Cholesterol to saturated fat index (CSI), metabolic parameters and inflammatory factors among obese individuals.

BACKGROUND: The role of dietary fat quality in promotion of cardiovascular diseases is studies before. However, the results are inconsistent. Recently, cholesterol to saturated fatty acid index (CSI) is suggested as a novel indicator of the atherogenicity and thrombogenicity potential of a diet. However, due to limited number of studies, in the current cross-sectional study, we aimed to evaluate the role of CSI in metabolic and inflammatory response among obese individuals. METHODS: In the current cross-sectional study 488 obese individuals aged 18-50 years old were involved in volunteer based invitation from outpatient obesity clinics. Subjects underwent anthropometric assays including weight, height, waist circumference (WC) and body composition and their fasting blood sample were obtained for biochemical assessments including blood sugar, serum lipids, hs-CRP and IL-6 concentrations by commercial kits. Physical activity was also assessed by short form of international physical activity questionnaire (IPAQ). RESULTS: According to our results, being at the top tetile of CSI was associated with higher anthropometric indices including weight, height, WC, FFM, and basal metabolic rate (BMR) compared with those at the lowest tertile (P < 0.05). Similarly, those at the highest category of CSI had significantly higher levels of serum glucose and hs-CRP both in crude and adjusted models in ANCOVA and in multinomial logistic regression models (P < 0.05). CONCLUSION: In the current study, for the first time, we identified the possible triggering role of dietary cholesterol to saturated fat index in increasing serum glucose and hs-CRP levels. due to cross-sectional design of the current study, causal inference is impossible. Further studies will help for better scientific justification.

Coconut shell carbon via phosphoric acid activation for rhodamine B, malachite green, and methylene blue adsorption - equilibrium and kinetics.

This study was aimed at evaluating the removal of different cationic dyes onto phosphoric acid-activated coconut shell carbon. The activated carbon was characterized for surface functional groups, thermal decomposition profiles, surface morphology, and textural properties. The specific area was recorded as 1,221 m2/g with 100% mesoporosity. On molecular basis, the activated carbon adsorbs malachite green, methylene blue, and rhodamine B at maximum capacities of 1.52 mmol/g, 0.80 mmol/g, and 0.58 mmol/g, respectively. It indirectly implies the selectivity of activated carbon toward malachite green, and behaves differently due to steric hindrance of dye molecules. All equilibrium data obeyed Langmuir model, while the kinetic data are closely fitted to pseudo-second order model as concentration increases. To conclude, coconut shell activated carbon is more effective to remove malachite green compared to methylene blue and rhodamine B.

This paper is expected to give a further insight into the valorization of coconut shell into activated carbon, and its re-purpose for the remediation of dye-contaminated streams, for which methylene blue, malachite green and rhodamine B were used as model pollutants. This study aims to contribute to the growing body of research on the selective removal of malachite green over the other two dyes onto coconut shell activated carbon, which to the best of our knowledge is still absent in the open literature.

Mitochondrial DNA Copy Number, a Damage-Associated Molecular Pattern Molecule, Can Predict Pancreatic Necrosis and Is Correlated with the Severity of Acute Pancreatitis.

