Impact of Diabetes Mellitus on Heart Failure Patients: Insights from a Comprehensive Analysis and Machine Learning Model Using the Jordanian Heart Failure Registry.

Background: Heart failure (HF) is a common final pathway of various insults to the heart, primarily from risk factors including diabetes mellitus (DM) type 2. This study analyzed the clinical characteristics of HF in a Jordanian population with a particular emphasis on the relationship between DM and HF. Methods: This prospective study used the Jordanian Heart Failure Registry (JoHFR) data. Patients with HF were characterized by DM status and HF type: HF with preserved ejection fraction (HFpEF) or HF with reduced ejection fraction (HFrEF). Demographics, clinical presentations, and treatment outcomes were collected. Statistical analyses and machine learning techniques were carried out for the prediction of mortality among HF patients: Recursive Feature Elimination with Cross-Validation (RFECV) and Synthetic Minority Over-sampling Technique with Edited Nearest Neighbors (SMOTEENN) were employed. Results: A total of 2007 patients with HF were included. Notable differences between diabetic and non-diabetic patients are apparent. Diabetic patients were predominantly male, older, and obese (p < 0.001 for all). A higher incidence of HFpEF was observed in the diabetes cohort (p = 0.006). Also, diabetic patients had significantly higher levels of cholesterol (p = 0.008) and LDL (p = 0.003), reduced hemoglobin levels (p < 0.001), and more severe renal impairment (eGFR; p = 0.006). Machine learning models, particularly the Random Forest Classifier, highlighted its superiority in mortality prediction, with an accuracy of 90.02% and AUC of 80.51%. Predictors of mortality included creatinine levels >115 µmol/L, length of hospital stay, and need for mechanical ventilation. Conclusion: This study underscores notable differences in clinical characteristics and outcomes between diabetic and non-diabetic heart failure patients in Jordan. Diabetic patients had higher prevalence of HFpEF and poorer health indicators such as elevated cholesterol, LDL, and impaired kidney function. High creatinine levels, longer hospital stays, and the need for mechanical ventilation were key predictors of mortality.

Machine Learning-Based Mortality Prediction in Chronic Kidney Disease among Heart Failure Patients: Insights and Outcomes from the Jordanian Heart Failure Registry.

Background and Objectives: Heart failure (HF) is a prevalent and debilitating condition that imposes a significant burden on healthcare systems and adversely affects the quality of life of patients worldwide. Comorbidities such as chronic kidney disease (CKD), arterial hypertension, and diabetes mellitus (DM) are common among HF patients, as they share similar risk factors. This study aimed to identify the prognostic significance of multiple factors and their correlation with disease prognosis and outcomes in a Jordanian cohort. Materials and Methods: Data from the Jordanian Heart Failure Registry (JoHFR) were analyzed, encompassing medical records from acute and chronic HF patients attending public and private cardiology clinics and hospitals across Jordan. An online form was utilized for data collection, focusing on three kidney function tests, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), and creatinine levels, with the eGFR calculated using the Cockcroft-Gault formula. We also built six machine learning models to predict mortality in our cohort. Results: From the JoHFR, 2151 HF patients were included, with 644, 1799, and 1927 records analyzed for eGFR, BUN, and creatinine levels, respectively. Age negatively impacted all measures (p ≤ 0.001), while smokers surprisingly showed better results than non-smokers (p ≤ 0.001). Males had more normal eGFR levels compared to females (p = 0.002). Comorbidities such as hypertension, diabetes, arrhythmias, and implanted devices were inversely related to eGFR (all with p-values <0.05). Higher BUN levels were associated with chronic HF, dyslipidemia, and ASCVD (p ≤ 0.001). Higher creatinine levels were linked to hypertension, diabetes, dyslipidemia, arrhythmias, and previous HF history (all with p-values <0.05). Low eGFR levels were associated with increased mechanical ventilation needs (p = 0.049) and mortality (p ≤ 0.001), while BUN levels did not significantly affect these outcomes. Machine learning analysis employing the Random Forest Classifier revealed that length of hospital stay and creatinine >115 were the most significant predictors of mortality. The classifier achieved an accuracy of 90.02% with an AUC of 80.51%, indicating its efficacy in predictive modeling. Conclusions: This study reveals the intricate relationship among kidney function tests, comorbidities, and clinical outcomes in HF patients in Jordan, highlighting the importance of kidney function as a predictive tool. Integrating machine learning models into clinical practice may enhance the predictive accuracy of patient outcomes, thereby supporting a more personalized approach to managing HF and related kidney dysfunction. Further research is necessary to validate these findings and to develop innovative treatment strategies for the CKD population within the HF cohort.

