OBJECTIVETo determine the present status of plant communities and their possible association with the habitat in Malam Jabba, Swat, Pakistan.

METHODSA study on the phytoecology was conducted in various ecologically important sites of Malam Jabba, Swat, Pakistan from 2002 to 2004. The altitude of these sites ranged from 1 200 m to 3 200 m. Quadrat method was used for evaluation of plants communities and the data on these attributes was converted to relative values. The plant communities were named after 3 leading species with highest importance values. Biological spectrum of the flora based on the life form was prepared by following Raunkiar's life form classes.

RESULTSThe floristic composition and structure of the study area were found to be 200 species belonging to 75 families. Asteraceae, Lamiaceae and Poaceae were important families in the study area. The biological spectrum showed that therophytic and hemicrytophytic life form and micro-nonophyllous leaf sizes were dominant in the area. The air and soil temperatures were decreasing with increasing elevation. Both the air and soil temperatures were relatively higher in south slopes than on the northeast slopes. The vegetation analysis of the area indicated eleven plant communities around the area. The present vegetation is the relics of moist temperate coniferous forest in the area. The communities reflect highly deteriorated conditions. Both the structure and composition of the surrounding vegetation were associated with the types of habitats.

CONCLUSIONSThe conservation of the remaining populations of the reported communities will be best achieved by proper time of sustainable harvesting. It is only possible with the participation of local communities.

Biodiversity ; Ecosystem ; Pakistan ; Plants ; classification

Background/aims: Crohn's disease (CD) results in significant morbidity, mortality, and healthcare burden. This study evaluated the temporal trends of CD hospitalizations with a fistula over the last decade to understand the outcomes of severe CD. Methods: National Inpatient Sample database from 2009 to 2019 was used to identify CD hospitalizations with a fistula. The outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), and mortality. Results: There was an increase in the total number of fistulizing CD hospitalizations from 5,386 in 2009 to 12,900 in 2019 (p<0.01). The mean age decreased from 44.9±0.6 to 41.8±0.4 years for the study period (p<0.01). Caucasians were the predominant ethnicity, followed by Africans, Hispanics, and others (p<0.001). The mean LOS for fistulizing CD hospitalizations decreased significantly from 11.57±0.09 days in 2009 to 7.20±0.05 days in 2019 (p<0.001). There was a significant decrease in inpatient mortality from 1.72% in 2009 to 0.73% in 2019 (p<0.01). The MIC did not have a significant trend. There was a decreasing trend toward partial/total colectomies, rectosigmoid, and small bowel surgeries from 2009 to 2019 (p<0.001). Conclusions There has been a rise in CD hospitalizations with fistulizing disease in the last decade. Despite this, the mortality and inpatient LOS have been decreasing significantly. In addition, the increase in CD hospitalizations with fistulizing disease has had no significant effect on hospital costs.

Currently, the literature contains few studies that describe any potential complications following arthroscopic acromioplasty. Because part of the anterior deltoid originates from the anterior acromion, there is a risk for violation and subsequent iatrogenic rupture or avulsion during this procedure. This type of injury can be a devastating problem for patients that may lead to poor function and debilitating pain. We present a patient with deltoid insufficiency following arthroscopic acromioplasty who elected to proceed with operative management with a planned arthroscopic evaluation of the shoulder followed by an open deltoid repair. At the final follow-up visit 2.5 years postoperatively, the patient reported improved pain from baseline and no residual disability and was able to perform most activities of daily living without difficulty. This case serves as an example of a surgical repair for a deltoid avulsion following arthroscopic acromioplasty. As there is still a lack of standard guidelines, our suture repair technique can be considered one method of treatment for this type of injury.

Purpose: Total hip arthroplasty (THA) using the direct anterior approach (DAA) is known to have a learning curve. The purpose of this study was to review cases where surgery was performed by an arthroplasty surgeon transitioning from the posterior approach (PA) to the DAA. We hypothesized similar complication rates and improvements in surgical duration over time. Materials and Methods: A review of 2,452 consecutive primary THAs was conducted. Surgical duration, length of stay (LOS), surgical complications, decrease in postoperative day (POD) 1 hemoglobin, transfusion rates, POD 0 and POD 1 pain scores, incision length, leg length discrepancy (LLD), and radiographic cup position were recorded. Results: No differences in surgical duration were observed after the first 50 DAA cases. A shorter LOS was observed for the DAA, and statistical difference was appreciated after the first 100 DAA cases. There were no differences in periprosthetic fractures. A higher rate of infections and hip dislocations were observed with the PA. The PA showed an association with higher transfusion rates without significant difference in POD 1 decrease in hemoglobin over the first 100 DAA cases. Similar POD 0 and POD 1 pain scores with a smaller incision were observed for the first 100 DAA cases. The DAA cohort showed less variation in cup inclination, version, and LLD. Conclusion DAA is safe and non-inferior in terms of reduced LOS, smaller incision, and less variation in cup position. Fifty DAA cases was noted to be the learning curve required before no differences in duration between approaches were observed.

COVID-19/virology* ; Cities ; Environmental Monitoring ; Genome, Viral ; Humans ; Infection Control/methods* ; Pakistan ; RNA, Viral/genetics* ; SARS-CoV-2/genetics* ; Sewage/virology*