Estimation of Effective Dose and Incidence Cancer During Computed Radiography

الهدف من إجراء هذه الدراسة هو تقييم الجرعة الإشعاعية لعينه من المرضي في عدد من المستشفيات(أنطاليا, يستبشرون, دار العلاج, رويال كير) في ولاية الخرطوم. أختبر عدد 360 مريض في أربعه مستشفيات مختلفة. جمعت البيانات باستخدام أوراق جمع البيانات المجدولة لكل المرضي وذلك للحفاظ علي بيانات كل مريض على حدى، ومن ثم حللت باستخدام برنامج الحزم الاحصائية و برنامج الاكسيل. أوضحت النتائج التي تم الحصول عليها أن النظام التقني الرقمي يتم استخدامه لتحسين استخدام الاشعاع ولكن مازالت هنالك مخاطر عالية. خلال فتره إجراء هذه الدراسة وجد أن هنالك محاسن لنظام التصوير الرقمي منها، أن له مدي ديناميكي عالي، و بعد عملي، و له خيارات متعددة للعرض، و كذلك له نقل الكتروني، و لدية مقدرة للأرشفة. ولكن يمكن أن يحدث زيادة في الجرعة دون أن يحدث ضرر علي نوعية الصورة. أوضحت الدراسة أن هنالك فروقات بين المستشفيات التي أجريت فيها هذه الدراسة. خلصت الدراسة الي أن الجرعات للمرضي يجب أن تنظم وتراقب وتقترح الدراسة أنشاء نظام حدود ومرجعيات الجرعات التشخيصية الوطني (DRLs) وأن يتبع كموجه للتقليل من الجرعات. و توصي الدراسة بالتشخيص عن طريق استخدام أجهزه التصوير الإشعاعي المحوسب لأن الجرعة الإشعاعية الناتجة منه أقل من أنظمه التصوير التقليدية ويمكِنُنا من التعديل في الصورة بجودة أكبر

The Determinant of Subjective Well-Being among the adult individuals in the UAE

Background: Enhancing individual wellbeing is a national priority in the United Arab Emirates. Up to date, wellbeing at the country level was measured through the national wellbeing survey that is sector specific comprising of 122 questions. The “World Health Organization 5 items (WHO-5) Well-being Index” is a reliable instrument to assess Subjective Well-Being, yet was never tested at national level in the UAE. Aim: This study examined the association of socio-economic determinants of health with the subjective well-being (SWB) using WHO-5 Well-being Index to inform public health policy in the UAE. Method: A cross-sectional survey from adults (aged 18+ and above) was conducted. About 10,000 individuals were randomly selected across all the seven Emirates. A total of 7367 adults (18 years and above) took part in the survey (response rate was 74%). The WHO-5 instrument is a valid screening measure as it includes only 5 items, is freely available in at least thirty-one languages, and is tremendously easy to complete, interpret and score. The social support of the respondents was evaluated by using the Multidimensional Scale of Perceived Social Support. Results: The results of the study demonstrate that majority of the participants (79.27%) reported moderate - high (≥50) well-being scores showing the good quality of life/well-being, whereas, only 20.72% of the individual reported ill-being/likely depression in the future. Respondent’s age, gender, marital status, monthly income (AED- UAE dirham), employment status and reporting at least one or more morbidity were found to be significantly associated with the SWB variables (p < 0.05). A significant association was found between the comprehensive/emotional and /mental well-being and perceived social support. Conclusion: The WHO-5 index can be used as a reliable screening tool to identify wellbeing inequalities among adult individuals based on socio-economic determinants of health in the UAE. Addressing the socio- Hira Abdul Razzak1, Dr. Alya Harbi2, Ms. Mubarkah Jaber AlKarbi3, Dr. Amin Mohamed ElShamy4 , Dr. Lubna Al Shaali5, Dr. Rasha E Salama6 , Ms. Malaz Bakri7, Dr. Ahmed Alosi8, Ms. Amna AlDhmanie9 1678 © 2021 JPPW. All rights reserved economic determinants of health in the UAE can enhance subjective well-being (SWB) and help the UAE to achieve its strategic aspiration to make the UAE among the world leaders in quality of life

