Morphometrics of T11-L5 Vertebrae in Jordanian Population: CT Scan-Based Study / Morfometría de las Vértebras T11-L5 en una Población Jordana: Estudio Basado en Tomografía Computarizada

SUMMARY: The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws.

Este estudio proporciona información sobre la morfometría de las vértebras, la cual puede ser utilizada por los médicos oara determinar el tamaño adecuado de los tornillos transpediculares a utilizar en intervenciones de columna en la población jordana y para estudios comparativos con otras grupos. Se realizó un análisis retrospectivo de tomografías computarizadas normales de las áreas lumbar y toracolumbar. Se recogieron medidas lineales y angulares de 336 vértebras de 25 hombres y 23 mujeres. Los resultados se compararon entre vértebras derechas e izquierdas y entre ambos sexos. La L5 tiene el AVBH más largo y el PVBH más corto en ambos sexos, también tenía el pedículo más corto y más ancho tanto en hombres como en mujeres. La relación de AVBH a PVBH mostró un aumento progresivo en ambos sexos de T11 a L5. De manera similar, el VBW aumentó progresivamente de arriba hacia abajo en ambos sexos, pero fue significativamente diferente entre ambos sexos. La L1 fue la vértebra más orientada cranealmente en los hombres, mientras que la L2 mostró la orientación más craneal en las mujeres. En ambos sexos L5 fue la vértebra más orientada caudalmente. Este estudio proporciona una base de datos para la morfometría vertebral en la población jordana, donde existen ligeras diferencias entre el lado derecho e izquierdo en las vértebras superiores estudiadas (T11-L2). Algunas mediciones mostraron diferencias significativas entre hombres y mujeres. Estos hallazgos deben tenerse en cuenta al insertar tornillos pediculares.

The Impact of Cultural Factors, The Level of Health Education Received by the Caregivers, and Stigma on Asthma Treatment among Children in Southern Jordan

Abstract For asthma treatment in children, caregivers need good knowledge and attitudes regarding the disease and its treatment. This study aimed to determine the impact of cultural factors, the level of health education provided to patients and their families, as well as the impact of stigmatization on the treatment awareness of children with asthma in southern Jordan. A validated questionnaire was used to collect data from a sample of ninety-seven caregivers selected from three hospitals in southern Jordan. Open ended questions were answered after demonstrating the inhaler technique in and evaluated according to the instructions of the National Asthma Education and Prevention Program (NAEPP, 2013). The result revealed moderate knowledge of asthma with a mean score of (22.36/32), as well as moderate knowledge of asthma treatment (24.26/40). A high mean was found for the impact of cultural and environmental factors (22.93/28), whereas low impact was found for stigma with a mean value of (4.73/12). Therefore, to improve future asthma management, additional efforts are required to educate caregivers and improve their asthma awareness and rectify any falsehoods regarding asthma medications by health care providers.

Assessing the racial differences in Q angle measurements in relevance to articular cartilage of the femoral condyle: a retrospective ultrasound study / Evaluación de las diferencias raciales en las mediciones del ángulo Q en relación con el cartílago articular del cóndilo femoral: un estudio ecográfico retrospectivo

SUMMARY: The Q-angle is defined as the acute angle formed by the vectors for combined pull of the quadriceps femoris muscle and the patellar tendon. This study aimed to investigate the variations in Q angle with respect to race. Moreover, this study performed ultrasound to evaluate of the thickness of articular cartilage covering the medial and lateral femoral condyle in volunteers with an increased Q angle. The study included 487 Jordanian and 402 Malaysians with age range 18-23 years. Moreover, the study included 30 participants aged between 18 and 22 years, with a total of 15 volunteers with Q >14° and 15 patients with Q ≤14°. Both Q angle and condylar distance were measured by well-trained medical practitioners according to a well-established protocol. The thickness of articular cartilage covering the medial and lateral femoral condyle of the femoral bone was measured using ultrasound. Regardless of race, Q angle was greater in females. Furthermore, Q angle was significantly greater in Arab volunteers compared to Malay volunteers. Q angle significantly increase with increasing condylar distance in both races. Finally, the statistical analysis showed a significantly reduced thickness of articular cartilage on both medial and lateral femoral condyle (P = 0.05) in the Q >14° group. Multiple factors including race and condylar distance and even the articular cartilage of femoral condyle should be considered during the examination and management of knee fractures and condylar diseases.