Jordanian parental perception of screen time and its association with psychological distress: A cross-sectional design.

BACKGROUND: The excessive use of electronic devices among children is a global concern because of its negative impact on behavior. This cross-sectional study aimed to assess parents' awareness of their children's electronic device use and their perspective on how screen time affects behavior for 4-10-year-olds in Jordan. METHODS: A cross-sectional study was conducted to assess parents' awareness of their children's electronic device usage. The study included 807 mothers and fathers from Jordan with at least one child aged 4 to 10. The data collection instrument consisted of a self-administered survey with 43 questions, including sociodemographic characteristics and the Strength and Difficulties Questionnaire. Descriptive analysis, categorical Chi-square test, Independent t-test, and Mann-Whitney U test were used for statistical analysis. The study followed ethical standards and principles. RESULTS: A survey of 807 parents in Jordan found that gaming and videos were the most common content watched by children, and 61.3% used devices alone. Only 37.1% of parents believed that device use could improve their children's psychological growth, while 72.7% and 65.9% believed it could impact negatively their children's mental and psychological growth, respectively. The Strengths and Difficulties Questionnaire showed that 51.4% of children were normal, while 25.3% were borderline and 23.3% were abnormal. CONCLUSION: Children in the study used electronic devices excessively and this was linked to severe behavioral problems. Parents should follow AAP guidelines and spend more time with their children through non-electronic activities to improve their behavior.

Pancytopenia with aplastic anemia in systemic lupus erythematosus: case series and literature review.

Aplastic anemia (AA) is a rare, potentially catastrophic hematopoiesis failure manifested by pancytopenia and bone marrow aplasia. AA occurrence in Systemic Lupus Erythematosus (SLE) patients is extremely rare. The diagnosis may be delayed due to other possible pancytopenia etiologies. Confirmation of peripheral cytopenias diagnosis necessitates a bone marrow aspiration. The management of AA is challenging, and the literature reported using glucocorticoids, danazol, plasmapheresis, cyclophosphamide, intravenous immunoglobulin, and cyclosporine. We report two cases of SLE patients who presented with pancytopenia, with bone marrow biopsy confirmed AA. One case was treated with cyclophosphamide but unfortunately succumbed to Acute Respiratory Distress Syndrome (ARDS), while the other case was managed with rituximab with a good response. Interestingly, both patients were on azathioprine before the diagnosis of AA. A comprehensive search for reported cases of AA in PubMed, Scopus, and the Directory of Open Access Journals databases was performed to enhance the understanding of the diagnostic and management challenges associated with AA in SLE, facilitating ongoing exploration and research in this field. The decision to do a BM aspiration and biopsy is recommended for SLE patients with an abrupt decline in blood counts and previously stable blood counts.

Knowledge of cardiovascular disease risk factors among caregivers of cardiology patients attending Jordan University Hospital.

