Impact of medical school experiences on the career choice of neurosurgery: a cross- sectional study from Pakistan.

BACKGROUND: Pakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on career choice, but no study has delved into the impact of medical school exposure among Pakistani medical students, especially for the field of neurosurgery. This study aims to evaluate the impact of neurosurgery exposure, mentorship, and interest groups on medical students' decision to pursue neurosurgery. METHODS: A national cross-sectional survey was conducted in Pakistan, collecting data from medical students, interns, and medical officers over a one-month period. Ethical approval was obtained from the Ethical Review Committee at Aga Khan University, Pakistan. The data was analyzed using SPSS version 26. RESULTS: Out of 2618 participants, 38.0% were male and 62.0% were female, with an average age of 21.82 years (± 2.65). Among them, only 358 (13.6%) were interested in pursuing neurosurgery as a career, while the remaining 2,260 (86.3%) were not. More females (58.9%) than males (41.1%) expressed interest in pursuing neurosurgery as their intended career. Most medical students interested in pursuing neurosurgery were in the early years of their medical school (1st Year: 19.6%, 2nd Year: 26.0%, 3rd Year: 20.9%). In our study, students from public sector institutions (52.2%) showed more interest in neurosurgery as a career choice compared to those from private sector institutions (44.1%). The main deterrents for choosing neurosurgery were intense training (42.2%), work-life balance (39.9%), limited residency slots (56.7%), medical knowledge (34.1%), and surgical skills (36.6%). CONCLUSION: This study highlights the need for increased student engagement to inculcate the decision to pursue neurosurgery among medical students in Pakistan. A significant gap is highlighted, with the majority of interested students in early years. Public sector students show higher interest than their private sector counterparts. However, barriers like intense training, limited residency slots, and work-life balance concerns influence career choice. Targeted interventions like mentorship programs are crucial for fostering future neurosurgeons and advancing patient care and research. By addressing the identified disparities in experiences and promoting a supportive educational environment, it is possible to cultivate a future generation of skilled and dedicated neurosurgeons who can contribute to advancements in patient care and research in the field.

Changes in serum lipids with the onset and progression of Diabetic Retinopathy in Type-II Diabetes Mellitus.

Objective: To investigate the role of serum lipids in the onset and progression of Diabetic Retinopathy (DR) in Type-II diabetes (T2DM) individuals. Methods: This cross-sectional study was conducted at the National Institute of Diabetes and Endocrinology (NIDE), Dow University of Health Sciences (DUHS) from March to May 2019. After signing the informed consent, healthy controls (n=30), T2DM patients (diabetic n=30), proliferative (PDR n=30) and non-proliferative (NPDR n= 30) of age 18 to 65 years were selected by convenient sampling. Background information was gathered through interviews and the fundoscopy was done. Fasting five ml venous blood samples were collected and analysed for triglycerides (TGs), cholesterol, HDL, LDL, VLDL and the HbA1c using commercially available assays. The SPSS, version 24.0, was used for data analysis. Results: The HbA1c level was high in the diabetes, NPDR and PDR groups than control (p<0.05). The serum TGs and cholesterol were raised while the HDL was low in the diabetes group than in control (p<0.05). The cholesterol and LDL were high in the diabetes group compared to NPDR and PDR groups (p<0.05). The cholesterol and VLDL showed a positive moderately strong correlation with HbA1c in the PDR group (p<0.05). Conclusion: The serum lipid levels vary with the HbA1c levels and greater degree of derangement is observed with increasing mean HbA1C independent of diabetic retinopathy. For this reason, strict control of HbA1c and serum lipid level by lifestyle and/or pharmacologic intervention is recommended in diabetes with or without retinopathy.

Evaluating students' experiences in self-regulated smart learning environment.

