Awareness of Final-Year Medical Students of Omdurman Islamic University on Their Career Choices

Background: Medical students undergo a complex process as a student to make a career decision and pursue further specialization. This study explores the factors that influence the career choices of the two genders studying in the final year of medicine at Omdurman Islamic University.Methods: This institution-based cross-sectional study was conducted on 194 male and female fifth-year medical students studying at Omdurman Islamic University. The questionnaire contains 15 multiple-choice questions to determine the factors affecting students’ career choices – lifestyle, income, family impact,…etc. – and the association between gender and the specialties they choose to pursue.Results: The specialties were preferred in the following order: surgery by 22.9%, internal medicine by 18.3%, obstetric gynecology by 13.8%, and pediatric by 10% (limited to the four major specialties). The least chosen specialties were histopathology, emergency medicine, psychiatry, and anesthesia (all were 0.9%). Family medicine and forensics were not chosen by any participant. Females significantly preferred dermatology, obstetrics and gynecology, otolaryngology, and pediatrics compared to their male counterparts. Whereas, males compared to females significantly preferred orthopedics and surgery. The factors influencing change in students’ specialties based on their gender were family views and family obligations. Nearly 80% of students choose a career based on personal interest; lifestyle and financial reward were also seen to play an important role in choosing a specialty. About 91% of participants agreed that there is a need for guidance. A great proportion of final-year students (62%) preferred to specialize abroad and related it to a good lifestyle and financial stability.Conclusion: This study showed that the students’ awareness about specialty choices was limited to certain specialties as seen in the literature. The most preferred specialties were surgery (22.9%), internal medicine (18.3%), obstetrics and gynecology (13.8%), and pediatric (10%). There are many factors influencing the selection of specialties, however, the most common one is personal interest followed by lifestyle issues and financial reward. Additionally, there is a significant gender difference in career-choice decisions

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Global impacts of Covid-19 on lifestyles and health and preparation preferences: an international survey of 30 countries

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Monte Carlo techniques for electron radiotherapy

