Predictive factors for readmission after bariatric surgery: Experience of an obesity center.

Avoidable readmissions after bariatric surgery are a major burden on the healthcare systems. Rates of readmission after bariatric surgery have ranged from 1% up to 20%, but the factors that predict readmission have not been well studied. The objective of this study was to determine readmission rates following bariatric surgery and identify factors that contribute to early (within 90 days of surgery) and late readmission. A retrospective cohort study of 736 patients undergoing either Laparoscopic Sleeve Gastrectomy or Laparoscopic Roux-en-Y Gastric Bypass in Jordan University Hospital from 2016 to 2019. Demographic characteristics, co-morbidities, and readmissions were extracted from their medical records and analyzed. Multivariable logistic regression analysis was performed to determine which factors predict readmission. A total of 736 patients had bariatric surgery (Laparoscopic Sleeve Gastrectomy 89% vs Laparoscopic Roux-en-Y Gastric Bypass 11%) during the study period. Thirty-day readmission rate was 6.62% and an overall readmission rate of 23.23%. Common reasons for early readmission (within 90 days of surgery) were nausea, vomiting, and dehydration. Late readmissions were mainly caused by gallbladder stones. Three risk factors were identified that independently predicted readmission: the type of procedure being performed (P-value = .003, odds ratio [OR] 2.14, 95% confidence interval [CI] 1.32-3.49), depression (P-value = .028, OR 6.49, 95% CI 1.18-52.9) and preoperative body mass index (P-value = .011, OR 1.03, 95% CI 1.01-1.05). Several factors were identified that cause patients to represent and subsequently admitted into hospitals. Early readmission was usually due to nausea, vomiting, and dehydration, whereas late admissions were mostly due to biliary complications. Preoperative body mass index and depression were independent risk factors for readmission.

Analysis of terminated pulmonary hypertension clinical trials. What are we doing wrong?

Despite significant interest in the diagnosis and treatment of pulmonary hypertension (PH) over the past two decades, there have been no notable advancements in reducing mortality. One contributing factor to this lack of progress is the insufficient number of well-designed and conducted trials. We aimed to evaluate factors associated with termination of PH clinical trials, to serve as a reference when designing future trials. We searched the ClinicalTrials.gov database for PH clinical trials conducted between January 1st 2000 to December 31st 2020. Information collected and analyzed included trial design, status, and publication status. Of the 240 analyzed clinical trials, 81% evaluated therapeutic interventions. Around 30.4% of the trials were terminated, most commonly due to recruitment issues. Terminated trials had a significantly lower number of enrolled patients when compared to trials that were completed (p= .017). Furthermore, there was an overall negative correlation between the year of trial initiation and the total number of enrolled patients (r= -0.18; p= .013). The likelihood of termination decreased by 1.9% for every additional enrolled patient. Ultimately, only 37.5% of the trials have been published. There was a significant positive correlation between number of patients enrolled and the journal's impact factor (r = 0.4, p < 0.05). Pharmaceutical companies sponsored the majority of the trials. The termination rate of PH trials is higher than other conditions. Factors such as recruitment contribute significantly to termination. Further studies are required to evaluate the challenges associated with recruiting this patient population.

The Risk of Developing Osteosarcoma After Teriparatide Use: A Systematic Review.

Teriparatide is a recombinant human parathyroid hormone analog with anabolic mechanism of action utilized in the treatment of osteoporosis with well-established clinical efficacy. Its use is significantly hindered due to label warnings resulting from pre-clinical rat studies demonstrating an increased risk of osteosarcoma. However, clinical trials and post-marketing surveillance studies did not demonstrate any increased risk of osteosarcoma, even after prolonged periods of surveillance reaching up to 15 years, with most of the identified cases of osteosarcomas being solitary and predominantly attributed to other factors. This systematic review provides a comprehensive overview of the currently available literature and provides the highest level of clinical evidence towards demonstrating the lack of any substantial evidence towards osteosarcoma development in patients utilizing TPTD.

Geographic variation in the association between Hashimoto's thyroiditis and Papillary thyroid carcinoma, a meta-analysis.