BACKGROUND: Mitochondrial DNA (mtDNA) is a damage-associated molecular pattern molecule that can trigger an immune-inflammatory response during pancreatic necrosis (PN). AIM: To evaluate the role of mtDNA in the detection of PN and severe acute pancreatitis (SAP). METHODS: The present study included 40 AP patients and 30 controls. AP patients were grouped into mild AP (MAP, n = 15), moderately severe AP (MSAP, n = 17), and SAP (n = 8). Also, the SAP + MSAP group, n = 25, was compared to MAP. AP patients were divided into NAP (n = 7) and non-necrotizing AP (n = 33). The mtDNA copy number, IL-6, and STAT3 expression levels were measured using quantitative real-time PCR. RESULTS: The mtDNA, IL-6, and STAT3 levels were significantly higher in AP patients than in controls and in the SAP + MSAP than in the MAP. However, the SAP had non-significantly higher levels of mtDNA, STAT3, and IL-6 levels than the MSAP and statistically significant mtDNA, STAT3, and IL-6 when compared to the MAP. mtDNA, IL-6, and STAT3 showed significantly higher levels in NAP compared with non-necrotizing AP. mtDNA was positively correlated with STAT3, IL-6, CRP, APACHE, and CT severity index (CTSI) and negatively correlated with albumin. In the receiver operating curve (ROC), mtDNA was the most significant independent predictor of PN and MAP vs. SAP + MSAP. IL-6 and mtDNA + CRP had higher diagnostic abilities for SIRS and high CTSI. CONCLUSIONS: mtDNA could enhance the prediction of NAP; however, its diagnostic ability of SAP needs further study.

Vitex doniana seed activated carbon for methylene blue adsorption: equilibrium and kinetics.

This study evaluated the characteristics of zinc chloride modified vitex doniana seed activated carbon (VDZnCl2) for the removal of methylene blue. VDZnCl2 was characterized for textural properties, surface morphology and surface chemistry. Batch adsorption of methylene blue by VDZnCl2 was evaluated for the effects of concentration, contact time, adsorbent dosage, and solution pH. The surface area increased from 14 to 933 m2/g with porous texture to facilitate adsorption. The SEM micrograph showed varieties of pores with widened cavities. The FTIR spectra showed the characteristics of O-H and C=C groups commonly found in carbonaceous materials. The maximum methylene blue adsorption was recorded as 238 mg/g at concentration range of 1-800 mg/L and VDZnCl2 dosage of 50 mg. Sips isotherm fitted well with the equilibrium data, suggesting that the adsorption by VDZnCl2 was a physical process onto its heterogeneous surface, while the applicability of pseudo-first-order kinetics implies that external diffusion was the rate controlling mechanism. The performance put up by VDZnCl2 suggested that it is a potential adsorbent substitute for dye wastewater treatment.

Vitex doniana commonly known as black plum is a deciduous flowering tree that grows around West Africa. Over 80% of the fruit is seed, and often discarded. To date, this seed has received marginal recognition as activated carbon feedstock for the removal of dyes and organic pollutants. However, there is no known study on the synthesis of zinc chloride (ZnCl₂) modified activated carbon from vitex doniana seed and its adsorption of methylene blue from wastewater. Therefore, this study was a first-time attempt of the synthesis of ZnCl₂ modified activated carbon adsorbent from vitex doniana and its removal of methylene blue from wastewater. This work systematically encouraged indigenous adsorbent synthesis for wastewater treatment and contribution to sustainable development goals.

Advancements in Neighboring-Based Energy-Efficient Routing Protocol (NBEER) for Underwater Wireless Sensor Networks.

Underwater wireless sensor networks (UWSNs) have gained prominence in wireless sensor technology, featuring resource-limited sensor nodes deployed in challenging underwater environments. To address challenges like power consumption, network lifetime, node deployment, topology, and propagation delays, cooperative transmission protocols like co-operative (Co-UWSN) and co-operative energy-efficient routing (CEER) have been proposed. These protocols utilize broadcast capabilities and neighbor head node (NHN) selection for cooperative routing. This research introduces NBEER, a novel neighbor-based energy-efficient routing protocol tailored for UWSNs. NBEER aims to surpass the limitations of Co-UWSN and CEER by optimizing NHNS and cooperative mechanisms to achieve load balancing and enhance network performance. Through comprehensive MATLAB simulations, we evaluated NBEER against Co-UWSN and CEER, demonstrating its superior performance across various metrics. NBEER significantly maximizes end-to-end delay, reduces energy consumption, improves packet delivery ratio, extends network lifetime, and enhances total received packets analysis compared to the existing protocols.