Cardiovascular disease (CVD) is an umbrella term that includes various pathologies involving the heart and the vasculature system of the body. CVD is the leading cause of death worldwide, accounting for an estimated 32% of all deaths. More than 40% of annual deaths in Jordan are due to CVD; this number is further expected to rise, particularly in the Eastern Mediterranean region where Jordan is located. Due to the chronic nature of CVD, the presence of a caregiver who can help mitigate the challenges patients face is essential, and their level of knowledge determines the quality of care they can provide. Hence, this cross-sectional study was conducted in the cardiology clinics at Jordan University Hospital (JUH). Questionnaires were distributed to 469 participants, defined in this study as the caregivers escorting patients with established coronary heart disease (CHD). The self-administered questionnaire included three sections: sociodemographic and health factors, knowledge of CVD risk factors, and CHD symptoms. The mean age of the study population was 44.38 years ± 15.92 and 54.2% of participants were males. Regarding knowledge of CVD risk factors, 84.6% of participants answered more than 70% of the questions correctly. More than 95% knew that chest pain is a symptom of an acute cardiovascular event. However, only 53.5% and 74.8% of the participants reported that jaw pain and arm pain are symptoms of an acute event, respectively. Several factors influenced the caregiver's knowledge, such as age, income, frequent health checkups, having a history of CVD, CKD, or DM, and their relationship to the patient. This study sheds light on the importance of caregiver knowledge in patient care. By improving the caregivers' knowledge, identifying their role in patient care, and raising CVD awareness in susceptible populations, healthcare professionals can improve the patients' quality of life. Overall, assessing caregivers' knowledge pertaining to CVD can provide invaluable data, which may enhance patient care by educating their caregivers.

Clinical, Radiological, and Microbiologic Characteristics of Patients with Noncystic Fibrosis Bronchiectasis in a Tertiary Center at Jordan.

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.

Paraneoplastic Cutaneous Manifestations of Hepatocellular Carcinoma. A Systematic Review and Meta-analysis.

Background: There remains a scarcity of published data on the clinical significance of paraneoplastic cutaneous manifestations in hepatocellular carcinoma (HCC). Method: A systematic search of MEDLINE was performed in December 2022. Inclusion criteria comprised studies reporting on patients with HCC, who had paraneoplastic cutaneous manifestations. Outcomes of interests comprise survival and response to cancer-directed and/or skin directed therapy. Results: A total of 48 studies comprising 60 HCC patients were included in the analysis. The most frequent reported skin abnormalities were dermatomyositis, pityriasis rotunda, and porphyria. Most patients presented with dermatomyositis had underlying viral hepatitis, while all reported porphyria and acanthosis cases were associated with metabolic causes of HCC, such as steatosis. Paraneoplastic skin changes were more common in patients with metastatic disease. Pityriasis Rotunda was associated with the lowest risk of death, (OR: 0.05, 95% CI: 0.003 to 0.89; p = 0.04), while dermatomyositis had a statistically significant higher risk of death (OR: 3.37, 95% CI: 1.01-12.1; p = 0.03). Most patients showed an improvement in their cutaneous abnormalities, following cancer-directed therapy. Conclusion: Paraneoplastic cutaneous manifestations are reported more frequently in patients with a higher burden of disease, especially presence of metastases. Certain cutaneous manifestations have prognostic implication.

Epidemiology, microbiology, and outcomes of infective endocarditis in a tertiary center in Jordan.

BACKGROUND: Infective endocarditis (IE) is a relatively rare but serious and life-threatening disease with substantial mortality and morbidity despite progress in diagnostic and treatment techniques. The aim of this study is to investigate the epidemiology, clinical characteristics, microbiological profile, and outcomes of IE patients in a tertiary care facility in Jordan, the Jordan University Hospital (JUH). METHODS: This is a retrospective case series study which was conducted at JUH. A total of 23 patients with either definite or possible IE according to the Modified Duke Criteria were included in the study. Medical records were reviewed, and relevant information was collected. Descriptive data analysis was performed. RESULTS: Our study identified a total of 23 patients with infective endocarditis; 65.2% were males, with a mean age of 40.4 years. The majority of patients had an underlying cardiac disease (60.9%), with the most common being congenital heart diseases (17.4%). The most commonly affected valves were the left-side heart valves, with the mitral valve (52.2%) being the most common followed by the aortic valve (34.8%). The most common organism detected in blood culture was Streptococcus viridans (21.7%) followed by methicillin-resistant Staphylococcus aureus. The most common complications among the patients were heart failure and septic shock, and the mortality rate among the patients was 13%. CONCLUSION: In patients with endocarditis, Streptococcus viridans is the most common culture-positive bacteria at JUH. One third of our patients needed surgical intervention and the mortality rate was 13%.

Epidemiology of proximal femur fractures in the young population of Qatar.