In this work simulation of electron beams and electron postmastectomy radiotherapy are evaluated using Monte Carlo Techniques. To achieve this several steps were followed. The first step was to perform measurements for dose distributions on a water tank for the different energies and field sizes provided by ELEKTA SL18 Linac available at the University Hospital of Larisa. The measurements were performed for the central axis percent depth dose (pdd), and the off-axis dose profiles at the depth of maximum dose (Dmax). Choosing, installing and using a code for the simulation of the Linac follow this. EGSnrc and the accompanying BEAMnrcMP, DOSXYZnrc and BEAMDP codes were installed. The linear accelerator was simulated using the manual provided by ELEKTA Company as a guide. Percent depth dose and dose profiles were generated and compared with the measurements and fine tuning was made to match the measurements and calculations in order to verify the simulated Linac. To reach a good match on the pdd curves several trials were performed changing the energy of the beam and the energy width, or full width at half maximum. The differences for the PDD curves were more significant in the build-up region and especially at the surface. Possible contaminating neutrons, scattered electrons from the phantom, dependence on the measuring device, the choice of the effective point of measurements and other parameters could be responsible for this mismatch. The mismatch becomes much smaller as the beam energy increases. On the other hand a slight discrepancy between measurements and calculations is noticed at the fall-off region with higher energies. But, in general these differences are within the 2%-2mm range. Regarding the off-axis dose profiles there was a good match between measurements and calculations. To get to this agreement a slight change in the jaws opening had to be made. The major discrepancy between measurements and calculations was in the right shoulder, where the measurements showed slight depression for some energies and field sizes. When one shoulder is apparently depressed and varies from the other one that is in a good match with MC calculations we consider that the profile is verified. In the second part of the work, the different sources of systematic error in linear accelerator simulations were studied. This includes slight alterations in the input beam parameters, the phantom design and placement and the configuration of the Linac components. This study aims at helping future researchers assess from the discrepancy between measured and calculated Pdd and dose profiles, where the mistake in simulation could possibly be.Στην παρούσα εργασία πραγματοποιήθηκε εξομοίωση δεσμών ηλεκτρονίων και δεσμών ηλεκτρονίων σε ακτινοθεραπεία μετά από μαστεκτομή με την χρήση τεχνικών Μόντε Κάρλο (Monte Carlo). Η διαδικασία για την επίτευξη αυτού ήταν η ακόλουθη. Στο πρώτο στάδιο της διαδικασίας αυτής πραγματοποιήθηκαν μετρήσεις σε ομοίωμα νερού της κατανομής δόσης για διαφορετικές ενέργειες και μεγέθη πεδίων στον γραμμικό επιταχυντή SL18 της ELEKTA, ο οποίος βρίσκεται στο Πανεπιστημιακό Νοσοκομείο Λάρισας. Συγκεκριμένα λήφθηκαν μετρήσεις επί της εκατό δόσης βάθους στον κεντρικό άξονα της δέσμης (PDD) και προφίλ επί της εκατό δόσης εκτός του κεντρικού άξονα (OAR) σε βάθος της μέγιστης δόσης (Dmax). Ο χρησιμοποιούμενος κώδικας που εγκαταστάθηκε και χρησιμοποιήθηκε ήταν ο EGSnrc μαζί με τα προγράμματα BEAMnrcMP, DOSXYZnrc και BEAMDP. Για την εξομοίωση του γραμμικού επιταχυντή χρησιμοποιήθηκαν τα blue print της ELEKTA. Οι καμπύλες επί της εκατό δόσης και δόσης προφίλ που προέκυψαν από τις εξομοιώσεις συγκρίθηκαν με τις αντίστοιχες που λήφθηκαν στο ομοίωμα νερού. Σκοπός της σύγκρισης ήταν η διαφορά των καμπυλών να βρίσκεται εντός αποδεκτών ορίων έτσι ώστε να θεωρηθεί ότι ο γραμμικός επιταχυντής εξομοιώθηκε επιτυχώς. Προκειμένου να επιτευχθεί η καλύτερη δυνατή ταύτιση των καμπυλών PDD έγιναν αρκετές δοκιμές για την εύρεση της κατάλληλης ενέργειας της δέσμης και του κατάλληλου ενεργειακού εύρους ή πλήρους εύρους στα μισά του μέγιστου (FWHM). Οι διαφοροποιήσεις των PDD καμπυλών ήταν μεγαλύτερες στην περιοχή ανοικοδόμησης (build-up region) και ειδικότερα στην επιφάνεια. Πιθανοί λόγοι αυτού ήταν η ύπαρξη νετρονίων, σκεδαζόμενων ηλεκτρονίων από το ομοίωμα, εξάρτησης του μετρητή, επιλογή κατάλληλου σημείου μέτρησης και άλλων παραγόντων. Η διαφορές ελαττώνονται καθώς η ενέργεια της δέσμης αυξάνεται. Στην περιοχή μετά από τη μέγιστη δόση παρατηρείται για μεγάλες ενέργειες μικρή διαφορά μεταξύ μετρήσεων και εξομοίωσης. Σε γενικές γραμμές όμως οι διαφορές αυτές δεν ξεπερνούν το 2% - 2mm εύρος. Σε σχέση με τις καμπύλες OAR η σύγκριση έδειξε καλή ταύτιση μεταξύ μετρήσεων και εξομοιώσεων. Για την επίτευξη της ταύτισης αυτής έγινε μία σχετικά μικρή μεταβολή στα ανοίγματα των διαφραγμάτων πεδίου (jaws). Η μεγαλύτερη διαφορά μεταξύ μετρήσεων και εξομοιώσεων σημειώθηκε στον δεξί ώμο, όπου τα αποτελέσματα έδειξα μία ελαφριά πτώση για μερικές ενέργειες και εύρη πεδίων. Σε περίπτωση που ο ένας ώμος έχει ελαφριά πτώση σε σχέση με τον άλλο και ο άλλος βρίσκεται εντός αποδεκτών ορίων, τότε θεωρείται ότι το εξομοιωμένο προφίλ είναι σωστό. Στο δεύτερο κομμάτι της παρούσας εργασίας μελετήθηκαν οι διαφορετικές πηγές συστηματικών λαθών στην εξομοίωση γραμμικών επιταχυντών. Αυτό σήμαινε μικρές μεταβολές στις εισαγόμενες παραμέτρους της, στον σχεδιασμό του ομοιώματος και της τοποθέτησης του και της διαμόρφωσης των τμημάτων του γραμμικού. Σκοπός της παρούσας μελέτης ήταν να βοηθηθούν μελλοντικοί ερευνητές στην γνώση του που βρίσκεται το πιθανό λάθος κατά την εξομοίωση PDD και OAR