Kinetics, thermodynamics, and thermal decomposition behavior of palm oil empty fruit bunch, coconut shell, bamboo, and cardboard pyrolysis: an integrated approach using Coats-Redfern method.

This study presents the kinetics and thermodynamics of biomass pyrolysis. The kinetics of the pyrolysis process was estimated using ten kinetic models from three different mechanisms, namely chemical reaction, diffusion, and nucleation and growth. Results showed that each pyrolysis subdivision was described by a different reaction model, signifying the complex nature of the pyrolysis process. The average values of activation energy determined from the kinetic models for empty fruit bunch, coconut shell, bamboo, and cardboard are 10.2-64.6 kJ/mol, 18.7-186.2 kJ/mol, 8.0-70.8 kJ/mol, and 13.1-277.3 kJ/mol, respectively. The biomass pyrolysis is endothermic and non-spontaneous and would require external energy to initiate the degradation process. The findings are helpful in characterizing the thermal degradation of biomass in exploring its potential as a source of alternative solid fuel.

Deep eutectic solvent-treated palm oil mill sludge adsorbents for methylene blue adsorption.

This study evaluated the adsorptive properties of deep eutectic solvent (DES)-treated palm oil mill sludge adsorbents for methylene blue removal. The adsorbents were prepared at a ratio of 1:2 at 80°C to form P1:D2@80°C, at 25°C to form P1:D2@25°C and without DES to form dry sludge (DS). The adsorbent samples were characterized for surface functional groups, textural properties and surface morphology. The values of specific area were 534, 236 and 184 m2/g, respectively. Batch adsorption of methylene blue at varying concentration, adsorbent dosage, pH, contact time and temperature was performed. The maximum adsorption capacities by Sips model were recorded as 72.07, 56.18 and 48.33 mg/g for P1:D2@80°C, P1:D2@25°C and DS, respectively. P1:D2@80°C displayed the highest rate constant (Ks = 0.0037 g/mg.min). The adsorption data were well fitted into Sips isotherm and pseudo-second-order kinetic models, suggesting that the adsorption is a physical process onto heterogeneous adsorbent surface via pore filling and electrostatic attraction. The adsorption was spontaneous, feasible and exothermic with decreased disorderliness in the solid-bulk solution interface. The DES-treated palm oil mill sludge adsorbent is a promising alternative adsorbent for dye removal from wastewater.

SARS-CoV-2 vaccine response in CAR T-cell therapy recipients: A systematic review and preliminary observations.

Evolving data suggest that SARS-CoV-2 vaccine responses are blunted in allogeneic hematopoeitic cell transplant (HCT) recipients. Responses to the vaccine in chimeric antigen receptor T-cell (CAR-T) therapy are unknown and are likely to be even more diminished. We manually searched vital databases and identified 5 studies that have so far reported COVID-19 vaccine response in a total of 70 CAR-T recipients. The cumulative humoral response rate across all 5 studies was 31%. However, the results are not generalizable due to non-standardized units of humoral response measurement and a lack of external validation. Heterogeneity existed in studies regarding the timing of vaccination post-CAR-T, intervals between the vaccine doses, platforms of response assessment, vaccine platforms, and pre-vaccine immune status. CAR-T-related factors that independently impact vaccine response to prevent COVID-19 have further been reviewed. We conclude that the results must be interpreted with caution given the limitations of small sample sizes, differences in immunoassays, lack of standard definitions and clinical correlates of SARS-CoV-2 immune response, and lack of cellular responses. Until large-scale, homogenous prospective data become available, these preliminary observations will help transplant and infectious disease clinicians with their decision-making while providing care to this profoundly immunosuppressed cohort of patients.

Development and validation of standard and real patient gallstone library using Fourier transform infra-red spectroscopy.