The increasing development in smart and mobile technologies transforms a learning environment into a smart learning environment that can support diverse learning styles and skills development. An online learner needs to be supported for an engaging and active learning experience. Previously, this progressive research developed and implemented a self-regulated smart learning environment (mobile app) among final-year undergraduate students to support online learning experiences. To understand students' experiences, there is a need to evaluate the mobile app. However, there is a lack of a well-documented study investigating students' experiences in terms of usability, challenges, and factors influencing satisfaction to inform a decision regarding future implementation. This study attempts to fill these gaps by exploring these experiences for sustainable future implementation. The study used cyclical mixed-method evaluations to explore the experiences of 85 final-year undergraduate students. The quantitative data were collected using a survey on the constructs of the research model previously developed to evaluate factors influencing students' satisfaction, and the qualitative used focus group discussions to explore usability experiences and challenges of implementations. The quantitative data were analyzed using SPSS 25 to confirm the structural equation model's relationship. The qualitative data were analyzed using a thematic process to understand students' experiences. The findings from the first mixed-method evaluation show that students were able to follow the learning process, and the application supported their online learning experiences. However, a student expressed the need to improve user functionalities to motivate and engage them in the learning process. The suggestions were incorporated into the mobile app development for the second evaluation. The findings from the second evaluation revealed similar support. However, students suggested a web-based version to support different operating systems and improve interactions. Furthermore, the information system qualities and moderating factors investigated supported students' satisfaction. Future research could explore facilitators' experiences in the mobile app for sustainable development and implementation for engaging online learning experiences and skills development.

Ventricular septal rupture after delayed STEMI: A modern management approach.

BACKGROUND: Myocardial infarction associated ventricular septal rupture (VSR) is a potentially catastrophic complication. Though surgical repair remains the definitive treatment, outcomes are poor with high mortality rates.Case and Management: We present the case of a 62-year-old male who presented with a delayed STEMI leading to a VSR and cardiogenic shock. His management strategy included early percutaneous VSR closure and use of an intra-aortic balloon pump and inotropes. This served as a bridge to definitive surgical VSR patch repair while allowing hemodynamic stabilization, end-organ recovery, and myocardial tissue stabilization. CONCLUSION: Mechanical support devices such as intra-aortic balloon pump and Impella combined with percutaneous closure options can serve as a bridge to definitive surgery for VSR. This requires rapid mobilization of a multi-disciplinary structural heart team including advanced imagers, structural interventionalists, and surgeons.

PMMA/ABS/CoCl2 Composites for Pharmaceutical Applications: Thermal, Antimicrobial, Antibiofilm, and Antioxidant Studies.

In this study, PMMA/ABS/CoCl2 ternary composite films were fabricated by the solution casting technique. The different weight ratios of cobalt chloride (≤10 wt) were incorporated into the PMMA/ABS blend (80:20). The chemical structure and thermal properties of the synthesized composites were assessed by FT-IR, TGA, and XRD. The biological properties of ternary composites, such as in vitro antibacterial activity and antioxidant capacity, were investigated. The enhanced thermal stability and promising antibacterial, selective antibiofilm, and potential antioxidant properties of PMMA/ABS/cobalt chloride composites demonstrated that they can be used for high-quality plastics and in many pharmaceutical applications.

Seroprevalence and pathological studies of Salmonella infection in commercial white layer birds.

The present study was conducted to determine the seroprevalence and pathology of Salmonella infection in white commercial layer birds of District Faisalabad during June 2018 and June 2020. The current study aimed to determine the isolation, identification of Salmonella gallinarum (S. gallinarum), its cultural prevalence, antimicrobial resistance, molecular characterization, and pathological lesions produced in different organs of commercial layer birds. Initial screening of poultry flocks was done through serum plate agglutination test followed by culturing in different media, motility test, molecular confirmation, and histopathology. Based on the serum plate agglutination test, seroprevalence in the commercial white layer in dead and live flocks was 40.09%. The cultural prevalence of Salmonella in the seropositive group was 75.36% and in the seronegative was 31.84%. Cultural prevalence in the liver of dead birds was 62.06%, in spleen 58.62%, and in cloacal swabs was 67.24%. A total of 178 isolates were characterized through cultural characteristic and motility tests, among them 63.48% isolates were S. gallinarum, and 36.51% isolates were S. pullorum. The antibiogram study revealed that all the tested isolates were resistant to amoxicillin, gentamycin, kanamycin, doxycyclin, and tetracyclin. While tested isolates were sensitive to ciprofloxacin against S. gallinarum. Pathologically liver was friable, showing bonze discoloration with focal necrosis, enteritis of various grades, mottled white spleen, and enlarged kidneys were found. Microscopically, leukocytic infiltration with focal necrosis and degeneration, in mucosa and submucosa of intestinal inflammatory cells were observed. In conclusion, the seroprevalence, antibiogram, and molecular characterization of Salmonella help to control the disease in a better way through bacterin production of local isolates.