ISSN 2347-954X (Print) Survey of Patients Radiation Doses in Computed Tomography Chest Imaging: Proposal of Diagnostic Reference Level

Abstract: Advances in CT system technology have improved the diagnosis of many clinical conditions and consequence new investigation methods emerged. However, CT procedures expose the patients to high an avoidable radiation doses which may increase the individuals lifetime radiation risk of developing cancer. This study was intended to evaluate patient doses during chest CT procedures in a certain radiological hospitals in order to establish a local diagnostic reference level (DRL). A total of 78 CT chest procedures were performed during one year. The range of patient dose per CT procedure was 126.0 mGy.cm to 1104.0 mGy.cm per chest procedure. The CTDIvol ranged between 3.0 mGy to 20 mGy per procedure. Patient dose variation attributed to CT modality and image acquisition protocol. Patients exposed to a higher radiation doses in 64 slices compared to other two modalities due to the use of sequential technique at the later one. Diagnostic reference level was proposed for chest CT procedures

Assessment of occupational exposure from PET and PET/CT scanning in Saudi Arabia

Nuclear medicine diagnostic procedures such as positron emission tomography (PET) scans and hybrid imaging using a combination of PET and computed tomography (CT), commonly referred to as PET-CT scanning. Hybrid imaging, which allows accurate visualization of internal anatomical structure and the consequent physiological processes simultaneously, is extensively used in oncology and other departments. Nevertheless, this exposes patients and medical personnel in such departments to significant doses of ionizing radiation, especially in hybrid imaging, where two sources of radiation (the radiopharmaceutical infusion and the CT scanner) are used. This necessitates strict compliance with international guidelines and regulations on radiation protection. Recent reports showed that occupational staff exposure might exceed the annual dose limits. This study evaluated occupational exposure associated with diagnostic hybrid PET-CT imaging and the consequent risks. Twenty medical personnel: 5 physicists, ten technologists, two medical doctors, and three nurses are included in this study. The assessment includes measuring occupational ambient doses using calibrated optical stimulating-luminescent dosimeters (OSL)(Al2O3:C). These badges were read using an automatic OSL reader. The results, displayed as (mean ± standard deviation): (range) of the effective dose (mSv) for the different personnel, can be summarized as follows(mean standard deviation and range). Physicists 0.72 ± 0.14 (0.49–0.83) mSv in 2019 and 0.67 ± 0.07 (0.59–0.78) in 2020; technologist 1.4 ± 0.96 (0–3.27) mSv in 2019 and 1.395 ± 1.27 (0.64–4.36) mSv; medical doctors 0.445 ± 0.42 (0.15–0.74) mSv in 2019 and 0.70 ± 0.04 (0.67–0.73) in 2020; and nurses 1.38 ± 0.25 (1.21–1.66) mSv in 2019 and 1.41 ± 0.17 (1.23–1.55) in 2020. The tube voltage of the scanner used in this study had a constant value of 120 kVp for all patients. Staff working in PET or PET-CT departments receive significant doses from the radiopharmaceuticals and the energetic gamma rays from the CT scanners. Hence, optimizing the CT acquisition parameter is necessary to optimize the occupational doses and restrict them to acceptable dose limits