PURPOSE: To review the epidemiological characteristics of proximal femur fractures in the young population (< 60 years) of Qatar between 2017 and 2019. METHODS: All patient treated for proximal femur fractures at Hamad General Hospital (HGH), a level one trauma center, were retrospectively reviewed between Jan 2017 and Dec 2019. All adults (18-60 years) with proximal femur fracture (femur head, femur neck, intertrochanteric and subtrochanteric fractures) were included with no restriction to the AO/OTA classification or fractures subtypes. Excluded cases were pathological fractures, cases with insufficient documentation or no radiographs. RESULTS: A total of 203 patients with a mean age of 40.07 ± 11.76 years were included, of who 89.9% were males. The incidence of proximal femur fracture was 3.12/100,000/year. Fall from height (48.1%) followed by road traffic accidents (26.9%) were common cause of injury. The most common fracture type was intertrochanteric fracture (36.1%) followed by femur neck fractures (33.7%). CONCLUSION: This study provides the initial insights into the proximal femur fractures in the young population of Qatar. This is the first study to investigate of the epidemiology of such fractures in this particular patient group. Contrary to the existing literature on older age groups, the majority of the injuries were observed in males. Falls from height followed by road traffic accidents were the primary mechanisms leading to these fractures. Improved understanding of the profile of these injuries can aid in their prevention by implementing more effective safety measures.

The impact of COVID-19 on antibiotic resistance and clinical outcomes among critically ill patients.

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.

The prevalence of anxiety and depression in bronchiectasis patients and their association with disease severity: a cross-sectional study.

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.

The Characteristics of Respiratory Bocavirus Infection in Acutely Sick Children Admitted to a Tertiary Hospital in Jordan.

OBJECTIVE: The clinical manifestations of human bocavirus infections are diverse, ranging from mild common cold to severe lower respiratory tract infections. Bocaviruses have frequently been codetected with other respiratory viruses. We aimed to estimate the burden of bocavirus and multiple viral infections and to investigate the risk factors associated with these infections. METHODS: This study was a retrospective chart review of admitted patients. The medical records of the included children were searched, and data on demographics, clinical presentation, imaging, laboratory and nasopharyngeal swab results were collected. RESULTS: A total of 157 patients were included. Most of the patients were males (62.1%) and under 6 months of age (52%). The 3 most common symptoms presented in the patients were cough (81.8%), rhinorrhea (58.6%) and fever (55.8%). Bocavirus DNA was detected in 12.66% of the patients, while 22.30% had multiple viruses. Age distribution was significantly different between bocavirus and nonbocavirus groups, with a lower proportion of bocavirus infection in all age groups (P = 0.032). The X-ray patterns significantly differed between the 2 study groups, with a lower number of patients in the bocavirus group having normal X-rays (P = 0.007). Patients infected with multiple viruses had more severe respiratory distress symptoms and diarrhea than those infected with only 1 virus. CONCLUSIONS: The prevalence of multiple viruses and bocavirus respiratory infections is significant. This study can guide physicians toward the clinical presentation and characteristics of children with respiratory bocavirus and multiple viral infections and propose future studies conducted in this regard.

Cardiovascular diseases across OSA phenotypes: A retrospective cohort study.

Background: Despite the considerable knowledge of Obstructive Sleep Apnea (OSA) implications for cardiac diseases, the evidence regarding cardiovascular complications across OSA phenotypes including Rapid Eye Movement OSA (REM-OSA) and Positional OSA (POSA) is limited. In this study, we aimed to evaluate the risk of cardiovascular diseases development and progression among patients with REM-OSA and POSA. Methods: Based on a retrospective cohort analysis, we included polysomnography studies done in the sleep lab at the Jordan University Hospital. Regarding cardiovascular diseases, primary outcomes were Heart Failure, and 1-years Major Adverse Cardiac Events while secondary outcomes were atrial fibrillation, pulmonary hypertension, other arrhythmia, metabolic profile, and echocardiographic measurements of the heart. Results: The total number of the included patients was 1,026 patients. POSA group had significantly lower percentage of patients with hypertension (P-value = 0.004). Additionally, systolic blood pressure and HbA1c were significantly lower among patients with POSA compared to the NPOSA group (P-value<0.050). Left ventricular end diastolic dimension was significantly higher among patients with POSA while ejection fraction was significantly lower (P-value<0.050). Patients with diabetes and mean HbA1c were significantly lower among patients with REM-OSA compared to patients with NREM-OSA (P-value = 0.015, P-value = 0.046). Multivariate regression analysis revealed that after adjusting for age, gender and preexisting comorbidities, POSA was significantly associated with lower ejection fraction and higher left ventricular diastolic diameter. Conclusion: In conclusion, our findings indicate that POSA might be associated with huge and clinically significant heart strain and poor cardiac functions, yet it might not have a clinically significant atherogenic effect. This study should guide clinicians to identify OSA phenotypes to imply the best treatment plan to reduce its detrimental impact on cardiac muscle.