RESUMEN: El ángulo Q se define como el ángulo agudo formado por los vectores de tracción combinada del músculo cuádriceps femoral y el tendón patelar. Este estudio tuvo como objetivo investigar las variaciones en el ángulo Q con respecto a la raza. Además, se realizó una ecografía para evaluar el grosor del cartílago articular que cubre los cóndilos femorales medial y lateral en voluntarios con un ángulo Q aumentado. El estudio incluyó a 487 jordanos y 402 malayos con un rango de edad de 18 a 23 años. Además, el estudio incluyó a 30 participantes con edades comprendidas entre 18 y 22 años, 15 voluntarios con Q> 14 ° y 15 pacientes con Q ≤ 14 °. Tanto el ángulo Q como la distancia condilar fueron medidos por médicos bien entrenados de acuerdo con un protocolo establecido. El grosor del cartílago articular que cubre los cóndilos femorales medial y lateral del fémur se midió mediante ecografía. Independientemente del grupo racial, el ángulo Q fue mayor en las mujeres. Además, el ángulo Q fue significativamente mayor en los voluntarios árabes en comparación con los voluntarios malayos. El ángulo Q se aumenta significativamente al incrementarse la distancia condilar en ambas grupos raciales. Finalmente, el análisis estadístico mostró una reducción significativa del grosor del cartílago articular en los cóndilos femorales medial y lateral (P = 0,05) en el grupo Q> 14. Durante la exploración y el tratamiento de las fracturas de rodilla y de las enfermedades condilares, se deben considerar múltiples factores, incluida la raza y la distancia condilar e incluso el cartílago articular del cóndilo femoral.

Anatomy education of medical students during the COVID 19 pandemic / Educación en anatomía de estudiantes de medicina durante la pandemia de COVID-19

SUMMARY: COVID-19 created extraordinary challenges to anatomy education and teaching practices, as the anatomists try to achieve best knowledge delivery level for their discipline, without the use of traditional teaching aids such as the cadavers and microscopic slides. The present study was conducted to collect medical students' response and opinions regarding the pros and cons of online teaching vs traditional teaching. 2263 medical studentswere recruited from the first three academic years. A multiple choice close-ended questionnaire regarding their opinion about virtual teaching mode for the anatomy discipline during COVID-19 pandemic was designed and circulated via emails.The majority (78.12 %) of the students agreed that they missed their traditional anatomy learning mode. Moreover, (92.92 %) of the students missed their campus and the college social life. The students strongly felt there is a gap and difficulty in understanding the topics that required practicing and visual orientation such as dissections, models, microscopic slides which help them in better memorizing and recalling the anatomical terms. The lack of proper devices and the absence of high quality internet were among the top reported issues that negatively affect online learning. These results indicated that, compared with traditional methods of teachings, the online learning in the medical schools had relatively poor planning and required continuous and combined efforts in order to improve the quality of online teaching specially for anatomy discipline, which may be an essential response for any unforeseen situation such as the COVID-19 pandemic. We should look at the current situation as an opportunity to apply modern anatomy education approaches which may be a necessity at the present time, with huge accomplishments achieved in the information and online technology field.

RESUMEN: La pandemia de COVID-19 creó desafíos extraordinarios para la educación y las prácticas de enseñanza de la anatomía, debido al objetivo del anatomista de lograr el mejor nivel de educación para su disciplina sin el uso materiales didácticos tradicionales, tal como los cadáveres y las láminas microscópicas. En este studio se analizó la respuesta y las opiniones de los estudiantes sobre los pros y los contras de la enseñanza en línea frente a la enseñanza tradicional. Se reclutaron 2263 estudiantes de medicina de los tres primeros años académicos. Se diseñó un cuestionario cerrado de opción múltiple con respecto a su opinión sobre el método de enseñanza virtual para la disciplina de anatomía durante la pandemia de COVID-19 y se distribuyó por correo electrónico. Además, (92,92 %) de los estudiantes dejaron de participar en la vida social universitaria y se ausentaron del campus. Los estudiantes sintieron fuertemente que hay una brecha y dificultad para comprender los temas que requieren práctica y orientación visual, como disecciones, modelos, diapositivas microscópicas que les ayudan a memorizar y recordar mejor los términos anatómicos. La falta de internet de calidad, y de dispositivos adecuados se encuentran entre los principales problemas reportados que afectan negativamente el aprendizaje en línea. Estos resultados indicaron que, en comparación con los métodos tradicionales de enseñanza, el aprendizaje en línea en las escuelas de medicina tenía una planificación relativamente deficiente y requería una planificación continua, además de esfuerzos para mejorar la calidad de la enseñanza en línea de anatomía, lo que que podría ser de apoyo fundamental ante cualquier situación imprevista como la pandemia de COVID-19. Actualmente, se debe considerar esta situación como una oportunidad para aplicar enfoques modernos de educación en anatomía con importantes logros en el campo de la tecnología informática y en línea.