The Association Between Muslim Religiosity and Internet Addiction Among Young Adult College Students.

The major focus of this research was to investigate the effects of religiosity factor on internet addiction among young adults enrolled at college level. We adopted two instruments to gather the information including OK-religious attitude scale for Muslims developed and used by Ok, Uzeyir, and Internet Addiction Test prepared by Widyanto and McMurran. In total, 800 Muslim college students enrolled in four colleges at graduate level of southern Punjab Pakistan were chosen through multi-phase sampling. The subscales revealed more than .76 Cronbach alpha coefficients. The outcomes expressed positive role in case of DE conversion in world faith toward internet indications, whereas intrinsic religious orientations remained beneficial in decreasing internet usage. Students' anti-religion subscale demonstrates higher increase in becoming of internet addict; however, intrinsic religious orientations show significant decrease in using internet. Similarly, DE conversion in world faith view and Anti-Religion Scale indicate students' significant contributions in expecting them being internet addict. The study determines that the religiosity factor considerably illuminate the variances in developing internet addiction among the Muslim college adults with the direct effect of intrinsic religious orientation and indirect effect of anti-religion aspect.

Incorporating conjugated carbonyl compounds into carbon nanomaterials as electrode materials for electrochemical energy storage.

The increasing demand for energy and growing concerns for environmental issues are promoting the development of organic electrode materials. Among these, conjugated carbonyl compounds (CCCs) represent one of the most attractive and promising candidates for sustainable and eco-benign energy storage devices in the coming future. However, most of the current compounds suffer from dissolution in organic electrolytes and low electronic conductivity, which result in severe capacity decay and poor rate performance. Recently, researchers have achieved considerable progress by introducing electroactive carbonyl compounds into carbon nanomaterials. This perspective provides an overview of the up-to-date development of these nanocomposites in metal ion batteries (lithium-ion batteries or sodium-ion batteries) and supercapacitors (SCs), including the synthesis, performance improvement and applications. We mainly focus on carbon nanotubes (CNTs), graphene and mesoporous carbon (MC) as carbon nanomaterials because of their high specific surface area, good conductivity, electrochemical stability and favourable interaction with conjugated carbonyl compounds. This strategy opens up new possibilities to realize cost-effective, sustainable and versatile energy storage devices.

Solution Processable Holey Graphene Oxide and Its Derived Macrostructures for High-Performance Supercapacitors.

Scalable preparation of solution processable graphene and its bulk materials with high specific surface areas and designed porosities is essential for many practical applications. Herein, we report a scalable approach to produce aqueous dispersions of holey graphene oxide with abundant in-plane nanopores via a convenient mild defect-etching reaction and demonstrate that the holey graphene oxide can function as a versatile building block for the assembly of macrostructures including holey graphene hydrogels with a three-dimensional hierarchical porosity and holey graphene papers with a compact but porous layered structure. These holey graphene macrostructures exhibit significantly improved specific surface area and ion diffusion rate compared to the nonholey counterparts and can be directly used as binder-free supercapacitor electrodes with ultrahigh specific capacitances of 283 F/g and 234 F/cm(3), excellent rate capabilities, and superior cycling stabilities. Our study defines a scalable pathway to solution processable holey graphene materials and will greatly impact the applications of graphene in diverse technological areas.

Seasonal abundance of soil arthropods in relation to meteorological and edaphic factors in the agroecosystems of Faisalabad, Punjab, Pakistan.