Valve Surgery in a Low-Volume Center in a Low- and Middle-Income Country: A Retrospective Cross-Sectional Study.

Background: Valvular heart disease (VHD) has a significant prevalence and mortality rate with surgical intervention continuing to be a cornerstone of therapy. We aim to report the outcome of patients undergoing heart valve surgery (HVS) in a low-volume center (LVC) in a low- and middle-income country (LMIC). Methods: A cross-sectional retrospective study was conducted at the Jordan University Hospital (JUH), a tertiary teaching hospital in a developing country, between April 2014 and December 2019. Patients who underwent mitral valve replacement (MVR), aortic valve replacement (AVR), tricuspid valve replacement (TVR), double valve replacement (DVR), CABG + MVR, and CABG + AVR patients were included. Thirty-day and two-year mortalities were taken as the primary and secondary outcomes, respectively. Results: A total number of 122 patients were included, and the mean age was 54.46 ± 14.89 years. AVR was most common (42.6%). There was no significant association between STS mortality score or Euroscore II with 30-day and 2-year mortality. Conclusion: LVC will continue to have a role in LMICs, especially during development to HICs. Further global studies are needed to assert the safety of HVS in LVC and LMICs.

Alterations in Patients' Clinical Outcomes and Respiratory Viral Pathogen Activity following the COVID-19 Pandemic.

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.

Stand-Alone Tibial Interference Screw Fixation and Tibial Interference Screw Plus Tibial Staple Fixation Produce Comparable Outcomes After Primary Anterior Cruciate Ligament Reconstruction Using Hamstring Autografts.

Purpose: To investigate the impact of adding a metal staple alongside the interference screw in tibial side graft fixation during anterior cruciate ligament reconstruction (ACLR). Methods: All patients treated with autograft hamstring ACLR at our institution between January 2017 and December 2021 with a minimum 1-year follow-up were reviewed retrospectively. Patients treated with a stand-alone interference screw for tibial side fixation were compared with those treated with a combination of interference screw and staple. The primary outcome was failure of the reconstructed graft. Secondary outcomes were operative time, complication rate, and reoperation rate. Results: A total of 497 patients met the study's inclusion and exclusion criteria. A combination of staple and interference screw was used in 167 patients (33.6%), whereas a standalone interference screw was used in 330 patients. There was no significant difference between the 2 groups in terms of operative time, complication rate, or failure rate. The mean follow-up was 23.25 (±13.29) months. Conclusions: Our results demonstrate that augmenting the interference screw with a staple for tibial-side fixation in ACLR does not have a significant impact on operative time, reoperation rate, complications, or failure rates. Level of Evidence: Level III, retrospective cohort study.

Endovascular Treatment plus Medical Treatment versus Medical Treatment Alone in Ischemic Stroke: A Systematic Review and Meta-Analysis.

