Diabetic Ketoacidosis in Northern Jordan: Seasonal Morbidity and Characteristics of Patients.

Purpose: This study aimed to characterize adult patients admitted with diabetic ketoacidosis (DKA) in northern Jordan. Methods: The study examined medical records of patients diagnosed with DKA from January 2015 to April 2018. Variables analyzed included diabetes type, precipitating illness, admission month, hospital length of stay, and biochemical markers. Results: Out of 232 admissions with DKA, 70% were diagnosed with type 2 diabetes, and 56% were females. 12% of admissions had a new diagnosis of diabetes, of which 51% had type 2 diabetes. Sepsis (48%), Non-adherence (26%), and diabetic foot infections (18%) were the most encountered precipitating factors for DKA in T1DM. As for T2DM, sepsis (52%), acute coronary syndrome (12%), and pancreatitis (8%) were the most precipitating factors for DKA. High urea levels, high creatinine levels, low phosphorous levels, low hemoglobin levels, and high platelet counts were associated with a longer hospital stay for type 1 diabetes. For type 2 diabetes, low pH on admission, old age, and high Hb A1c within 6 months of admission were factors associated with a prolonged hospital stay. The study found a significant peak of admissions for DKA in both type 1 and type 2 patients in the winter and spring months (Pearson P-value= 0.0013). Conclusion: The results of the present study highlight the seasonal variation in the frequency of DKA hospitalizations. It also highlights sepsis as the most frequent precipitating factor of DKA in both type 1 and type 2 DM patients.

Evaluation of serum VIP and aCGRP during pulmonary exacerbation in cystic fibrosis: A longitudinal pilot study of patients undergoing antibiotic therapy.

BACKGROUND: Objective monitoring of improvement during treatment of pulmonary exacerbation can be difficulty in children when pulmonary function testing cannot be obtained. Thus, the identification of predictive biomarkers to determine the efficacy of drug treatments is of high priority. The major aim of the current study was to investigate the serum levels of vasoactive intestinal peptide (VIP) and alpha calcitonin gene related peptide (aCGRP) of cystic fibrosis pediatric patients during pulmonary exacerbation and post-antibiotic therapy, and possible associations of their levels with different clinicopathological parameters. METHODS: 21 patients with cystic fibrosis were recruited at onset of pulmonary exacerbation. Serum was collected at time of admission, three days post-antibiotic therapy, and two weeks post-antibiotic therapy (end of antibiotic therapy). Serum VIP and aCGRP levels were measured using ELISA. RESULTS: Overall least square means of serum aCGRP level but not VIP changed from time of exacerbation to completion of antibiotic therapy (p = 0.005). Serum VIP was significantly associated with the presence of diabetes mellitus (p = 0.026) and other comorbidities (p = 0.013), and with type of antibiotic therapy (p = 0.019). Serum aCGRP level was significantly associated with type of antibiotic therapy (p = 0.012) and positive Staphylococcus aureus microbiology test (p = 0.046). CONCLUSION: This study could only show significant changes in serum aCGRP levels following treatment of pulmonary exacerbations. Future studies with larger sample size are required to investigate the clinical importance of VIP and aCGRP in cystic fibrosis patients.

Lifestyle Variations during and after the COVID-19 Pandemic: A Cross-Sectional Study of Diet, Physical Activities, and Weight Gain among the Jordanian Adult Population.

The way that COVID-19 has been handled since its inception in 2019 has had a significant impact on lifestyle-related behaviors, such as physical activities, diet, and sleep patterns. This study measures lifestyle-related behavior during the COVID-19 pandemic lockdown using a 22-item questionnaire. The responses were collected from March 2021 to September 2021. A total of four hundred and sixty-seven Jordanian participants were engaged in assessing the changes caused by the pandemic and their effect on BMI. The validity and reliability of the questionnaire were tested for 71 participants. Cronbach's alpha values for the questionnaire exceeded 0.7, demonstrating good reliability and internal consistency. The effect of each question regarding physical activity and dietary habits over the BMI difference was studied using ANOVA. The study shows that more than half of the participants reported snacking more between meals and increased their sitting and screen time, while 74% felt more stressed and anxious. BMI difference among the individuals throughout the lockdown was significantly associated with these variables. In contrast, 62% of the participants showed more awareness about their health by increasing the intake of immunity-boosting foods, and 56% of the participants showed an increase in the consumption of nutrition supplements. Females and married individuals tended to be healthier. Therefore, their BMI showed stability compared to others based on their gender and marital status. Exercise, sleep, and avoiding 'junk' food, which contributes to weight gain and COVID-19 vulnerability, are strongly recommended.

Effect of immersive virtual reality on pain in different dental procedures in children: A pilot study.

