Congenital Diaphragmatic Hernia at a Non-ECMO Center in Jordan.

OBJECTIVES: We studied the clinical characteristics and outcomes of neonates with congenital diaphragmatic hernia (CDH) admitted to a non-extracorporeal membrane oxygenation (ECMO) center. METHODS: A retrospective chart review of neonates with CDH admitted to a University Hospital, in Amman, Jordan, between 2005 and 2019. Demographic characteristics and their management details were extracted and factors associated with survival were analyzed. RESULTS: A total of 28 neonates born with CDH were included; their survival rate was 39.3%. Onset of respiratory distress, pre-operative ventilation, and length of hospitalization were significantly associated with mortality. Survival after surgery was significantly associated with a higher gestational age and a longer hospital stay. CONCLUSION: Our study showed a high mortality rate for CDH patients. Decreasing the health inequity and improved clinical interventions could improve outcomes.

Investigating medical students' satisfaction towards video-based learning versus face-to-face lectures: a Jordanian tertiary teaching hospital experience.

PURPOSE: We aimed to evaluate the disparity between video-based learning and lecture-based learning on Jordanian medical students' satisfaction. METHODS: We conducted this cross-sectional study using a web-based questionnaire adapted from Student Evaluation of Educational Quality survey. Using convenience sampling, medical students studying at the University of Jordan and Jordan University Hospital were recruited. Participants in either clinical or basic-science years that have completed the entire survey were included in the final analysis. RESULTS: We surveyed a total 487 participants among which male to female ratio was 1.19:1. Participants perceived greater benefit in terms of learning, instructor enthusiasm, content organization, breadth of teaching, and quality and number of assignments when using video-based learning (all p<0.01). In contrast, face-to-face learning was associated with significantly higher benefits in terms of group interactions (p<0.01) and capacity for rapport building (p<0.01). There was no significant difference in perceived examination performance between the two learning modalities (p=0.11). CONCLUSION: Video-based learning is the preferred learning modality among Jordanian medical students. Despite its dominance across multiple domains, it should be implemented as an adjunct to traditional classroom teaching for it is vital in the development of good communication skills and building rapport in medical students.

The implications of vaping on surgical wound healing: A systematic review.

BACKGROUND: E-cigarette use is rapidly growing, and little is known about the postoperative complications. Cigarette smoking has been well-established to be associated with delayed wound healing and increased complications in surgical patients. Due to the intricate and harmonious nature of the wound-healing process, vaping may impair tissue regeneration, posing a risk for patients undergoing surgery. This systematic review aimed to review the evidence on the implications of vaping on wound healing. METHODS: A systematic search of PubMed and Scopus databases was conducted on October 2022 per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following keywords were used to conduct the search: vaping, vape, e-cigarettes, electronic cigarettes, wound healing, tissue regeneration, postoperative complications, wound infection, and blood flow. RESULTS: Of 5,265 screened articles, only 37 were eligible for qualitative synthesis. A total of 18 articles studied the effect of e-cigarettes on human volunteers, 14 investigated e-cigarette extract on human cell lines, and 5 used animal rat models. CONCLUSION: Despite limited objective data, the recommendation is that e-cigarettes be treated as tobacco cigarettes; hence, vaping should be stopped in the perioperative period to decrease the incidence of wound healing complications. Clinical trials are required to understand the health hazards of e-cigarettes further and maximize patient safety and clinical outcomes.

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.

Nuss bar removal without straightening is a safe technique: a single center experience.

Background: A Nuss bar often placed to correct pectus excavatum is usually removed after a period of 2 to 3 years. Bar removal can result in potentially life-threatening complications. To minimize this risk, a recent systematic review recommends in-situ straightening of the bar before removal. Alternatively, the bar can be removed without straightening by extraction along the thoracic curvature. This study reports our single-center experience with this latter technique for bar removal, with focus on perioperative complications. Methods: A single-center retrospective observational cohort study was conducted. Consecutive patients undergoing Nuss bar removal between 2011 and 2020 were eligible for inclusion. The primary outcome was the incidence of perioperative complications. Secondary outcomes included duration of operation, blood loss, and length of postoperative hospital stay. Results: A total of 331 patients were included. Of these, 288 (87%) were male with a median age of 20 years [interquartile range (IQR), 19-26 years]. Perioperative complications occurred in a total of 4 patients (1%) following Nuss bar removal. Two patients (0.6%) experienced major complications (deep incisional surgical site infection and hemothorax respectively); there was no mortality. The median duration of surgery was 30 minutes (IQR, 20-40 minutes). Patients were discharged after a median postoperative stay of 1 day (IQR, 1-1 day). Conclusions: Nuss bar removal without prior in-situ bar straightening appears to be a safe and effective technique. It is associated with a low complication rate of 1%.

Estimation of sex based on metrics of the sternum in a contemporary Jordanian population: A computed tomographic study.