Frequency of enlarged external occipital protuberance and its association with age and sex: a cross-sectional CT scan study / Frecuencia de la protuberancia occipital externa agrandada y su asociación con la edad y el sexo: un estudio de tomografía computarizada transversal

SUMMARY: External occipital protuberance (EOP) is a midline bony protrusion in the occipital bone, the significance of which has gained recent attention in the medical community. Our present study aims to assess the average size of EOP in a Jordanian cohort and its relation to age and sex, while determining the frequency of enlarged EOP in this cohort. The present study was a cross-sectional study that was carried out in a referral hospital in Jordan. We reviewed thousands of CT scans taken with dedicated bone window imaging during the last two years, beginning January 2018. Measurements were taken by trained radiology residents and were then further reviewed by radiology specialists. An EOP was classified as enlarged (EEOP) if it exceeded 10 mm. A total of 4409 patients, 2265 (51.4 %) females and 2144 (48.6 %) males, met our inclusion criteria. Their mean age was 54.1 ? 22.2 years. The mean size of the EOP in these patients was 8.4 ? 4.2 mm (range: 0-56 mm). Out of the 4409-study population, 1210 (27.4 %) presented with EEOP. The prevalence of an EEOP was significantly higher in the male population (33.6 %) when compared with the female population (21.6 %) (P < 0.001). The size of the EOP was also significantly related to the age of the patient, with EEOP increasing with increasing age. The mean size of EOP in our Jordanian cohort was 8.4 ? 4.2 mm. The frequency of enlarged EOP was found to be 27.4 % in our cohort, and was significantly more common in males and in older patients.

RESUMEN: La protuberancia occipital externa (POE) es una protuberancia ósea localizada en el plano mediano del hueso occipital, cuya importancia recientemente ha ganado atención en la comunidad médica. Este estudio tuvo como objetivo evaluar el tamaño promedio de POE en una cohorte jordana y su relación con la edad y sexo, mientras se determina la frecuencia de POE aumentada en este grupo. Se llevó a cabo un estudio transversal en un hospital de referencia en Jordania. Revisamos miles de imagenes radiológicas en tomografía computarizada y visualización de ventanas durante los últimos dos años, a partir de enero de 2018. Las mediciones fueron tomadas por residentes de radiología, y luego revisadas por especialistas en radiología. Un POE se clasificó como aumentado (POEA) si superaba los 10 mm. Un total de 4409 pacientes, 2265 (51,4 %) mujeres y 2144 (48,6 %) hombres, cumplieron con nuestros criterios de inclusión. La edad media fue de 54,1 ? 22,2 años. El tamaño medio del POE en estos pacientes fue de 8,4 ? 4,2 mm (rango: 0-56 mm). De la población del estudio 4409, 1210 (27,4 %) presentaron POEA. La prevalencia de una POEA fue significativamente mayor en la población masculina (33,6 %) en comparación con la población femenina (21,6 %) (P <0,001). El tamaño del POE también se relacionó significativamente con la edad del paciente, aumentando el POEA con la edad. El tamaño medio de POE en nuestra cohorte jordana fue de 8,4 ? 4,2 mm. Se encontró que la frecuencia de aumento de POE en nuestra cohorte fue del 27,4 % y fue significativamente más común en hombres y en pacientes mayores.

Age, gender and climate associations with the seroprevalence of Neospora species infection in horses in Jordan / Idade, sexo e associações climáticas com a soroprevalência da infecção por Neospora em cavalos da Jordânia

Abstract A cross-sectional study was carried out on a sample of 379 horses to determine the seroprevalence of Neospora spp. in Jordan using the indirect fluorescent antibody test. Five variables, namely locality (n=10), climatic zone (n=4), age group (n=3), gender, and breed were tested as risk factors for Neospora-immunoglobulin (Ig)G seropositivity at four cutoff titers (1:50, 1:200, 1:400, and 1:800) using univariate and multivariate logistic regression analyses. A total of 122 (32%; 95% CI: 28, 37) sera samples had anti-Neospora-IgG at a cutoff titer of 1:50. Increased Neospora-IgG seropositivity was found in horses in three localities (Madaba, Zarka, and Petra) and was associated with the following variables: cool temperate climate; age >14 years; and female gender. Seropositivity was found among horses from Madaba at all cutoff titers, Zarka at titers >1:200, and Petra at titers <1:200. Cool temperate climate was associated with titers <1:400. Horses aged >14 years were found to be associated with seropositivity at titers ≥1:200. Female gender was associated with high seropositivity at >1:800.