BACKGROUND: Analysis of the constituents of gallstones using various spectroscopic techniques assists in identification of the pathogenesis of gallstones. In the current study, using Fourier Transform Infra-Red (FTIR) Spectroscopy, a Gallstone Standard Library (GSL) and a Gallstone Real Patients' Library (GRPL) were developed and validated for gallstone composition analysis. METHODS: The study was conducted at the Department of Pathology & Laboratory Medicine, Aga Khan University, Pakistan. Pure standards (cholesterol, calcium carbonate, bilirubin and bile salts) and gallstone specimens were analyzed using FTIR Nicolet iS-5 Spectrometer from Thermo Fisher Scientific, USA. Thermo Scientific™ QCheck™ algorithm, embedded within the OMNIC™ software, was used to identify the unique spectral fingerprint of the patient samples to match with known, standard material. Matching of > 75% was considered acceptable. Validation for accuracy of the library was performed for twenty analyzed gallstones at an international reference lab. RESULTS: Concerted search analysis was performed against the developed GSL consisting of 71 "pure component" spectrum divided into 5 types to generate the library. For the Gallstone Real Patient Library (GRPL), 117 patient samples were analyzed. Ninety-eight gall stones (83.8%) out of 117 stones matched with the developed GSL. Majority stones were mixed stones (95.92%), with cholesterol being the primary component (91.83%). Results of the developed library were 100% in agreement with the reports received from the external reference lab. CONCLUSIONS: The library developed displayed good consistency and can be used for detection of gallstone composition in Pakistan and replace the traditional labor- and time-intensive chemical method of gallstone analysis.

Perceptions of oncology as a career choice among the early career doctors in Pakistan.

BACKGROUND: Lack of oncologists is a growing global concern. With the rise in cancer burden across the world, the supply-demand mismatch of the oncology workforce is projected to increase. Furthermore, oncology is a low-ranked field of choice among medical students, and without understanding the perceptions and concerns of early-career doctors regarding oncology, any investments made in cancer care will be futile. This study aims to determine the opinions of young doctors and the factors most affecting their preferences in order to devise focused strategies to attract more doctors into oncology. METHODS: A cross-sectional study was conducted on 300 early-career doctors across various public and private hospitals in Pakistan, from March to November 2019. A close-ended, self-administered questionnaire was used to assess their opinions in terms of the workplace environment, scope, and the emotional and financial aspects of oncology. Data was analyzed using SPSS version 23 and the influence (positive or negative) of the perceptions on the choice of oncology as a career was determined by binary logistic regression analysis. RESULTS: Almost three-quarters of the participants did not want a career in oncology. The top positive perceptions about oncology in descending order were: progressive field, gender-neutral, stable working hours, financially healthy, and work-family balance. Top negative perceptions were: lack of oncologic facilities in hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load, and depressing environment. Participants who attended private medical school (p < 0.10), planned to live abroad (p < 0.10), had an oncologist (p < 0.05), cancer survivor or death due to cancer in the family (p < 0.05), were more likely to adopt oncology as a career. Those who believed that poor patient prognosis can have an impact on career choice were less likely to prefer oncology (p < 0.05). CONCLUSION: Despite the rising cancer burden, early career doctors are reluctant to join oncology. Curricular, infrastructural and policy changes are needed at the level of medical school, oncology training and practice to recruit more young doctors and minimize the existing paucity of the oncologic workforce.

Getting Smarter about Smart Cities: Improving Data Security and Privacy through Compliance.

Smart cities assure the masses a higher quality of life through digital interconnectivity, leading to increased efficiency and accessibility in cities. In addition, a huge amount of data is being exchanged through smart devices, networks, cloud infrastructure, big data analysis and Internet of Things (IoT) applications in the various private and public sectors, such as critical infrastructures, financial sectors, healthcare, and Small and Medium Enterprises (SMEs). However, these sectors require maintaining certain security mechanisms to ensure the confidentiality and integrity of personal and critical information. However, unfortunately, organizations fail to maintain their security posture in terms of security mechanisms and controls, which leads to data breach incidents either intentionally or inadvertently due to the vulnerabilities in their information management systems that either malicious insiders or attackers exploit. In this paper, we highlight the importance of data breaches and issues related to information leakage incidents. In particular, the impact of data breaching incidents and the reasons contributing to such incidents affect the citizens' well-being. In addition, this paper also discusses various preventive measures such as security mechanisms, laws, standards, procedures, and best practices, including follow-up mitigation strategies.