PURPOSE: The association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis (HT) remains a matter of debate. Several genetic and environmental factors have been found to influence this association. Because of the variation in these factors among different populations, we conducted a country- and region-based meta-analysis to examine whether the geographic area influences this association. METHODS: We searched PubMed and Web of Science databases for original articles that investigated the association between HT and PTC from February 1955 to February 28, 2023. The included studies were stratified according to their country and region of origin. Various subgroup analyses were conducted. The primary outcome was the pooled relative risk (RR) and its 95% confidence interval (CI) for each region and country. RESULTS: Forty-six studies including a total of 93,970 participants met our inclusion criteria. They originated from 16 countries distributed in five regions. Significant variation was found among countries but not among regions. Upon analysis of all 46 included studies, countries were classified based on their RR and its 95% CI. Excluding countries with pooled sample sizes <500, Sri Lanka (RR 4.23, 95% CI 2.91-6.14), Poland (RR 3.16, 95% CI 2.79-3.57) and Japan (2.68, 2.14-3.36) showed the strongest association between HT and PTC while Greece (RR 1.06, 95% CI 1.00-1.13), Spain (RR 0.70, 95% CI 0.23-2.11), and Jordan (0.62, 0.32-1.32) showed no significant association. CONCLUSION: Our findings revealed a variation in the association between HT and PTC among countries but not among regions. The country-to-country variation could be due to certain genetic and/or environmental factors subject to geographic variation that influence this association. These findings may help guide health policies aiming to mitigate the risk of PTC in the HT population by helping identify high-risk and low-risk countries.

Predictors of glaucoma knowledge and its risk factors among Jordanian patients with primary open angle glaucoma at a tertiary teaching hospital: A cross-sectional survey.

PURPOSE OF STUDY: To assess and compare glaucoma knowledge between Jordanian patients with glaucoma and non-glaucoma ophthalmic patients. METHODS: A cross-sectional survey was developed after an extensive literature search to investigate glaucoma-related knowledge among participants with glaucoma visiting the Jordan University Hospital clinics from October 2021 to February 2022. Responses were compared to a sample of ophthalmic participants with eye conditions other than glaucoma visiting the ophthalmology clinics at the same time frame. RESULTS: A total of 256 participants filled out the survey, of which 53.1% were diagnosed with glaucoma while 46.9% had ophthalmic conditions other than glaucoma. Our sample of participants is characterized by a mean age of 52.2 ± 17.8 years and a male-to-female ratio of 1.04:1. Overall, participants with glaucoma were more aware of their disease than participants with other ophthalmic conditions. Compared to their ophthalmic non-glaucoma counterparts, those diagnosed with glaucoma face significantly more daily life difficulties due to their ophthalmic disease (p <0.001). Results of the independent sample t-test demonstrate that participants with glaucoma have significantly higher knowledge scores (p <0.001) and were able to recognize more glaucoma symptoms than their non-glaucoma counterparts (p = 0.002). Similarly, those with a positive family history of glaucoma displayed higher knowledge (p = 0.005). Multivariate linear regression demonstrates that family history of glaucoma, higher symptom recognition score, reliance on ophthalmologists, and the internet for glaucoma-related information are positive predictors of higher knowledge scores. CONCLUSION: We have demonstrated that both glaucoma and non-glaucoma ophthalmic patients display average levels of glaucoma knowledge. Raising awareness through various interventions may improve the lifestyles of patients with glaucoma and alleviate the economic burden associated with treating the disease.

Perceived barriers towards the importance and application of medical research: a source of gender disparity among medical undergraduates.

BACKGROUND: Little is known about gender disparity among medical undergraduates in the developing world. Therefore, this study aims to explore the attitudes and perceived barriers among Jordanian medical students, particularly women. METHODS: An online, self-administered questionnaire, developed after an extensive literature review, was disseminated across all six Jordanian medical schools targeting more than 5000 medical students. Student t-test and ANOVA were used to document mean differences among different groups. Linear and logistic regression models were used to find predictors of publication and number of publications. RESULTS: A total of 636 students participated in the survey with a women to men ratio of 1.1. Women medical students report significantly higher knowledge (t(634) = 2.47, p = 0.013), personal (t(634) = 3.31, p = 0.001), and total barriers scores than men (t(634) = 3.02, p = 0.003). Moreover, compared to men, women were less likely to find same-sex mentorship (t(634) = 3.18, p = 0.001) or receive credited authorship (t(634) = 2.12, p = 0.011). Overall, women medical students were more likely to perceive that their gender (t(634) = 3.58, p < 0.001) and people's perception of their gender (t(634) = 4.25, p < 0.001) are barriers to their career advancement. Binary logistic regression demonstrated that gender is a significant predictor of being able to publish (OR: 1.645; 95%CI: 1.002-2.731), while linear regression demonstrated that gender is a predictor of number of publications (ß: 0.113; 95%CI: 0.063-0.288). CONCLUSION: A significant gender disparity exists in terms of both attitudes and overall barriers among Jordanian medical undergraduates which calls for immediate policy changes as to produce successful clinicians and researchers.