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BACKGROUND: Jordan has experienced several COVID-19 waves in the past 2 years. Cross-sectional studies have been conducted to evaluate distress in healthcare practitioners (HCPs), but there is limited evidence with regards to the impact of continuing pandemic waves on levels of distress in HCPs. We previously studied psychological distress in HCPs during the start of the pandemic (period 1, when cases were infrequent and the country was in lockdown), and demonstrated that HCPs were experiencing considerable stress, despite the country reporting low caseloads at the time. In this study, we sought to utilize the same methodology to reexamine levels of distress as COVID-19 peaked in the country and HCPs began managing large numbers of COVID-19 cases (period 2). METHODS: A cross-sectional online survey utilizing a tool previously used during period 1 was completed by HCPs working in various settings. Demographic, professional and psychological factors such as distress, anxiety, depression, burnout, sleep issues, exhaustion, and fear were assessed; and coping strategies also were measured. Items in the tool were assessed for reliability and validity. A multivariable regression was used to identify factors that continued to impact distress during period 2. RESULTS: Samples in both periods (n = 937, n = 876, respectively) were relatively comparable in demographic characteristics, but in period 2, a greater proportion of nurses and healthcare practitioners reported working in general hospitals. During the pandemic peak (period 2), 49.0% of HCPs reported high levels of distress (compared to 32% in period 1); anxiety and depression scores were approximately 21% higher in period 2; and 50.6% reported fatigue (compared to 34.3% in period 1). Variables significantly associated with greater distress in period 2 included experiencing burnout, experiencing sleep disturbances, being fatigued, having fatalistic fears, and having fears related to workload. Conversely, being male, reporting satisfaction at work, and using positive coping practices were associated with a significantly lower odds of being in distress. CONCLUSIONS: Between the two periods (early pandemic and first wave), COVID-19-related mental health continued to deteriorate among HCPs, highlighting the need to do more to support HCP front-liners facing COVID-19 surges.
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Esgotamento Profissional , COVID-19 , Angústia Psicológica , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Depressão/epidemiologia , Pessoal de Saúde/psicologia , Humanos , Jordânia/epidemiologia , Masculino , Reprodutibilidade dos TestesRESUMO
AIM: Diabetic kidney disease (DKD) is a major long-term complication of diabetes mellitus (DM). Given the paucity of data on DKD in Jordan, we aimed to evaluate the prevalence, characteristics and correlates of DKD in Jordanian patients with type 2 DM. METHODS: This cross-sectional study included 1398 adult patients with type 2 DM who sought medical advice in the endocrinology clinic between March and September 2019. Demographic, clinical and laboratory data were reviewed. DKD was defined as reduced eGFR, and/or albuminuria. Three regression models were constructed to identify factors associated with CKD stages, albuminuria and DKD. RESULTS: Overall, 701 (50.14%) patients had DKD, with a median age of 59.71 ± 11.36 years. Older age, high triglycerides, and low high-density lipoprotein were associated with DKD (multivariable odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.03, p < 0.01; OR: 1.1, 95% CI: 1.01-1.2; and OR: 0.98, 95% CI: 0.97-0.99, p < 0.01 respectively). Metformin and renin-angiotensin system blockers were negatively associated with albuminuria and chronic kidney disease stages (p < 0.01). CONCLUSION: Our study demonstrated that approximately one half of patients with type 2 DM had DKD. Further studies are necessary to understand this high prevalence and the underlying factors. Future research are needed to assess implementing targeted community-based intervention.