A Novel Design and Development of a Strip-Fed Circularly Polarized Rectangular Dielectric Resonator Antenna for 5G NR Sub-6 GHz Band Applications.

In this article, a rectangular dielectric resonator antenna (RDRA) with circularly polarized (CP) response is presented for 5G NR (New Radio) Sub-6 GHz band applications. A uniquely shaped conformal metal feeding strip is proposed to excite the RDRA in higher-order mode for high gain utilization. By using the proposed feeding mechanism, the degenerate mode pair of the first higher-order, i.e., TEδ13x at 4.13 GHz and TE1δ3y, at 4.52 GHz is excited to achieve a circularly polarized response. A circular polarization over a bandwidth of ~10%, in conjunction with a wide impedance matching over a bandwidth of ~17%, were attained by the antenna. The CP antenna proposed offers a useful gain of ~6.2 dBic. The achieved CP bandwidth of the RDRA is good enough to cover the targeted 5G NR bands around 4.4−4.8 GHz, such as n79. The proposed antenna configuration is modelled and optimized using computer simulation technology (CST). A prototype was built to confirm (validate) the performance estimated through simulation. A good agreement was observed between simulated and measured results.

MIMO Antenna System for Modern 5G Handheld Devices with Healthcare and High Rate Delivery.

In this work, a new prototype of the eight-element MIMO antenna system for 5G communications, internet of things, and networks has been proposed. This system is based on an H-shaped monopole antenna system that offers 200 MHz bandwidth ranges between 3.4-3.6 GHz, and the isolation between any two elements is well below -12 dB without using any decoupling structure. The proposed system is designed on a commercially available 0.8 mm-thick FR4 substrate. One side of the chassis is used to place the radiating elements, while the copper from the other side is being removed to avoid short-circuiting with other components and devices. This also enables space for other systems, sub-systems, and components. A prototype is fabricated and excellent agreement is observed between the experimental and the computed results. It was found that ECC is 0.2 for any two radiating elements which is consistent with the desirable standards, and channel capacity is 38 bps/Hz which is 2.9 times higher than 4 × 4 MIMO configuration. In addition, single hand mode and dual hand mode analysis are conducted to understand the operation of the system under such operations and to identify losses and/or changes in the key performance parameters. Based on the results, the proposed antenna system will find its applications in modern 5G handheld devices and internet of things with healthcare and high rate delivery. Besides that, its design simplicity will make it applicable for mass production to be used in industrial demands.

Effect of physical activity and vitamin D compared with vitamin D alone on muscle strength, back flexibility and aerobic activity in patients with chronic kidney disease: A comparative study from Pakistan.

BACKGROUND AND OBJECTIVES: To compare the differences in musculoskeletal health with vitamin D alone in comparison with vitamin D with physical activity (PA) among chronic kidney disease (CKD) patients. METHODS AND STUDY DESIGN: An open labeled, randomized, controlled trial was conducted at two tertiary care centers in Pakistan. Patients with CKD stage 2-4 and vitamin D deficiency (<20 ng/mL) were recruited in the trial. Both the arms were given oral vitamin D (cholecalciferol) drops (4000 IU) once daily for three months. One arm received only vitamin D (VD arm), while the second arm received vitamin D along with PA (VDPA arm). RESULTS: Of the 1,235 CKD stage 2-4 subjects contacted, forty-six subjects were enrolled. Eighteen were assigned to VD arm and twenty-eight were assigned to VDPA arm. Between groups comparison shows that bicep strength increases from 15 to 17 kg. Likewise, back flexibility and aerobic fitness also increased among those who receive vitamin D and physical activity, however these differences were not statistically significant (p>0.05). Sensitivity analysis within group comparison shows rise of bicep strength from 13.8 kg to 15.2 kg in the VD alone arm (p=0.05); however, in the VDPA arm, there is a greater difference of 14.3 kg to 17.2 kg (p<0.001). CONCLUSIONS: Targeted PA among CKD patients has potential to improve bicep strength and back flexibility. However, as the sample size was small, further studies would be required to suggest whether a PA should be included as part of the treatment regimen.