Resumo Um estudo transversal foi realizado, na Jordânia, em uma amostra de 379 cavalos, para determinar a soroprevalência de Neospora spp., usando-se o teste de anticorpos fluorescentes indiretos. Cinco variáveis: localidade (n=10), zona climática (n=4), grupo etário (n=3), sexo e raça, foram testadas como fatores de risco para soropositividade para Neospora-imunoglobulina (Ig)G, considerando-se quatro pontos de corte (1:50, 1:200, 1:400 e 1:800) por meio de análises de regressão logística univariada e multivariada. Um total de 122 (32%; 95% CI: 28, 37) amostras de soros apresentaram anti-Neospora-IgG, utilizando-se como ponto de corte o título de 1:50. Cavalos de três localidades apresentaram aumento da soropositividade para Neospora-IgG (Madaba, Zarka e Petra) o que foi associado às seguintes variáveis: clima temperado fresco; idade >14 anos; e sexo feminino. Os cavalos de Madaba apresentaram soropositividade em todos os títulos utilizados como ponto de corte; os cavalos de Zarka em títulos >1:200; e os cavalos de Petra em títulos <1:200. O clima temperado fresco foi associado aos títulos <1:400. Cavalos com idade >14 anos estiveram associados à soropositividade nos títulos ≥1:200. O sexo feminino esteve associado à alta soropositividade nos títulos >1:800.

MTHFR gene polymorphisms in hypothyroidism and hyperthyroidism among Jordanian females

ABSTRACT Objective Methylenetetrahydrofolate reductase (MTHFR) is involved in DNA methylation that is associated with autoimmune pathology. We investigated the association between MTHFR genetic polymorphisms at g.677C>T and g.1298A>C and their haplotypes, and the risk of thyroid dysfunction among Jordanian females. Subjects and methods A case-control study involving 98 hypothyroidism cases, 66 hyperthyroidism cases and 100 controls was conducted. Polymerase chain reaction/restriction fragment length polymorphism technique was performed to determine genotypes. Statistical analysis using SPSS software was performed. Results Genetic analysis showed a significant difference in genotype frequency of g.1298A>C between cases, and controls [hypothyroidism: AA (45.9%), AC (37.8%), CC (16.3%); hyperthyroidism: AA (9.1%), AC (69.7%), CC (21.2%); controls: AA (37.8%), AC (29.6%), CC (32.7%); CChypo vs. AAhypo: 2.55, 95% CI: (1.18-5.52); OR at least on Chypo: 1.79, 95% CI: (1.07-2.99)]; CChyper vs. AAhyper: 4.01, 95% CI: (1.79-9.01); OR at least on Chyper: 0.18, 95% CI: (0.07-0.48)]. There was no significant difference in genotype frequency of g.677C>T between cases and controls [hypothyroidism: CC (50.0%), CT (32.7%), TT (17.3%); hyperthyroidism: CC (77.3%), CT (15.2%), TT (7.6%); controls: CC (55.6%), CT (32.3%), TT (12.1%)]. There was a significant difference of MTHFR haplotypes among hypothyroidism cases and controls. TA and CC had a lower hypothyroidism risk whereas; TC showed a higher risk. Conclusions g.1298A>C genetic polymorphism of MTHFR may modulate the risk of thyroid disease. CC, TA, and TC haplotypes affect the risk of hypothyroidism. Larger samples should be included in the future to verify the role of MTHFR polymorphisms in thyroid diseases.

Incidence, Risk Factors and Prognosis of Acute Kidney Injury Following Hematopoietic Stem Cell Transplant: A Pilot Study

BACKGROUND AND OBJECTIVES: The burden of acute kidney injury (AKI) has not been explored in Jordanian patients who receive hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent HSCT. METHODS: A retrospective pilot study included 70 adult patients who received peripheral HSCT was conducted. Weekly measurement of serum creatinine (SCr) was obtained for 3 months after chemotherapy and HSCT. Then, stages of Risk, Injury, and Failure of Kidney were determined based on the Kidney Disease for Improving Global Outcomes (KDIGO). RESULTS: The median follow-up was 41 months. Mortality was reported in 16 patients (23%). Out of 60 patients that had SCr values, 19 patients (31.6%) had AKI in 90 days after chemotherapy. Allogeneic HSCT, male donors, high-dose melphalan protocols and values of blood urea nitrogen (BUN) were significantly higher among patients with AKI. CONCLUSIONS: Combining many nephrotoxic drugs and dosing adjustments should be considered in uniform protocols. Multidisciplinary care should be utilized to assess early kidney dysfunction that decreases adverse events and improves outcomes.