ABSTRACT: There is a paucity of osteometric standards for sex estimation from unknown skeletal remains in Jordan and the sexual dimorphism of the sternum has not yet been investigated. The aim of this study was to evaluate the sexual dimorphism in sternal measurements using 3D multidetector computed tomography (MDCT), and to assess their reliability for sex estimation in a Jordanian population. A total of 600 MDCT scans (300 males and 300 females) were used and a total of 8 sternal measurements were studied (manubrium length, sternal body length, combined length of manubrium and body, corpus sterni width at 1st and 3rd sternebrae, sternal index and area). Sexual dimorphism was evaluated by means of discriminant function analyses. Significant sexual dimorphism was found mainly in middle-aged and older adults. Including all subjects, multivariate, and stepwise functions gave an overall accuracy of 83.0% and 84.0%, respectively. Additionally, multivariate and stepwise analyses were conducted separately for each age group. The accuracy of sex estimation in multivariate analysis (all variables) varied from 63.2% in the young, and 83.7% in the middle adults to 84.9% for older adults. In stepwise analysis, the highest accuracy rates were provided by only sternal area in young adults (81.6%), and sternal area combined with sternal body length in middle-aged and older adults (84.2% and 85.3%, respectively). The best sex discriminator using univariate analysis (single variable) was sternal area followed by sternal body length (84.0% and 80.8% respectively). Notably, univariate analyses for most variables gave relatively higher classification accuracies in females but were poor at predicting males in the sample (sex bias ranged between -6.4% and -20%). Our data suggest that dimorphism in the human sternum increases with advancing age and separate discriminant functions are needed for each age group in Jordanians. In addition, multivariate and stepwise analyses using sternum gave higher classification accuracies with comparatively lower sex biases compared to univariate analyses.

Estimation of sex from measurements of foramen magnum region in a contemporary Jordanian population: A computed tomographic study.

Several studies have shown variability in basicranial measurements between populations. Therefore, each population should have specific standards to optimize the accuracy of identification. The aim of this study was to evaluate the sexual dimorphism in foramen magnum and occipital condyles measurements using 3D multidetector computed tomography (MDCT), and to assess their utility and reliability for sex estimation in a Jordanian population by means of discriminant function analyses. A total of 500 MDCT scans (288 males and 212 females) were used and a total of 8 basicranial measurements were studied (3 measurements were derived from foramen magnum, and 5 measurements were derived from occipital condyles). Significant sexual dimorphism was found in all basicranial measurements. The most dimorphic variables were length of occipital condyle and maximum bicondylar distance. Including all variables, multivariate and stepwise functions gave an overall accuracy of 77.8% and 78.6%, respectively. However, the multivariate analyses conducted separately for measurements derived from foramen magnum and occipital condyles gave lower overall accuracy of 68.6% and 70.0%, respectively. Basicranial measurements derived from foramen magnum alone predicted males with relatively higher accuracy but were poor at predicting females in the sample (82.6% were males, 49.5% were females, sex bias 33.1%). Adding occipital condyles measurements to the multivariate analysis increased the percentage of correct sexing in females and reduced considerably the sex bias (78.8% male, 76.4% female, sex bias 1.4%). Discriminant function analysis using basicranial measurements derived from both foramen magnum and occipital condyles measurements can be utilized to estimate sex in our population.

Intraocular Medulloepithelioma: AIRP Best Cases in Radiologic-Pathologic Correlation.

Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).

Peak-height formula for higher-order breathers of the nonlinear Schrödinger equation on nonuniform backgrounds.

Given any background (or seed) solution of the nonlinear Schrödinger equation, the Darboux transformation can be used to generate higher-order breathers with much greater peak intensities. In this work, we use the Darboux transformation to prove, in a unified manner and without knowing the analytical form of the background solution, that the peak height of a high-order breather is just a sum of peak heights of first-order breathers plus that of the background, irrespective of the specific choice of the background. Detailed results are verified for breathers on a cnoidal background. Generalizations to more extended nonlinear Schrödinger equations, such as the Hirota equation, are indicated.

Dynamic patient grouping and prioritization: a new approach to emergency department flow improvement.

The demand on emergency departments (ED) is variable and ever increasing, often leaving them overcrowded. Many hospitals are utilizing triage algorithms to rapidly sort and classify patients based on the severity of their injury or illness, however, most current triage methods are prone to over- or under-triage. In this paper, the group technology (GT) concept is applied to the triage process to develop a dynamic grouping and prioritization (DGP) algorithm. This algorithm identifies most appropriate patient groups and prioritizes them according to patient- and system-related information. Discrete event simulation (DES) has been implemented to investigate the impact of the DGP algorithm on the performance measures of the ED system. The impact was studied in comparison with the currently used triage algorithm, i.e., emergency severity index (ESI). The DGP algorithm outperforms the ESI algorithm by shortening patients' average length of stay (LOS), average time to bed (TTB), time in emergency room, and lowering the percentage of tardy patients and their associated risk in the system.

Anatomy of the Akhmediev breather: Cascading instability, first formation time, and Fermi-Pasta-Ulam recurrence.

By invoking Bogoliubov's spectrum, we show that for the nonlinear Schrödinger equation, the modulation instability (MI) of its n=1 Fourier mode on a finite background automatically triggers a further cascading instability, forcing all the higher modes to grow exponentially in locked step with the n=1 mode. This fundamental insight, the enslavement of all higher modes to the n=1 mode, explains the formation of a triangular-shaped spectrum that generates the Akhmediev breather, predicts its formation time analytically from the initial modulation amplitude, and shows that the Fermi-Pasta-Ulam (FPU) recurrence is just a matter of energy conservation with a period twice the breather's formation time. For higher-order MI with more than one initial unstable mode, while most evolutions are expected to be chaotic, we show that it is possible to have isolated cases of "super-recurrence," where the FPU period is much longer than that of a single unstable mode.