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Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/epidemiologia , Fatores Etários , Albuminúria , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/complicações , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/diagnóstico , Dislipidemias/complicações , Feminino , Taxa de Filtração Glomerular , Humanos , Hipoglicemiantes/uso terapêutico , Jordânia/epidemiologia , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Sistema Renina-Angiotensina/efeitos dos fármacos , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: There is conflicting evidence regarding the impact of the Coronavirus 2019 (COVID-19) pandemic on antimicrobial resistance, with few studies conducted in low- and middle-income countries. We investigated the impact of the COVID-19 pandemic on multidrug resistant organisms (MDROs) among critically ill patients and their clinical outcomes. METHODS: This was a retrospective observational study of patients admitted to the medical Intensive Care Unit at Jordan University Hospital and had blood, urine, or bronchoalveolar bacterial cultures taken during 2 time periods: prepandemic (ie, 1/2016 to 1/2019) and pandemic (ie, 1/2020 to 1/2023). We compared the clinical outcomes (ie, in-hospital deaths, the need for O2 devices, intubation, the length of hospital stay, and the occurrence of complications) and prevalence of MDROs between the 2 periods and conducted multivariate analyses. RESULTS: There were 1,254 patients (479 prepandemic and 775 postpandemic. The percentage of patients who had MDROs was significantly higher among patients with a culture taken during the pandemic (82.4%) compared to before it (17.6%) (P-value=.000). Multivariate analysis demonstrated that patients cultured during the pandemic were more than 3 times as likely to have an MDRO (odds ratio = 3.210; 95% confidence interval: 2.236-4.609). CONCLUSIONS: The increase in MDROs during the COVID-19 pandemic is an alarming threat to public health; thus, investigating the antibiotic resistance situation as the pandemic subsides is crucial.
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BACKGROUND: Only a small number of the investigations that were carried out in the Middle East attempted to characterize patients with NCFB. In order to characterize patients with NCFB, as well as their etiologies, microbiological profiles, and outcomes, we therefore carried out this investigation. METHODS: This retrospective cohort study was carried out at the Jordan University Hospital (JUH), a tertiary facility located in Amman, Jordan. Non-cystic Fibrosis Bronchiectasis (NCFB) was defined as an HRCT scan typical for bronchiectasis along with a negative sweat chloride test to rule out cystic fibrosis. Patients' data were collected by the use of Electronic Medical Records (EMR) at our institution. Frequent exacerbation was defined as more than 2 exacerbations in 1 year of the onset of the diagnosis. RESULTS: A total of 79 patients were included, and 54.4% of them were female. The mean and standard deviation of the patient's age was 48.61 ± 19.62. The etiologies of bronchiectasis were evident in 79.7% of the sample. Asthma, Chronic Obstructive Pulmonary Diseases (COPD), and Kartagener syndrome were the most prevalent etiologies, accounting for related illnesses in 21.8%, 21.5%, and 13.9% of the patients, respectively. The most frequent bacteria cultured in our cohort were Pseudomonas and Candida Species. Moreover, 43 patients of the study cohort were frequent exacerbators, and 5 patients died. CONCLUSION: Our study supports the need to identify several bronchiectasis phenotypes linked to various causes. These findings provide information to clinicians for the early detection and treatment of bronchiectasis in Jordan.
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Bronquiectasia , Fibrose Cística , Doença Pulmonar Obstrutiva Crônica , Humanos , Feminino , Masculino , Estudos Retrospectivos , Jordânia/epidemiologia , Bronquiectasia/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/complicações , Fibrose Cística/diagnóstico por imagem , Fibrose Cística/complicações , FibroseRESUMO
Objective: Breakthrough COVID-19 infections are common following immunisation with various types of vaccines. The patterns of infections have not been well established. We aimed to analyse the signs and symptoms of post vaccination infections in addition to the need for hospital admission, ER visit and supplemental oxygen in relation to age and gender. Methods: A cross-sectional cohort study was conducted in JUH from March 2021 to August 2022, we interviewed 1479 individuals who are >15 years of age and got a breakthrough infection. The statistical analysis was performed using STATA statistical software. Results: Out of the 1479 cases, 50.2 % and 69.4 % were females and less than 45 years of age respectively. Symptoms of cough, fever and headache were reported by nearly 50 % of the patients, while one-third complained of dyspnoea. We found that participants older than 45 years had worse clinical outcomes (P-value < 0.001). 13 deaths were identified in this study due to breakthrough infection, 92.3 % of them were older than 45 years (P-value < 0.001). Participants ≥45 years who experienced a breakthrough infection of COVID-19 were 0.7 times less likely to be females using adjusted logistic regression. Conclusion: This study indicates that despite more severe symptoms reported in younger patients, the major clinical outcomes were worse among older patients, which makes age a major risk for poor outcomes regardless of symptoms. Thus, older people should be evaluated carefully when presenting with mild symptoms of COVID-19 breakthrough infection. The study also confirms that there is no difference in the incidence of COVID-19 breakthrough infections between males and females. Prospective studies are needed to risk stratify COVID-19 breakthrough infections, which should take into account variants of the virus and comorbidities.