Outcomes of Elective Endovascular Aneurysmal Repair for Abdominal Aortic Aneurysms in Jordan

PURPOSE: The outcomes of endovascular aneurysmal repair (EVAR) for infrarenal abdominal aortic aneurysms (AAAs) in the Middle East have rarely been reported. We analyzed the outcomes of EVAR in a Jordanian population.MATERIALS AND METHODS: We conducted a retrospective review of the medical records of patients with infrarenal AAA who were treated with elective EVAR between January 2004 and January 2017 at a single center in Jordan. Patient characteristics, anatomical characteristics, procedural details, and early and late postoperative outcomes were analyzed.RESULTS: A total of 288 patients (mean age, 70 years; 77.8% males) underwent EVAR for infrarenal AAA (median aneurysm size, 64 mm). Bifurcated endografts were used in 265 patients, and aorto-uni-iliac devices were used in 22 patients. Successful endograft deployment was achieved in all patients with no open conversion. Early complications included localized groin hematoma in 15, femoral artery dissection in 4, wound infection in 3, and seroma in 3 patients. With a mean follow-up of 60 months, 50 endoleaks were detected, including 9 type I, 38 type II, and 3 type III. Seven patients had unilateral graft limb occlusion. The 30-day mortality was 1.7%, and long-term mortality was 7.0%, mostly due to non-AAA-related causes.CONCLUSION: EVAR was safely performed in Jordanian patients with minimal complications. However, long-term surveillance is important due to the risk of endoleaks and consequent intervention.

The best vein to be accessed based on descriptive study of dorsal metacarpal vein / 대한해부학회지

Nutrient intake patterns and breast cancer risk among Jordanian women: a case-control study / 한국역학회지

OBJECTIVES: Breast cancer (BC) is the most common type of cancer worldwide. Globally, BC is rapidly becoming a major common health problem among women. This study aimed to evaluate the association between nutrient intake patterns and BC risk among Jordanian women.METHODS: A total of 400 Jordanian women 20-65 years of age were recruited in this case-control study. Two hundred women recently diagnosed with BC were matched in age, income, and marital status to 200 BC-free women. A food frequency questionnaire was used to assess nutrient intake patterns.RESULTS: In this study, 3 nutrient intake patterns were identified: a high vitamin C and β-carotene nutrient intake pattern; a high calcium, phosphorus, and vitamin D nutrient intake pattern; and a high-fat nutrient intake pattern. A significant increase in BC risk was associated with the high vitamin C and β-carotene nutrient pattern (the highest for the fourth quartile; odds ratio [OR], 5.42; 95% confidence interval [CI], 2.11 to 13.91; p(trend)=0.001). In the high calcium, phosphorus, and vitamin D nutrient pattern, a significant inverse trend was detected for the risk of BC. The high-fat nutrient pattern showed a significant direct association with BC risk in the third (OR, 3.88; 95% CI, 1.58 to 9.51) and fourth (OR, 3.87; 95% CI, 1.53 to 9.77) quartiles (p(trend)=0.001).CONCLUSIONS: A significant increase in BC risk was detected for the high vitamin C and β-carotene nutrient intake pattern and the high-fat nutrient intake pattern. However, for the high calcium, phosphorus, and vitamin D nutrient intake pattern, a significant inverse trend was observed.

Nutrient intake patterns and breast cancer risk among Jordanian women: a case-control study / 한국역학회지