Soil arthropods are an important component of agroecosystems, contributing significantly to their biodiversity and functioning. However, seasonal patterns, population dynamics, and significant roles of these soil arthropods in improvement of soil structures and functions are influenced by many factors. The objective of the current study was to investigate soil arthropod abundance in relation to a blend of meteorological and edaphic factors and to find out the difference in abundance among various crops (sugarcane, cotton, wheat, alfalfa fodder, and citrus orchards). The arthropod sampling was done by pitfall traps and Tullgren extractions on fortnightly intervals. Soil temperature and relative humidity were noted on the field sites while analysis for soil pH, organic matter, and soil moisture contents were done in the laboratory. The rainfall data was obtained from an observatory. Results showed that significant differences were found in soil arthropod abundance across different sampling months and crops. Out of total 13,673 soil arthropods sampled, 38 % belonged to Collembola, followed by 15 % Hymenoptera, 15 % Acarina, 11 % Myriapods, 6 % Coleoptera, 5 % Orthoptera, and 5 % Araneae. Mean abundance per sample was highest in summer months as compared to winter. Overall abundance per sample was significantly different between all crops (p < 0.05). Cluster analysis revealed four categories of soil arthropods according to abundance, i.e., highly abundant (Collembola, Acarina, Myripoda, Hymenoptera), moderately abundant (Orthoptera, Aranae, Coleoptera), least abundant (Dermaptera, Hemiptera, Diptera), and rare (Blattaria, Isoptera, Diplura, Lepidoptera). Soil temperature and soil organic matter showed significant positive correlation with abundance, while relative humidity was significantly negatively correlated. Soil moisture and soil pH showed no significant correlations while no correlation was found with total rainfall. PCA analysis revealed that soil surface arthropods were the major contributors of variation in overall abundance in extreme temperature months while microarthropods in low-temperature months. CCA analysis revealed the occurrence of different arthropod groups in correspondence with different abiotic variables. Results are discussed in view of position of these arthropods as useful indicators under changing environmental conditions impacting agroecosystems in the study area.

Unveiling the silent threat of new onset atrial fibrillation in covid-19 hospitalized patients: A retrospective cohort study.

BACKGROUND: COVID-19, a highly infectious respiratory disease, has been associated with a range of cardiovascular complications. One of the most commonly reported cardiovascular issues in COVID-19 patients is the development of arrhythmias. Among all types of arrhythmias, atrial fibrillation is the most frequently observed. Atrial fibrillation is characterized by an irregular and often rapid heartbeat, and it can be a serious and potentially life-threatening condition. OBJECTIVE: To investigate the incidence and association of new onset atrial fibrillation in COVID-19 hospitalized patients and its impact on survival. METHOD: A retrospective cross-sectional study that encompassed all patients, both positive and negative for COVID-19, who were consecutively admitted to the Aga Khan University Hospital in Karachi, a tertiary care facility, from June 2021 to December 2021. RESULTS: A total of 1,313 patients who met the inclusion criteria of our study were enrolled as participants. These patients were then stratified into two groups based on COVID-19 status: the study group (COVID-19 positive) comprised 626 (47.7%) patients and the control group (COVID-19 negative) consisted of 687 (52.3%) patients. The incidence of new-onset atrial fibrillation was 85 (13.6%) in COVID-19 positive compared to 43 (5.2%) in COVID-19 negative group. The study found a strong association between COVID-19 and new-onset atrial fibrillation in both univariate (unadjusted odd ratio 2.35 [95% CI, 1.60-3.45], p-value < 0.01) and a multiple-adjusted regression analysis (adjusted odd ratio 3.86 [95% CI, 2.31-6.44], p-value < 0.01). CONCLUSION: These findings highlight the importance of vigilant monitoring of cardiovascular complications in COVID-19 patients, especially those with pre-existing conditions that predispose them to the development of atrial fibrillation. The study underscores the need for prompt recognition and management of new onset atrial fibrillation in COVID-19 patients, as this may mitigate the risk of adverse outcomes and improve overall prognosis.

Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan.

Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.

Diagnostic Accuracy of Intraoperative Brain Smear: A Meta-Analysis of Studies from Resource-Limited Settings.

