional survey of a representative sample of anesthesiologists in Pakistan (January 2021 to June 2021). The survey questionnaire was adapted from the American Society of Anesthesiologists (ASA) survey on drug shortages and was modified based on the national essential medication list 2018 of Pakistan. It was distributed through Google Forms to anesthesiologists practicing in both the private and government sector. The names of hospitals or the identity of anesthesiologists was not required. The questionnaire consisted of 20 items and focused on the anesthesiologists’ experience of drug shortages, the availability of drugs, and the impact of drug shortages on their individual practice. Results Two hundred and forty-six responses were received. Approximately 50% (122/246) of anesthesia practitioners in Pakistan reported anesthetic drug shortages. Fifty-seven percent of respondents mentioned using an inferior drug that may have significantly affected the delivery of anesthetic care. Four participants mentioned severe morbidity and another four mentioned observing a mortality associated with drug shortage. Conclusion Anesthetic drug shortages are common in anesthetic practice in Pakistan and they appear to affect patient care and outcomes.

Purpose: The purpose of this review article is to execute and present a comprehensive and systematic literature review of research articles which have used UTAUT models (classic or extended) for studying factors effecting the adoption of internet and mobile banking from 2015 to April 2020 in developing countries. Design/methodology/approach: This research has identified and studied 28 subject related articles. Data was collected through comprehensive electronic research using search engines of Google Scholar, Yahoo, Base and ProQuest. The search criteria were the keywords internet banking, mobile banking adoption and UTAUT model. For further selection consideration was given to the articles where classic as well as extended UTAUT models were applied. Additionally, the \"descriptive\" approach was applied to position the internet and mobile banking adoption in the comprehensive internet banking literature stream, from the previous authoritative review of the internet banking adoption literature [2] which covered the period from1999 to 2012. Findings: The findings from the analysis of primary data collected from developing countries show that the studies have used cross sectional approach, questionnaire/survey methods, and structural equation modelling analysis techniques whereas, SPSS, SEM, PLS were found to be the largely used analysis tools. Moreover, variables such as performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation and price value were the main indicators of behavioral intention. Perceived risk was found to be the most added external variable in UTAUT baseline model. Practical Implication: This review article provides, for future endeavors, an extensive literature on a specified subject. The findings of this research would make a clear path for potential researchers to develop a new theory for studying the adoption of internet and mobile banking. Originality/Value: The research has filled the research gap by providing a review of literature on specified subject from 2015 to April 2020 and provided the researchers with additive knowledge about the model used and the factors effecting the adoption of internet and mobile banking.

Purpose - With the upsurge, massive growth and development of internet and information technology, banking and financial services are being offered by the banks to their customers through e-banking extensively. This study aims to identify the elements influencing the adoption of Electronic Banking in Pakistan by using extended Unified Theory of Acceptance and Use Technology (UTAUT) theory. Design/methodology/approach - The research model was tested using survey-based research from 150 customers of three commercial banks of Pakistan. Data was analyzed using Statistical Package for Software Sciences. Findings - The findings supported all hypothesized relationship of Performance Expectancy (PE), Effort Expectancy (EE), Social Influence (SI), Facilitating Conditions (FC), Security (S), Risk (R) and Trust (T) with the Behavioral Intention (BI) and Usage Behavior (UB). The key and most important construct of usage of consumer's behavior in internet banking adoption is explained and positive relationship is seen among PE, EE, SI, FC, R, T, and S at the significance level 0.00. The Confirmatory Factor Analysis (CFA) explained the total variance of 78.44%. Practical implications - The findings of this research would help the banks managers in making their strategic decisions and policies for the implementation of e-banking. Additionally, the banks can improve their security systems by eliminating the element of risk and gaining the trust of their customers. Originality/value - The study is contributing in the literature by incorporating and testing UTAUT theory proposed by [1], for studying the factors which are effecting the adoption of e-banking in Pakistan, this theory was extended by adding three additional constructs.