OBJECTIVES: Breast cancer (BC) is the most common type of cancer worldwide. Globally, BC is rapidly becoming a major common health problem among women. This study aimed to evaluate the association between nutrient intake patterns and BC risk among Jordanian women. METHODS: A total of 400 Jordanian women 20-65 years of age were recruited in this case-control study. Two hundred women recently diagnosed with BC were matched in age, income, and marital status to 200 BC-free women. A food frequency questionnaire was used to assess nutrient intake patterns. RESULTS: In this study, 3 nutrient intake patterns were identified: a high vitamin C and β-carotene nutrient intake pattern; a high calcium, phosphorus, and vitamin D nutrient intake pattern; and a high-fat nutrient intake pattern. A significant increase in BC risk was associated with the high vitamin C and β-carotene nutrient pattern (the highest for the fourth quartile; odds ratio [OR], 5.42; 95% confidence interval [CI], 2.11 to 13.91; p(trend)=0.001). In the high calcium, phosphorus, and vitamin D nutrient pattern, a significant inverse trend was detected for the risk of BC. The high-fat nutrient pattern showed a significant direct association with BC risk in the third (OR, 3.88; 95% CI, 1.58 to 9.51) and fourth (OR, 3.87; 95% CI, 1.53 to 9.77) quartiles (p(trend)=0.001). CONCLUSIONS: A significant increase in BC risk was detected for the high vitamin C and β-carotene nutrient intake pattern and the high-fat nutrient intake pattern. However, for the high calcium, phosphorus, and vitamin D nutrient intake pattern, a significant inverse trend was observed.

Enhancing value of quality assurance rounds in improving radiotherapy management: a retrospective analysis from King Hussein Cancer Center in Jordan

PURPOSE: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. MATERIALS AND METHODS: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation orre-planning prior to commencement of RT. Minor modification included treatment plan changes which didn’t necessarily require RT re-planning. RESULTS: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). CONCLUSION: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/ or treatment decisions.

Current Status of Theranostics in Jordan / 대한핵의학회잡지

Exploring the unknown is one of the key factors that lead to great discoveries in mankind history.With the advances in medicine and the development of new approaches towards patient care, like next-generation sequencing and patient-centered care, the need for treatments tailored to patient through personalized medicine has become more compelling. Theranostics has been introduced as a combination of a diagnostic tool and a therapeutic tool on the same vector for a specific disease, to facilitate personalized medicine. Nuclear medicine has shown the capability of providing a strong platform for this new approach through its arms, molecular imaging, and targeted molecular therapies. Though the prototype of theranostics has been practiced in Jordan since decades in the field of diagnosis and treatment of well-differentiated thyroid cancer, recently, the King Hussein Cancer Center (KHCC), a leading and comprehensive cancer center in Jordan and in the Middle East, has leaped forward to introduce the new approaches of theranostics through the nuclear medicine applications. This paper sheds the light on the most important aspects of this new theranostics practice in Jordan such as peptide receptor radionuclide therapy (PRRT) and prostate-specific membrane antigen (PSMA)–based theranostics.

Incidence of nausea and vomiting after fast-track anaesthesia for heart surgery

Abstract Objective: The aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay. Methods: A prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU. Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as second line of management. Results: Nausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%). Among females, 38 (33.9%) patients developed nausea and 20 (17.9%) developed vomiting. Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting. Conclusion: PONV are relatively low after FTCA and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary.

Osteometric assessment of various mandibular morphological traits for sexual dimorphism in Jordanians by discriminant function analysis / Evaluación osteométrica de diversos rasgos morfológicos mandibulares para el dimorfismo sexual en jordanos mediante el análisis de funciones discriminantes

The aim of this study was to analyze the sexual dimorphism in the mandibles of Jordanians and derive a population specific equation for sex prediction. The employed sample comprised 270 cone beam computed tomography (CBCT) images of Jordanians (147 males and 123 females) aged 27-55 years. The images were rendered to 3D surface models, using customized software that provided various views for each mandible, on which measurements made of nine parameters (ramus height, right and left coronoids height, mandibular length, gonial angle, Intergonial breadth, Intercondylar breadth, mental and mandibular foramena) for the analysis of sex identification. The collected data sets were treated statistically using the Statistical Package SPSS version-21. Canonical discriminant function analysis was used to specify a parameter or combination of parameters that best separate the two sexes. Stepwise analysis together with leave-one-out classification procedure was applied (utilizing the Wilks lambda method), which identified six parameters that formed the best combination most precisely predicting sex. It also identified the predictors' coefficients from which a predictive equation for the Jordanian population was derived. The discriminant function group centroid discriminant scores for males and females and the sectioning cut-score were also defined. According to the equation, the function score for any set of measurements that is above the cut score is probably for a male individual whereas a score that was below the cut score is probably for a female subject.