Validation of the Arabic Version of General Medication Adherence Scale (GMAS) in Sudanese Patients with Diabetes Mellitus

Objective: The aim of this study was to validate the Arabic version of General Medication Adherence Scale (GMAS) in Sudanese patients with type 2 diabetes mellitus (T2DM). Methods: A 3-month cross-sectional study was conducted among patients with T2DM at Al- Daraja Health Center, located in Wad Medani, Sudan. A convenient sample of patients was selected, and the study sample size was calculated using the item response ratio. Factorial, known group, and construct validities were determined. Internal consistency and reliability were also determined. Results: Responses were provided by 500 patients. The average medication adherence score was 30 (median 31). The normed fit index (NFI) was 0.950, the comparative fit index (CFI) was 0.963, the incremental fit index (IFI) was 0.963, and the root-mean-square error of approximation (RMSEA) was 0.071. The results from these fit indices indicated a good model. Factorial, known group and construct validities were all established. A significant association was found between adherence score and age (P = 0.03) since a larger proportion of older patients were found to have high adherence compared to patients in other age groups. The reliability (α) of the questionnaire was 0.834. Conclusion: The Arabic version of GMAS was validated in Sudanese patients with T2DM making it a suitable scale to be used in this population

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Chilaiditi syndrome in COPD patient: A case report

Chilaiditi syndrome is defined as the interposition of the colon between the liver and the diaphragm or abdominal wall and is known as Chilaiditi's sign on X-rays. Although rare, this procedure can lead to serious complications. Due to its infrequency and propensity for severe complications, diagnosing and differentiating this syndrome from other acute abdominal emergencies are very important for preventing unnecessary treatment or surgical procedures. We present a 72-year-old male with a history of chronic obstructive pulmonary disease (COPD) who presented to the emergency department with persistent shortness of breath, abdominal discomfort, and vomiting. Physical examination revealed chest crepitation, tenderness in the left iliac fossa, and high blood pressure. Laboratory tests revealed a positive COVID-19 status, elevated C-reactive protein level, and respiratory alkalosis. Imaging, including a chest X-ray and CT scan, confirmed the presence of bowel loops under the diaphragm, confirming the diagnosis of Chilaiditi syndrome. Collaborative management by surgical and medical teams was essential in navigating this complex condition. This case highlights the complexity of chilaiditi syndrome, which can be episodic and intermittent, in addition to the importance of recognizing Chilaiditi's sign on imaging, particularly on CT scans, to differentiate it from pneumoperitoneum. Vigilance is crucial in identifying potential complications and guiding appropriate treatment to prevent adverse outcomes

Physician experiences with teleconsultations amidst conflict in Sudan

Abstract The current conflict in Sudan severely hinders the accessibility of health services across the country. To address this, several initiatives were proposed including offering services using teleconsultations. This study aimed to assess Sudanese doctors' teleconsultation experience, perception, and concerns during the recent conflict. This cross-sectional survey focused on Sudanese medical officers, residents, specialists, and consultants living inside or outside the country having a practice license from the Sudan Medical Council and conducting teleconsultations with Sudanese patients during the conflict period. The questionnaire was distributed to personal and professional contacts and via social media platforms in the English language among doctors who provided teleconsultation during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26. The study enrolled 2463 clinicians from 17 different specialties, and females represented more than half the sample (56.8%). Internal medicine was the most frequent specialty (36.1%) and the majority (68.7%) of clinicians had less than 5 years of work experience. Voice call was the most frequent platform (50.1%) used for teleconsultation during the conflict and had the highest convenience score (p < 0.01), whereas messaging platforms had the lowest score. Most clinicians (73.3%) agreed that teleconsultations created a trusted patient-physician relationship and provided good-quality care (61.8%). However, 85.1% highlighted the importance of physical touch in medical practice. Clinicians were concerned that incomplete information (81.4%), missed diagnosis (76.8%), medicolegal problems (71.0%), and prescription errors (68.4%) could arise with teleconsultations. Most respondents (70.7%) emphasized the importance of continuing to offer teleconsultation even after the war abated. In conclusion, physicians who participated in the current study agreed that teleconsultation provided quality care even in this dire crisis in Sudan. Based on our study findings, we recommend upscaling telemedicine interventions including teleconsultations at the national level. This would require unified coordination efforts of a wide mix of stakeholders to address concerns identified in the current study