BACKGROUND: Intraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on limited number of samples, but its diagnostic accuracy especially in low-resource settings, where its practice would be extremely helpful, is still undetermined. To investigate the diagnostic accuracy of intraoperative brain smear in resource-limited settings for diagnosis of brain tumors. METHODS: A systematic search was conducted on PubMed, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase for all articles utilizing intraoperative brain smears that were extracted. Studies from low- and middle-income countries (LMICs) with test performance characteristics were selected and subsequent values were summarized using a hierarchical summary receiver operating characteristic (ROC) curve via STATA and pooled using a random-effects model on MetaDiSc 2.0. RESULTS: Twelve studies consisting of 1124 patients were identified. Six studies included both adult and pediatric population groups, while 4 investigated adults and 2 included pediatric patients. The pooled diagnostic odds ratio (OR) was calculated to be 212.52 (CI: [104.27-433.13]) of Bivariable pooled specificity and sensitivity were 92% (CI: [86%-96%]) and 96% (CI: [93%-98%]), respectively. CONCLUSIONS: Our study shows that intraoperative brain smear is not only an accurate and sensitive diagnostic modality in resource-rich settings, but it is also equally useful in resource-limited settings, making it an ideal method for rapid diagnosis.

Brain Drain: A Cross-Sectional Study Evaluating Migration Intentions of Neurosurgery Trainees in Pakistan.

Background Pakistan has a significant proportion of medical graduates who intend to leave the country for better opportunities abroad, leading to a brain drain. However, the push and pull factors within neurosurgery remain unexplored, emphasizing the need for evaluation to enact policy changes. Materials and Methods We conducted a nationwide survey across 22 College of Physicians and Surgeons of Pakistan accredited neurosurgery training centers in all provinces of Pakistan. SPSS version 26 and STATA 15 were used for data analysis. Results We collected responses from 120 neurosurgery trainees across Pakistan. Trainees were categorized into two groups: those intending to leave (64%) and those intending to stay (36%) in Pakistan. A significant association was observed between the availability of fellowship training in the residents' hospital and the decision to leave or remain in Pakistan ( p = 0.034). About 67.5% of our respondents did not have any publication, and among the intention to leave group, a greater percentage had academic involvement, when compared with the stay group. A significant association ( p = 0.012) was also observed between the decision to leave or remain in Pakistan and the number of publications in nonindexed journals. Conclusion There remains a need for improvement in the standard of training provided by neurosurgery programs across the country. Our study found that disparities in research and academic exposure, as well as the lack of fellowship opportunities, may serve as stimuli for residents to leave Pakistan.

Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings.

Background: Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan. Methods: A nationwide survey was conducted, covering 22 CPSP-accredited neurosurgery training programs in Pakistan. Convenience sampling was utilized with a pilot tested questionnaire and responses were analyzed using STATA 15. Results: The response rate was 98% (120/122) with 70.8% male and mean age of 30.4 ± 4.1 years. Training programs included teaching courses (79%) and journal club (66%); however, there was a lack of cadaver workshops (14%) and cranial model-based stimulation (22%). 67% of trainees lacked publications in indexed journals. 69% worked 50-100 h weekly, with 62% experiencing burnout due to workload and hours and a third reporting poor work-life balance. Trainees dedicated more to operating rooms (37%, 10-24 h/week) and clinics (34%, 24-48 h/week) compared to study (42%, <5 h/week) and research (64%, <5 h/week). Gender equality was rated poorly by 50%. Disparities emerged in subspecialty exposure, with over half of trainees lacking exposure to deep brain stimulation (67%), and epilepsy (75%). 52.5% of the training institutes did not offer fellowships and 64.1% of trainees planned to pursue fellowships abroad. Conclusions: Steps need to be taken to improve working hours, gender equity, and increase simulation courses, diversify subspecialty exposure, and promote research initiatives.

Gender Differences in Medical Students' Perception of Neurosurgery: A Cross-Sectional Study from Pakistan.