Assessment of sugar and sugar accumulation-related gene expression profiles reveal new insight into the formation of low sugar accumulation trait in a sweet orange (Citrus sinensis) bud mutant.

The accumulation of soluble sugars in fleshy fruits largely determines their sweetness or taste. A spontaneous sweet orange mutant 'Hong Anliu' (HAL, Citrus sinensis) accumulates low soluble sugar content in fruit juice sacs than its wild type, 'Anliu' (AL) orange; however, the cause of reduced sugar content in 'HAL' fruit remains unclear. In this study, sugar content and expression profiles of genes involved in sugar metabolism and transport were compared between 'HAL' and 'AL' fruit juice sacs. In both cultivars, fructose and glucose displayed the increasing trends with significantly lower contents in 'HAL' than 'AL' after 160 DAF; moreover, sucrose had a declining trend in 'HAL' and increasing trend in 'AL' with fruit development. On the other hand, transcript levels of VINV, CWINV1, CWINV2, SUS4, SUS5, SPS1, SPS2, VPP-1, VPP-2, and some sugar transporter genes were significantly decreased in 'HAL' compared with 'AL' after 100 DAF or 160 DAF. Interestingly, the transcript levels of SPS2 and SUT2 exhibited a similar trend as it was found for sucrose content in both cultivars. These results suggested that the low sugar accumulation in 'HAL' fruit JS is accompanied by the reduced sink strength, sucrose-synthesis ability, and vacuolar storage ability compared with 'AL'; reduction of CWINVs, VINV, SPS2, SUT2, VPP-1, and VPP-2 transcript levels possibly plays a key role in the low storage of soluble sugars in the vacuoles of mutant juice sacs.

Dentition status among an ethnically diverse older urban Malaysian population.

BACKGROUND: Poor oral health affects not only dietary choices but overall well-being. This study explores the influence of lifestyle, socio-demographics and utilization of dental services on the dentition status of an older urban Malaysian population. METHODS: A total of 1210 participants 60 years and above, representing the three main ethnic groups were recruited from a larger cohort study. Weighted factors valued for comparison included socio demographics and health status. Knowledge of and attitude and behaviour towards personal oral health were also assessed. Dentition status, adapted from WHO oral health guidelines, was the dependent variable investigated. Data were analysed using descriptive chi square test and multivariate binary logistic regression. RESULTS: Overall, 1187 respondents completed the study. The dentition status and oral health related knowledge, attitude and behaviour varied between the three ethnic groups. The Chinese were significantly less likely to have ≥13 missing teeth (OR = 0.698, 95% CI: 0.521-0.937) and ≥1 decayed teeth (0.653; 0.519-0.932) compared to the Malays, while the Indians were significantly less likely than the Malays to have ≥1 decayed teeth (0.695; 0.519-0.932) and ≥2 filled teeth (0.781; 0.540-1.128). CONCLUSION: Ethnic differences in dentition outcome are related to oral health utilization highlighting the influence of cultural differences and the need for culturally sensitivity interventions.