Efficacy and Clinical Outcomes of mRNA COVID-19 Vaccine in Pregnancy: A Systematic Review and Meta-Analysis

BACKGROUND: The world has witnessed one of the largest pandemics, dubbed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of December 2020, the USA alone reported 98,948 cases of coronavirus disease 2019 (COVID-19) infection during pregnancy, with 109 related maternal deaths. Current evidence suggests that unvaccinated pregnant women infected with SARS-CoV-2 are at a higher risk of experiencing complications related to COVID-19 compared to nonpregnant women. This review aimed to provide healthcare workers and non-healthcare workers with a comprehensive overview of the available information regarding the efficacy of vaccines in pregnant women. SUMMARY: We performed a systematic review and meta-analysis following PRISMA guidelines. The search through the database for articles published between December 2019 and October 2021 was performed. A comprehensive search was performed in PubMed, Scopus, and EMBASE databases for research publications published between December 2019 and October 2021. We focused on original research, case reports, case series, and vaccination side effect by authoritative health institutions. Phrases used for the Medical Subject Heading [MeSH] search included ("COVID-19" [MeSH]) or ("Vaccine" [MeSH]) and ("mRNA" [MeSH]) and ("Pregnant" [MeSH]). Eleven studies were selected and included, with a total of 46,264 pregnancies that were vaccinated with mRNA-containing lipid nanoparticle vaccine from Pfizer/BioNTech and Moderna during pregnancy. There were no randomized trials, and all studies were observational (prospective, retrospective, and cross-sectional). The mean maternal age was 32.2 years, and 98.7% of pregnant women received the Pfizer COVID-19 vaccination. The local and systemic adverse effects of the vaccination in pregnant women were analyzed and reported. The local adverse effects of the vaccination (at least 1 dose) such as local pain, swelling, and redness were reported in 32%, 5%, and 1%, respectively. The systemic adverse effects such as fatigue, headaches, new onset or worsening of muscle pain, chills, fever, and joint pains were also reported in 25%, 19%, 18%, 12%, 11%, and 8%, respectively. The average birthweight was 3,452 g. Among these pregnancies, 0.03% were stillbirth and 3.68% preterm (&lt;37 weeks) births. KEY MESSAGES: The systemic side effect profile after administering the COVID-19 mRNA vaccine to pregnant women was similar to that in nonpregnant women. Maternal and fetal morbidity and mortality were lowered with the administration of either one or both the doses of the mRNA COVID-19 vaccination.Scopu

Parkinsonism Relat Disord

Background: Several studies suggested a significant role of epigenetic changes, including alterations in miRNA, histone modifications, and DNA methylation of α-synuclein (SNCA) in Parkinson’s disease (PD) pathogenicity. As of yet, only very few studies have been carried out in this field in Africa and none in Sudan. Materials and methods: We collected DNA from 172 Sudanese individuals (90 cases, 82 controls) who donated saliva for DNA extraction (mean age of onset: 40.6 ± 22.4 years). A family history of PD was evident in 64 patients. DNA preparation and bisulfite sequencing of SNCAintron1 was performed as described earlier. Results: Of the fourteen analyzed CpGs of SNCAintron1, CpGs 16-23 were hypomethylated in PD (P-value ranged from 0.023 to 0.003). P–values improved, when sporadic cases were excluded from the analysis. Conclusion: We identified the presence of a specific pattern of DNA methylation in a young Sudanese cohort of familial PD, which confirms the importance of the methylation of SNCAintron1 for PD. This phenomenon appears to be independent of ethnicity, the impact of environmental factors, drug history, or familial clustering