INTRODUCTION: This study was conducted to assess the hypothesis that endovascular treatment in addition to medical treatment improve stroke mortality and post-stroke disability. METHODS: In this systematic review and meta-analysis, the studies were included if they were randomized controlled trials in design and compared between endovascular treatment and medical therapy versus medical therapy alone in stroke management. RESULTS: The search yielded 22 articles that included 5,049 patients. The analysis showed significant association between the intervention and reduction in disability measured by Modified Rankin Scale (mRS) (mRS = 0-2) (odds ratio [OR] = 1.61; 95% confidence intervals [95% CI]: 1.27-2.06) and National Institute of Health Stroke Scale (NIHSS) (NIHSS = 0-15) (OR = 2.13; 95% CI: 1.04-4.34). Also, we found a significant difference in disability scores between the intervention and the medical therapy group (mRS weighted mean difference [WMD] = -0.59; 95% CI: -1.15 to -0.02, NIHSS WMD = -4.52; 95% CI: -6.32 to -2.72). Additionally, there was significant reduction in mortality in the intervention group (OR = 0.79; 95% CI: 0.68-0.92). There was no significant difference in the rate of any serious adverse effects between the two study groups except for asymptomatic intracerebral hemorrhage. CONCLUSION: Our study provides strong evidence stemmed from randomized clinical trials that endovascular treatment combined with medical therapy is superior to medical therapy alone in the management of stroke.

Prevalence and risk factors of COVID-19 infection, mortality, and post-infection lung fibrosis in patients with type 2 diabetes: a cross-sectional study.

OBJECTIVES: The clinical course of coronavirus disease 2019 (COVID-19) infection is often aggressive, with unfavorable outcomes for those with comorbidities such as type 2 diabetes mellitus (T2DM). We aimed to assess the prevalence and risk factors of COVID-19 infection, mortality, and post-infection lung fibrosis in patients with COVID-19 infection who had T2DM. METHODS: In this cross-sectional study, we included adult patients with T2DM who attended an endocrinology clinic and underwent testing for COVID-19 infection. RESULTS: Among 1039 included patients, the mean age was 59.5 ± 11.0 years and 429 (41.3%) were men. Overall, 87.1% of patients had received COVID-19 vaccination and 32.3% had confirmed COVID-19 infection. The COVID-19-related mortality was 3.0% and rate of post-COVID-19 lung fibrosis was 19.1%. Vaccination was associated with lower COVID-19-related mortality (odds ratio [OR]: 0.03, 95% confidence interval [CI]: 0.0-0.3) and post-COVID-19 lung fibrosis risk (OR: 0.3, 95% CI: 0.1-0.9). CONCLUSION: Patients with T2DM exhibited a high prevalence of COVID-19 infection and associated mortality. However, COVID-19 vaccines were beneficial in reducing the risks of COVID-19-related mortality and post-infection lung fibrosis in these patients. COVID-19 vaccines and boosters are recommended for patients with T2DM. Further studies involving larger study populations are necessary to validate these findings.

Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis.

Purpose: To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease. Methods: This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate. Results: The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively. Conclusions: Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results. Clinical relevance: Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.

Inter-Arm Blood Pressure Difference an Indicator of Coronary Artery Disease.

INTRODUCTION: Considering the scarcity of the literature on the association between inter-arms blood pressure difference (IABPD) and coronary artery disease (CAD). AIM: We performed this study to investigate the prevalence of IABPD within the Jordanian population and to assess if it has an association with CAD. METHODS: We sampled patients visiting the cardiology clinics at the Jordan University Hospital between October, 2019 and October 2021 into two groups. Participants were divided into two groups; patients with severe CAD and control group who had no evidence of CAD. RESULTS: We measured the blood pressure for a total of 520 patients. Of the included patients, 289 (55.6 %) had CAD while 231 (44.4%) were labeled as controls who were normal. A total of 221 (42.5%) participants had systolic IABPD above 10 mmHg, while 140 (26.9%) had a diastolic IABPD above 10 mmHg. Univariate analysis demonstrated that patients with CAD were significantly more likely to be older (p < 0.001), of the male gender (p < 0.001), hypertensive (p < 0.001), and having dyslipidemia (p < 0.001). Moreover, they had significantly higher IABPD differences in terms of both systolic and diastolic blood pressure (p < 0.001 and p = 0.022, respectively). Multivariate analysis showed that CAD was a positive predictor of abnormal systolic IABPD. CONCLUSION: In our study, elevated systolic IABPD was associated with a higher prevalence of severe CAD. Patients with abnormal IABPD might be subjected to more specialist investigation as IABPD consistently predicts coronary artery disease, peripheral arterial disease or other vasculopathy throughout the literature.