El objetivo de este estudio fue analizar el dimorfismo sexual en las mandíbulas de los jordanos y derivar una ecuación específica de la población para la predicción del sexo. La muestra consistió en 270 imágenes de tomografía computarizada de haz cónico (CBCT) de jordanos (147 hombres y 123 mujeres) con edades entre los 27 y 55 años. Las imágenes se representaron en modelos de superficie 3D, utilizando software personalizado que proporcionó varias imágenes para cada mandíbula, en las que se midieron nueve parámetros (altura de la rama, altura de los procesos coronoides derecho e izquierdo, longitud mandibular, ángulo gonial, amplitud intergonial, amplitud intercondilar y foramen mandibular) para el análisis de la identificación de sexo. Los conjuntos de datos recopilados se trataron estadísticamente utilizando el programa estadístico SPSS versión-21. El análisis de función discriminante canónica se utilizó para especificar un parámetro, o una combinación de parámetros que separaran mejor los dos sexos. Se aplicó el análisis por pasos junto con el procedimiento de clasificación de dejar salir uno (utilizando el método de Wilks lambda), que identificó seis parámetros que formaban la mejor combinación que predecía con mayor precisión el sexo. También se identificó los coeficientes de los predictores a partir de los cuales se obtuvo una ecuación predictiva para la población jordana. Se definieron además, los puntajes discriminantes centroide del grupo para hombres y mujeres, además del puntaje de corte seccional. De acuerdo con la ecuación, el puntaje de la función para cualquier conjunto de medidas que está por encima del puntaje de corte es probablemente para un individuo masculino, mientras que un puntaje que estaba por debajo del puntaje de corte, probablemente era femenino.

Serum Branched Chain Amino Acids Are Associated with Type 2 Diabetes Mellitus in Jordan / 가정의학회지

BACKGROUND: Diabetes mellitus is a global public health problem that is caused by the lack of insulin secretion (type 1) or resistance to its action (type 2). A low insulin-to-glucagon ratio predicts an increase in the serum levels of branched chain amino acids, a feature confirmed in several populations. This relationship has not been assessed in Jordan. The objective of this study was to investigate the association between serum branched chain amino acids and type 2 diabetes mellitus in patients in Jordan. METHODS: Two hundred type 2 diabetes mellitus patients and an additional 200 non-diabetic controls were recruited. Age, body mass index, and waist circumference of the subjects were recorded. Branched chain amino acid, total cholesterol, and triglyceride levels were measured from the collected serum samples. RESULTS: Serum branched chain amino acid levels were significantly higher in type 2 diabetes mellitus patients than in non-diabetes individuals (P < 0.0001). In binomial regression analysis, serum branched chain amino acid levels remained significantly associated with diabetes mellitus and increased its risk (odds ratio, 1.004; 95% confidence interval, 1.001–1.006; P=0.003). CONCLUSION: Type 2 diabetes mellitus is associated with higher branched chain amino acid levels in Jordan independent of age, sex, body mass index, waist circumference, and total serum cholesterol and serum triglyceride levels.

Lower Levels of Serum Adiponectin and the T Allele of rs1501299 of the ADIPOQ Gene Are Protective against Polycystic Ovarian Syndrome in Jordan / 가정의학회지

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common reproductive disorder. Obesity, which is linked with lower adiponectin levels, increases a woman's risk of developing PCOS; however, the association between adiponectin and PCOS is controversial. Adiponectin levels could be affected by single nucleotide polymorphisms (SNPs) in the ADIPOQ gene. This study aimed to test the relationship between serum adiponectin and PCOS in Jordan and the association between the rs2241766, rs1501299, and rs266729 SNPs in the ADIPOQ gene and PCOS. METHODS: One hundred and fifty-four women with PCOS and 149 age- and body mass index–matched normally menstruating controls were recruited. Serum adiponectin levels were measured using enzyme-linked immunosorbent assay. Genotyping was performed using polymerase chain reaction–restriction fragment length polymorphism analysis. RESULTS: Serum adiponectin levels were significantly lower (P=0.0064) in PCOS women and rs1501299 (+276 G/T) genotype distributions were significantly different (P=0.01) between them and normally menstruating women. Multivariate analysis revealed that adiponectin levels remained significantly lower in PCOS women (P=0.001; odds ratio [OR], 0.9; 95% confidence interval [CI], 0.84–0.96). The GT genotype of rs1501299 increased the risk of PCOS (P < 0.001; OR, 5.46; 95% CI, 2.42–12.33) and increased the risk of PCOS by three-fold (P < 0.001; OR, 3.00; 95% CI, 1.36–6.60) relative to the TT genotype. The GG genotype increased the risk of PCOS as well (P < 0.001; OR, 3:00; 95% CI, 1.36–6.60). CONCLUSION: PCOS is associated with lower serum adiponectin levels independent of age and body mass index. The T allele of the rs1501299 (+276 G/T) SNP of the ADIPOQ gene protects against PCOS.