BACKGROUND: Implementing effective pain management is important to increase patient compliance during paediatric dental procedures. AIM: This pilot study was conducted to evaluate the effectiveness of virtual reality (VR) on pain perception in dental procedures in children. MATERIAL AND METHODS: Fifty-four children aged between 5 and 12 years were included. Patients scheduled to receive dental procedures not requiring local anesthesia (eg, fluoride therapy) were assigned to Group A, and patients scheduled to receive painful dental procedures requiring local anesthesia (eg, pulp therapy, teeth extraction) were assigned to Group B. Patients in each group were randomly assigned and were equally likely to either receive VR during their dental procedure, or treatment as usual (without VR). Visual analog scale (VAS), Wong-Baker FACES rating scale, and the 'Face, Legs, Activity, Cry, Consolability' scale (FLACC scale) were used to assess the pain levels during dental procedures. RESULTS: Patients receiving painful dental procedures requiring local anesthesia reported significant reductions in pain intensity/worst pain during the dental procedure on all subjective and behavioral pain measures of pain intensity with the use of VR distraction technique (P < .05 on each). Patients receiving non-painful dental procedures showed the predicted pattern but no significant reduction in worst pain during VR. CONCLUSION: The use of VR was found to be an effective distraction tool to ease pain and anxiety in the tested dental procedures, for children receiving painful dental procedures.

Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan.

BACKGROUND: Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. METHOD: A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student's t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. RESULTS: Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03-1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1-2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84-0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. CONCLUSION: Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

Frailty and Its Correlates in Cognitively Intact Community-Dwelling Older Adults.

BACKGROUND: Frailty syndrome is characterized by a decline in physiological and psychological reserve and may be associated with poor health outcomes. OBJECTIVES: The current study explored frailty and its correlates among cognitively intact community-dwelling older adults. METHODS: A secondary analysis of data collected from 109 community-dwelling older adults who are cognitively intact was conducted for the purpose of this study. The Arabic versions of the culturally adapted Tilburg Frailty Indicator, the Montreal Cognitive Assessment, the Geriatric Depression Scale, and the Short Form-36 Quality of Life (QOL) survey. Multiple linear regression was used to examine the relationships between frailty and depression. RESULTS: The results indicated a high prevalence of frailty (78%) and depression (38%) among cognitively intact community-dwelling older adults. Frailty was found to be associated with increased age, being single or illiterate, living alone, having a high number of comorbid conditions, having high rate of depression, and having poor QOL. CONCLUSION: High prevalence of frailty is associated with high depression scores, a high number of comorbid conditions, and poor QOL among cognitively intact community-dwelling older adults.

Social impairment in children with epilepsy assessed by the social responsiveness scale.

Children with epilepsy are at risk for impaired social cognition and autism. We aimed at evaluating the utility of the social responsiveness scale (SRS) for assessment of social impairment in these children. Prospective study; the SRS was applied to a group of children with epilepsy and a healthy control group. Intellectual disability in the epilepsy group was assessed utilizing adapted versions of the Wechsler Intelligence and adaptive behavior scales. One hundred and one children with epilepsy and 92 healthy children were included. The majority of children in both groups had normal SRS scores. Significant differences were identified in children with high total scores indicating significant deficiencies in reciprocal social behavior; high scores were found in 16% of children with epilepsy versus 7% of normal children, p < .05, particularly involving social communication, p < .05. Intellectual disability was identified in 42% of children with epilepsy, particularly processing speed index, p < .001. Intellectual disability had a significant effect on total scores, p = .016. Children with epilepsy have increased risk of social impairments. Social impairments are more likely in the presence of intellectual disability. The SRS is a quick identification tool that can be employed in the outpatient setting.

Body mass index and potential correlates among elementary school children in Jordan.

PURPOSE: Childhood obesity and overweight are on the rise worldwide, and Jordanian children are no exception to this rule. Childhood Obesity has major implications on the physical and mental health of individuals, and it can often develop into adult obesity. Obesity/overweight correlates have not been researched extensively in the Middle East region, where Jordan is central. This region is undergoing tremendous changes because of wars, globalization, and the influx of refugees. The cultural and eating habits of the people are changing along with demographical changes. Thus, timely research is required to assess the current health state of this dynamic society. The main goal of this study is to understand the environmental and cultural factors that are associated with Body Mass Index (BMI) z score in elementary school children in Jordan. METHODS: A total of 1260 children enrolled in this descriptive, cross-sectional study. The study used a parental self-reporting questionnaire that contains possible factors associated with BMI, zBMI, demographics, and other pertinent information. RESULTS: Several factors have been associated with higher zBMI among elementary school children: if a child owns a smartphone (p = 0.0037), uses electronics to play ([Formula: see text]), uses electronics for longer hours ([Formula: see text]), eats food while using electronics or watching TV ([Formula: see text] and [Formula: see text], respectively), sleeps less hours in weekends ([Formula: see text]), was breastfed for lower number of months ([Formula: see text]), lives in rural areas ([Formula: see text]), goes to a private school ([Formula: see text]) and is a male ([Formula: see text]). CONCLUSION: Investigating characteristics and environmental determinants of childhood obesity play an essential role in establishing effective intervention program and reduce future risks of morbidity. LEVEL OF EVIDENCE: Level V, descriptive (cross-sectional) study.

Outcomes of arteriovenous fistula creation: A Jordanian experience.