Radiotherapy alone with concurrent chemoradiotherapy plus temozolamide in locally advanced soft tissue sarcoma at Mayo Hospital Lahore: A randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of combining an oral chemotherapeutic agent temozolamide with radiotherapy in the management of the un-resectable non-metastatic soft tissue sarcomas compared with radiotherapy alone. METHODS: The randomised controlled phase 3, double-arm study was conducted at King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from December 2012 to July 2017. Patients with all sub-types of locally advanced un-resectable soft tissue sarcomas were randomised into two groups. Group-A received radiotherapy alone while Group-B received concomitant chemoradiotherapy with temozolamide after receiving two cycles of standard chemotherapy. Response was evaluated according to response evaluation criteria in solid tumours through computed tomography scan or magnetic resonance imaging after 6 weeks following completion of radiotherapy. SPSS 21 was used for data analysis. RESULTS: Of the 64 patients, 32(50%) were assigned to each group. The mean age of Group-A was 36.25±20.31 and of Group-B 37.84±15.79 years .There were 18(56.3%) males in Group-A and 20(62.5%) in Group-B. Improvement in trends of overall response rate was observed in Group-B 24(75%) compared to 18(56.3%) in Group-A (p=0.12).. CONCLUSIONS: Though not statistically significant, there was improvement in response rate with the addition of temozolamide to standard radiation therapy.

Predictors of therapeutic failure among patients with acute brucellosis treated by dual therapy with doxycycline-rifampin.

OBJECTIVE: To determine the frequency of therapeutic failure among patients with acute and subacute brucellosis and to explore the predictors of failure. METHODS: The study included 213 consecutive, naïve patients with acute and subacute brucellosis. All participants underwent clinical evaluation, chest radiography, stool microscopic examination and interferon-gamma release assay. Patients received the WHO-recommended therapy of doxycycline 200 mg/day and rifampin 900 mg/day, for 6 weeks. RESULTS: Mean age of the study population was 39.8 ± 12.2 years; 64.8% of them were males. The therapeutic failure rate was 16.4%. Adverse effects were reported by 13.1%. Multivariate analysis of factors associated with therapeutic failure revealed latent tuberculosis infection (LTBI) (OR 3.1, 95% CI, 1.9-24.6, P: 0.009), ascariasis (OR 2.6, 95% CI 1.5-17.9, P: 0.012), and the use of acid suppressive therapy (OR 2.1, 95% CI 1.2-19.5, P: 0.037) as the predictors of therapeutic failure. CONCLUSIONS: The prevalence of therapeutic failure among the Egyptian patients with acute/subacute brucellosis is increasing. Predictors of therapeutic failure are LTBI, ascariasis, and the use of acid suppressive therapy.

A novel method for safe and accurate placement of the rocker pins of head immobilization devices utilizing a digital caliber phantom: technical note.

BACKGROUND: Immobilization of the head and skull by head immobilization devices (HIDs) is a common practice in neurosurgery. A variety of complications and morbidities are associated with pinning the skull during application of HIDs. OBJECTIVE: Our aim is to describe a new technique that avoids repeated puncturing of the head and skull during application of HIDs and hence avoiding the potential complications resulting from multiple re-adjustments. METHODS: We used a pre-adjusted digital millimetric caliber (DMC) as a phantom for the two rocker pins of the HID to mimic and simulate the process of skull pinning. Localization and preparation of the accurate skull pinning sites are safely guided by the pinning phantom. RESULTS: The technique was applied in different neurosurgical approaches. The pinning phantom was utilized to accurately locate the suitable pinning sites. Contrary to the common practice, there was no need for repeated head and skull puncturing. Minimal manipulations of the head and neck are exerted in this approach as compared with the usual techniques. The head of the patient is allowed to be kept safe on the operating table until the final one-time confident skull pinning by the sterilized skull clamp pins. CONCLUSION: The process of scalp and skull pinning of HIDs is technically demanding. The DMC utilized as a pinning phantom is a useful technique which provides safe and confident application of the skull rocker pins of HIDs allowing the neurosurgeon to avoid multiple puncturing of scalp and skull and minimizing manipulations of the head and cervical spine.