BACKGROUND: Despite 15,000 annual medical graduates, few choose neurosurgery, especially women. The scarcity of female neurosurgeons is a global concern, particularly in resource-limited settings such as Pakistan. This study focuses on gender-based differences in medical student perceptions of neurosurgery in Pakistan. METHODS: A nationwide cross-sectional study was conducted from March 6 to April 20, 2023, using a Web-based survey. Data collectors were recruited through an ambassadorship program, distributed evenly across all provinces. A questionnaire was used after a pilot study. Data analysis was performed using SPSS version 26 and STATA 15. RESULTS: A total of 2353 medical students participated in the study, of which 63.4% were female and 36.5% were male. Around 40.3% of women strongly agreed to the existence of potential gender bias in neurosurgery, in contrast to their corresponding male students, at 17.3%. Some of the highlighted deterring factors in pursuing neurosurgery as a career according to women include longer training duration (44.6%), poor work-life balance (41%), limited residency slots (50.6%), and limited exposure to neurosurgery (45.1%). Other factors included the high-intensity nature of training (33.6%), perceived gender bias (31.4%), competitive work environment (29.1%), complex surgical skills (38.6%), required level of medical knowledge (29.6%), and financial burden (33.9%). CONCLUSIONS: Our study shows that female students are more likely to believe in the existence of potential gender bias in the field compared with their counterpart male participants, which highlights the graveness of the situation in view of the evident paucity of female neurosurgeons in the country.

Delay in the Diagnosis of Pediatric Brain Tumors in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Vague symptoms and a lack of pathognomonic features hinder the timely diagnosis of pediatric brain tumors (PBTs). However, patients in low- and middle-income countries (LMICs) must also bear the brunt of a multitude of additional factors contributing to diagnostic delays and subsequently affecting survival. Therefore, this study aims to assess these factors and quantify the durations associated with diagnostic delays for PBTs in LMICs. METHODS: A systematic review of extant literature regarding children from LMICs diagnosed with brain tumors was conducted. Articles published before June 2023 were identified using PubMed, Google Scholar, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. A meta-analysis was conducted using a random-effects model through R Statistical Software. Quality was assessed using the Newcastle Ottawa Scale. RESULTS: A total of 40 studies including 2483 patients with PBT from 21 LMICs were identified. Overall, nonspecific symptoms (62.5%) and socioeconomic status (45.0%) were the most frequently reported factors contributing to diagnostic delays. Potential sources of patient-associated delay included lack of parental awareness (45.0%) and financial constraints (42.5%). Factors contributing to health care system delays included misdiagnoses (42.5%) and improper referrals (32.5%). A pooled mean prediagnostic symptomatic interval was calculated to be 230.77 days (127.58-333.96), the patient-associated delay was 146.02 days (16.47-275.57), and the health care system delay was 225.05 days (-64.79 to 514.89). CONCLUSION: A multitude of factors contribute to diagnostic delays in LMICs. The disproportionate effect of these factors is demonstrated by the long interval between symptom onset and the definitive diagnosis of PBTs in LMICs, when compared with high-income countries. While evidence-based policy recommendations may improve the pace of diagnosis, policy makers will need to be cognizant of the unique challenges patients and health care systems face in LMICs.

Applications, limitations and advancements of ultra-low-field magnetic resonance imaging: A scoping review.

Background: Ultra-low-field magnetic resonance imaging (ULF-MRI) has emerged as an alternative with several portable clinical applications. This review aims to comprehensively explore its applications, potential limitations, technological advancements, and expert recommendations. Methods: A review of the literature was conducted across medical databases to identify relevant studies. Articles on clinical usage of ULF-MRI were included, and data regarding applications, limitations, and advancements were extracted. A total of 25 articles were included for qualitative analysis. Results: The review reveals ULF-MRI efficacy in intensive care settings and intraoperatively. Technological strides are evident through innovative reconstruction techniques and integration with machine learning approaches. Additional advantages include features such as portability, cost-effectiveness, reduced power requirements, and improved patient comfort. However, alongside these strengths, certain limitations of ULF-MRI were identified, including low signal-to-noise ratio, limited resolution and length of scanning sequences, as well as variety and absence of regulatory-approved contrast-enhanced imaging. Recommendations from experts emphasize optimizing imaging quality, including addressing signal-to-noise ratio (SNR) and resolution, decreasing the length of scan time, and expanding point-of-care magnetic resonance imaging availability. Conclusion: This review summarizes the potential of ULF-MRI. The technology's adaptability in intensive care unit settings and its diverse clinical and surgical applications, while accounting for SNR and resolution limitations, highlight its significance, especially in resource-limited settings. Technological advancements, alongside expert recommendations, pave the way for refining and expanding ULF-MRI's utility. However, adequate training is crucial for widespread utilization.