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Mucormycosis is an opportunistic fungal infection that usually affects patients with diabetes mellitus or immunosuppression. The fungus invades the nearby blood vessels leading to thrombosis and necrosis of the organs involved. Although Mucorales can invade any organ in the body, the gastrointestinal system is an uncommon site for infection. Mucormycosis is a fatal infection, and prompt intervention is required to ensure survival. In this report, we present a case of a 46-year-old man with history of valve replacement surgery on warfarin, who admitted with abdominal pain and life-threatening gastrointestinal bleeding. Esophagogastroduodenoscopy revealed an active gastric ulcer bleeding, and the diagnosis of mucormycosis infection was confirmed with direct microscopy and histopathological evaluation from a tissue biopsy. Typically, antifungal therapy alone is inadequate to control mucormycosis infection and surgical intervention is often required. Our patient was successfully treated using antifungal therapy alone. This report presents a rare case of gastrointestinal mucormycosis in setting of valve replacement and was successfully treated with antifungal therapy.
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BACKGROUND: Before the COVID-19 pandemic, respiratory pathogens such as influenza, parainfluenza, and respiratory syncytial virus were the most commonly detected viruses among hospitalized patients with respiratory tract infections. METHODS: This was a retrospective observational study of inpatients and outpatients who attended Jordan University Hospital and underwent Nasopharyngeal Aspiration (NPA) in the periods from December 2017 to December 2018 and from December 2021 to December 2022. The results of multiplex respiratory pathogen real-time PCR tests for nasopharyngeal swab specimens were extracted from the electronic-based molecular diagnostic laboratory record of JUH. We compared the prevalence of the detected viruses as well as the patients' characteristics and outcomes between the two periods. RESULTS: The total number of included patients was 695. Our analysis showed that a higher percentage of patients with hypertension and diabetes presented before the pandemic compared to the same period after it (p-value < 0.001). The need for O2 devices, white blood cell counts, diastolic blood pressure, and the length of hospital stay were significantly higher among patients who presented before the pandemic (p-value < 0.050). Influenza H1N1 (8.70% vs. 4.03%), influenza B (1.67% vs. 0.25%), parainfluenza (1.00% vs. 0.00%), human metapneumovirus (5.35% vs. 0.76%), adenoviruses (6.35% vs. 3.02%), and coronaviruses (8.70% vs. 3.53%) were detected with higher frequency in the period before the pandemic (p-value = 0.011, 0.045, 0.045, 0.000, 0.035, 0.004). These results were similar in terms of changes in the detection rates of viruses after matching the number of tested patients between the periods before and after the pandemic. CONCLUSIONS: We have demonstrated a reduction in the detection of several viruses, which might be due to the increase in public awareness toward infection protection measures after the COVID-19 pandemic.