Age prediction in the adult based on the pulp-to-tooth ratio in lower third molars: a cone-beam CT study / Predicción de edad en el adulto basada en la proporción pulpa-a-diente en terceros molares inferiores: un estudio por TC de haz de cono

Estimation of age-at-death is an integral part of the identification process of individuals in many forensic odontology cases where their identity cannot be determined by visualization or other ways. Dental age estimation in the adult is more challenging as most of the dentition is completely developed by 18 years of age. This study employs a mesio-distal (MD) pulp-to-tooth ratio taken at the neck of lower third molars (LM3) to provide an estimation of age at the time of radiographic imaging based on the well-known fact that pulp volume tends to decrease with advancing age due to continued apposition of secondary dentine throughout adulthood. A total of 155 Cone-beam computed tomography (CBCT) radiographs of LM3s for a random sample of 155 Jordanian Arabs (80 females, 75 males; age range= 18-58 years, mean age= 28.2 years, SD =10.0 years) were used. Both pulp and tooth MD diameters were measured at the neck. MD pulp-to-tooth ratios for LM3s were linearly regressed against age. Statistically significant negative association was found between an individual's age at the time of imaging and the MD pulp-to-tooth ratio taken at the neck. Specifically, the strength of the association is r= -0.361, which means only 13.0 % of the variation in age can be explained by the MD pulp-to-tooth ratio taken at the neck. Therefore, it was concluded that MD pulp-to-tooth ratio taken at the neck of LM3s is not a reliable predictor of chronological age in adults, possibly due to the large variation in the timing of LM3 development.

La estimación de la edad es una parte integral del proceso de identificación de los individuos, en muchos casos en odontología forense donde la identidad no puede ser determinada por visualización u otras formas. La estimación de la edad dental en el adulto es aún más difícil ya que la mayor parte de la dentición se desarrolla completamente a los 18 años de edad. Este estudio emplea una relación mesio-distal (MD) de pulpa a diente tomada a nivel del cuello de los terceros molares inferiores (LM3) para proporcionar una estimación de la edad en el momento de la imagen radiográfica basada en que el volumen de pulpa tiende a disminuir con el avance de la edad debido a la continua posición de la dentina secundaria a lo largo de la edad adulta. Se examinaron un total de 155 radiografías de LM3 en una muestra aleatoria de 155 árabes jordanos (80 mujeres, 75 varones), rango de edad = 18-58 años, edad media = 28,2 años, DE = 10,0 años. Específicamente, la fuerza de la asociación es r=0,361, lo que significa que sólo el 13,0 % de la variación en la edad puede explicarse por la proporción pulpa-a-diente.

Celiac Disease in South Jordan / 대한소아소화기영양학회지

PURPOSE: Celiac disease, an autoimmune enteropathy triggered by exposure to gluten, is not uncommon in South Jordan. However, its prevalence is underestimated due to lack of physician awareness of the diversity of disease presentation. The clinical spectrum includes classic gastrointestinal manifestations, as well as rickets, iron-deficiency anemia, short stature, elevated liver enzymes, and edema. Our goal was to evaluate celiac disease presentation in clinically diagnosed children. METHODS: Retrospective study included all children diagnosed with celiac disease between September 2009 and September 2015. Hospital charts were reviewed. Demographic data, clinical characteristics, and follow-up were recorded. RESULTS: Thirty-five children were diagnosed with celiac disease during the study period. Mean age±standard deviation was 6.7±3.8 years (range, 2.0–14 years). There were 17 (48.6%) female patients. The average duration between onset of symptoms and diagnosis was 16.3±18.7 months. Fifteen (42.9%) patients presented with classic malabsorption symptoms, whereas 7 (20.0%) patients presented with short stature. Positive tissue transglutaminase antibodies (tTg)-immunoglobulin A (IgA) was seen in 34 (97.1%) patients. The one patient with negative tTg-IgA had IgA deficiency. Although tTG-IgA values were not available for objective documentation of compliance, clinical data (resolution of presenting abnormalities and growth improvement) assured acceptable compliance in 22 (62.9%) patients. CONCLUSION: CD in children may present with diverse picture. Although of the small number, the non-classical presentations are not uncommon in our rural community. Gluten-free diet is the main strategy for treatment and associated with usually correction of laboratory abnormalities and improvement of growth.