Temporal Delays in the Management of Traumatic Brain Injury: A Comparative Meta-Analysis of Global Literature.

OBJECTIVE: A meta-analysis was conducted to compare: 1) time from traumatic brain injury (TBI) to the hospital, and 2) time within the hospital to intervention or surgery, by country-level income, World Health Organization region, and healthcare payment system. METHODS: A comprehensive literature search was conducted and followed by a meta-analysis comparing duration of delays (prehospital and intrahospital) in TBI management. Means and standard deviations were pooled using a random effects model and subgroup analysis was performed using R software. RESULTS: Our analysis comprised 95,554 TBI patients from 45 countries. BY COUNTRY-LEVEL INCOME: From 23 low- and middle-income countries, a longer mean time from injury to surgery (862.53 minutes, confidence interval [CI]: 107.42-1617.63), prehospital (217.46 minutes, CI: -27.34-462.25), and intrahospital (166.36 minutes, 95% CI: 96.12-236.60) durations were found compared to 22 high-income countries. BY WHO REGION: African Region had the greatest total (1062.3 minutes, CI: -1072.23-3196.62), prehospital (256.57 minutes [CI: -202.36-715.51]), and intrahospital durations (593.22 minutes, CI: -3546.45-4732.89). BY HEALTHCARE PAYMENT SYSTEM: Multiple-Payer Health Systems had a greater prehospital duration (132.62 minutes, CI: 54.55-210.68) but greater intrahospital delays were found in Single-Payer Health Systems (309.37 minutes, CI: -21.95-640.69). CONCLUSION: Our study concludes that TBI patients in low- and middle-income countries within African Region countries face prolonged delays in both prehospital and intrahospital management compared to high-income countries. Additionally, patients within Single-Payer Health System experienced prolonged intrahospital delays. An urgent need to address global disparities in neurotrauma care has been highlighted.

A study of the immunomodulatory effects of coconut oil extract in broilers experimentally infected with velogenic Newcastle disease virus.

Objective: This study aims to evaluate the immunomodulatory effects of coconut oil extract (COE) in broilers experimentally infected with velogenic Newcastle disease virus (vNDV). Methods: A total of 150 broiler birds (day-old) were equally divided into five study groups i.e., negative control, positive control, COE-1, COE-2, and COE-3. On day 10, broilers of groups COE-1, COE-2, and COE-3 were supplemented with 1, 2, and 3 ml of COE respectively per liter of drinking water for 15 days. On day 13, 0.1ml/bird (10-5.25 ELD50) of vNDV was inoculated in broilers of positive control, COE-1, COE-2, and COE-3 groups intramuscularly. During this study, growth performance, morbidity, and mortality rates of each study group were recorded. The antibody titer against NDV was determined on days 7, 14, 21, 28, and 35. The levels of IgY and IgM were also determined on the 7th, 14th, and 21st days post-SRBC inoculation. On day 33, avian tuberculin was injected between the 1st and 2nd toes of the left side (intradermally) to measure lymphoproliferative responses. On day 35, the phagocytic activity in the blood was assessed through a carbon clearance assay by injecting carbon black ink into the right-wing vein. The visceral organs having gross lesions were also collected for histopathology. Results: The COE significantly improved the growth performance, and lowered the morbidity and mortality rates of broilers. There was a significant rise in antibody titers against NDV and levels of IgY and IgM antibodies against SRBC in COE-supplemented broilers. The lymphoproliferative response and phagocytic activity were also enhanced. Among COE-supplemented groups, the broilers of the COE-3 group showed a significant increase in growth performance and boosted immune defense. Conclusions: Coconut oil extract has the potential to boost the growth performance and immune status of broilers. It can be used effectively as a feed additive and alternative to antibiotics to prevent the spread of infectious poultry pathogens.