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COVID-19 , Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Infecções por Paramyxoviridae , Infecções Respiratórias , Vírus , Humanos , Influenza Humana/epidemiologia , Pandemias , COVID-19/epidemiologia , Vírus/genética , Infecções por Paramyxoviridae/epidemiologiaRESUMO
Bronchiectasis is a chronic lung disease characterized by recurrent respiratory symptoms. Several studies demonstrated that psychological comorbidities are common in patients with bronchiectasis. The aim of this study is to investigate the prevalence of anxiety and depression in bronchiectasis patients and assess their association with disease severity. In this cross-sectional study, we included patients diagnosed with bronchiectasis. The study was conducted using an interviewer-administered questionnaire via phone calls and data collected from the electronic medical records at JUH. The questionnaire included patients' demographics and disease characteristics. Anxiety and depression were assessed using GAD7 and PHQ9 respectively. Bronchiectasis disease severity was assessed using BSI and FACED score. The total number of included patients was 133. Moreover, 53.4% of the participants were females while the rest were males (46.6%). PHQ9 demonstrated that 65.4% of the patients had depression. Regarding anxiety, GAD7 scale showed that 54.1% of the patients had anxiety. Pearson correlation showed that bronchiectasis severity index was significantly associated only with PHQ9 depression scores (r = 0.212, P value = 0.014). The prevalence of depression and anxiety is high among patients with bronchiectasis. We believe that patients affected with bronchiectasis should be screened for depression to improve their quality of life.
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Bronquiectasia , Depressão , Masculino , Feminino , Humanos , Estudos Transversais , Depressão/psicologia , Qualidade de Vida/psicologia , Prevalência , Índice de Gravidade de Doença , Ansiedade/epidemiologia , Ansiedade/psicologia , Bronquiectasia/complicações , Bronquiectasia/epidemiologia , Bronquiectasia/diagnóstico , Gravidade do PacienteRESUMO
Post-COVID-19 condition affects patients on various aspects. This 41-year-old female presented to the outpatient clinic complaining of severe insomnia characterized by inconsistent 2 h of sleep per day despite taking sleep aid pills after being infected with COVID-19 and persisting for 6 months after recovery.
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COVID-19 is a public health crisis that has caused numerous deaths, necessitated an increased number of hospital admissions, and led to extended inpatient stays. This study aimed to identify the factors associated with COVID-19 mortality, intensive care unit admission, intubation, and length of hospital stay among Jordanian patients. This was a one-year retrospective study of 745 COVID-19 patients admitted to Jordan University Hospital. Data regarding the patients' demographics, clinical and co-morbid conditions, imaging, laboratory parameters, mortality, intensive care unit admission (ICU), and intubation were collected from their medical records using a coding manual. The data revealed that the overall rates of COVID-19-related mortality, ICU admission, and invasive intubation were 23.0%, 28.3%, and 10.8%, respectively. Chronic kidney disease (CKD), troponin, lactate dehydrogenase (LDH), and O2 saturation <90% were significantly associated with the mortality rate. The variables that were significantly associated with ICU admission were heart failure and the use of remdesivir. However, O2 saturation <90% and gastrointestinal (GI) symptoms were the only variables associated with invasive intubation. The findings of this study suggest that study-related health outcomes can be used to predict the severity of COVID-19, and they can inform future research aiming to identify specific populations who are at a higher risk of COVID-19 complications.
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The aim of this study was to assess postacute coronavirus disease 2019 (COVID-19) syndrome (PACS) symptoms according to the onset of the infection while evaluating the effect of COVID-19 vaccination on the symptoms of PACS. We conducted a retrospective single-center cohort study in which nonhospitalized COVID-19 survivors and healthy controls were compared for the occurrence of PACS. The total number of patients in this study was 472. At 6-12 and > 12 months after the infection, COVID-19 survivors had a significantly higher incidence of posttraumatic stress disorder (PTSD) and anxiety than the non-COVID-19 cohort. Furthermore, depression, cognitive deficit, tics, impaired quality of life and general health impairment were significantly more prevalent among COVID-19 survivors at < 6 months, 6-12 months and > 12 months than in the non-COVID-19 cohort. However, respiratory symptoms were significantly more prevalent among COVID-19 survivors only in the first 6 months after infection. In addition, cognitive deficit (OR = 0.15; 95% CI 0.03-0.87) and impaired quality of life (B = - 2.11; 95% CI - 4.21 to - 0.20) were significantly less prevalent among vaccinated COVID-19 survivors than among nonvaccinated survivors. Longitudinal studies are needed to establish the time that should elapse after COVID-19 infection for the symptoms of PACS to appear. Randomized clinical trials are needed to assess the possibility that COVID-19 vaccines might relieve PACS symptoms.
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COVID-19 , Transtornos de Estresse Pós-Traumáticos , COVID-19/epidemiologia , Vacinas contra COVID-19 , Estudos de Coortes , Humanos , Prevalência , Qualidade de Vida , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologiaRESUMO
BACKGROUND: Obstructive sleep apnea (OSA) is a common cause of sleep-disordered breathing with a large proportion of the patients exhibiting positional OSA (POSA). In this study, we aimed to evaluate the differences in the demographics, comorbidities, and polysomnographic features between POSA and non-POSA (NPOSA) in a Jordanian sample to further discern the propulsive elements for each group. METHODS: In this study, we evaluated 1037 adult patients with OSA. POSA was defined as an overall apnea and hypopnea index (AHI) >5, an overall AHI severity at least 1.4 times the nonsupine severity (overall/NS-AHI), and a minimum amount of time (i.e., 20 min) in the supine and nonsupine positions. To compare the clinical characteristics between POSA and NPOSA patients, statistical analyses were performed. RESULTS: The prevalence of POSA was 41.7%. In comparison to NPOSA patients, POSA patients had higher female sex prevalence, milder OSA, lower body mass index, lower hypertension prevalence, and lower hemoglobin A1C levels compared to NPOSA patients. Moreover, sleep efficiency, total sleep time, and supine sleep time were significantly higher in POSA patients. Nonsupine sleep time, total AHI, rapid eye movement (REM) AHI, non-REM (NREM) AHI, supine AHI, nonsupine AHI, left and right AHI, mean oxyhemoglobin saturation (SpO2) awake, mean REM and NREM SpO2, SpO2 nadir, and time SpO2 below 90% were significantly lower among POSA patients. The multivariate regression analysis showed that only female gender and hypertension were significantly associated with POSA. CONCLUSION: POSA is common among OSA patients and demonstrates different clinical characteristics in comparison to NPOSA. Future prospective studies are needed to better characterize the POSA patients and investigate the benefit of positional therapy.
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OBJECTIVES: To characterize psychological distress and factors associated with distress in healthcare practitioners working during a stringent lockdown in a country (Jordan) that had exhibited one of the lowest incidence rates of Covid-19 globally at the time of the survey. METHODS: A cross-sectional online survey sent to healthcare practitioners working in various hospitals and community pharmacies. Demographic, professional and psychological characteristics (distress using Kessler-6 questionnaire, anxiety, depression, burnout, sleep issues, exhaustion) were measured as were sources of fear. Descriptive and multivariable statistics were performed using level of distress as the outcome. RESULTS: We surveyed 937 practitioners (56.1% females). Approximately 68%, 14%, and 18% were nurses/technicians, physicians, and pharmacists (respectively). 32% suffered from high distress while 20% suffered from severe distress. Exhaustion, anxiety, depression, and sleep disturbances were reported (in past seven days) by approximately 34%, 34%, 19%, and 29% of subjects (respectively). Being older or male, a positive perception of communications with peers, and being satisfied at work, were significantly associated with lower distress. Conversely, suffering burnout; reporting sleep-related functional problems; exhaustion; being a pharmacist (relative to a physician); working in a cancer center; harboring fear about virus spreading; fear that the virus threatened life; fear of alienation from family/friends; and fear of workload increases, were significantly associated with higher distress. CONCLUSION: Despite low caseloads, Jordanian practitioners still experienced high levels of distress. Identified demographic, professional and psychological factors influencing distress should inform interventions to improve medical professionals' resilience and distress likelihood, regardless of the variable Covid-19 situation.