OBJECTIVE: The arteriovenous fistula is considered the preferred hemodialysis access due to its lower complication rate and longer patency. The aim of this study is to report the outcomes of arteriovenous fistula creation and to study the predictive factors for these outcomes. STUDY DESIGN AND METHOD: This is a retrospective study of all patients who underwent autogenous arteriovenous fistula creation procedure by a single surgeon during the period from October 2011 till December 2017. MATERIAL: All the procedures were performed at an academic referral center by a single surgeon. All patients who underwent arteriovenous fistula creation in the upper limb during the study period were included. All patients were diagnosed with end-stage renal disease and referred for arteriovenous fistula creation either before or after initiating hemodialysis. METHOD: Data were collected from the patients' charts. The primary outcomes were the primary failure and secondary patency rates. Secondary outcome was to find the factors associated with decreased patency. The Kaplan-Meier curve with the log-rank test was used to describe the patency while univariate and multivariate analyses were done to the factors considered relevant to the patency. RESULTS: The total number of procedures was 291; of which, 18 were lost to follow-up. The primary failure rate was 12%. Secondary patency rate at 1 and 5 years was 79% and 53%, respectively. Diabetes mellitus and fistulae placed on right side were associated with decreased patency. CONCLUSION: The primary failure rate was relatively low in this study but the long-term functionality of the arteriovenous fistulae needs to be improved.

Association of smoking with direct medical expenditures of chronic diseases in north of Jordan: a retrospective cohort study.

OBJECTIVE: This study aimed to estimate the association of smoking with the direct medical expenditures for chronic disease management in north of Jordan. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study using hospital database. Patients who were diagnosed with at least one chronic disease,were aged 18 years or older and had attended King Abdullah University Hospital for disease management and procedures from 1 July 2015 through 30 June 2016 were included in the study. MAIN OUTCOME MEASURES: The outcome of interest was the direct medical expenditures for chronic disease management according to smoking status. RESULTS: Data were collected from 845 patients having at least one chronic disease (mean age of 61±10.7 years). Smokers formed 22% of total patients. The back transformed mean total expenditure per patient of smokers, former smokers and non-smokers was 875 JD, 928 JD and 774 JD, respectively. Drugs were the most expensive healthcare resource used, accounting for 43% of total expenditure, followed by inpatient-related and outpatient-related services (19%). Smokers and former smokers were associated with the highest inpatient expenditures and inpatient-related and outpatient-related services expenditures. However, smokers were associated with the lowest outpatient and medication expenditures. CONCLUSIONS: Smokers and former smokers presented with higher statistically significant inpatient-related and outpatient-related services expenditures and higher transformed mean total expenditures compared to non-smokers; highlighting this economic burden is useful for promoting tobacco control policies.

Evaluation of Patched-1 Protein Expression Level in Low Risk and High Risk Basal Cell Carcinoma Subtypes.

Objective: Basal cell carcinoma (BCC) is the most common malignancy in humans and represents a growing public health care problem. The major etiological factors contributing to BCC development are exposure to ultraviolet radiation and genetic alterations. BCC is primarily caused by dysregulation of sonic Hedgehog (HH) signaling pathway in basal cells of the skin. BCC can be classified into low risk non-aggressive and high risk aggressive subtypes. BCC subtypes differentiation is essential for prognosis and for better disease management and treatment strategies. The aim of this study was to assess the correlation between PTCH1 protein expression level and the aggressiveness of BCC histopathology. Methods: Archival paraffin embedded blocks containing BCC were retrieved from a cohort of 101 patients. Immunohistochemistry staining was performed to assess the expression level of PTCH1 which is a key component of Hedgehog pathway. Results: 101 paraffin embedded samples were evaluated and classified as high risk and low risk BCC subtypes by histopathological finding. High risk BCC subtypes were found in 40 samples (39.6%) and low risk subtypes were identified in 61 samples (60.4%). Nodular was the most frequent subtype which was found in (56/ 101), followed by infiltrative (22/101) and micronodular (14/ 101) subtypes. Positive PTCH1 expression was found highest in nodular subtypes (46.5%). Conclusion: In this study, the correlation between low risk or high risk BCC subtypes and PTCH1 expression level was not statistically significant (p>0.05), but the frequency of positive PTCH1 expression was found to be higher in low risk subtypes than high risk BCC subtypes.

Acoustic characteristics of Arabic pharyngealized obstruents in children with cochlear implants.

Speech production of children with cochlear implants (CIs) is generally characterized by low intelligibility and reduced phoneme accuracy. However, limited research investigated their speech production using acoustic measures. The current study examined voice onset time (VOT) for pharyngealized plosives [t,d], and spectral moments and noise duration for pharyngealized fricatives [s,ð] produced by Arabic speaking children with CIs. Productions from children with CIs were compared with both chronological age-matched and hearing experience-matched normal hearing children. Results showed that children with CIs exhibited difficulty producing distinct VOTs between plosives and produced different spectral patterns of both fricatives relative to both comparison groups; however, they were able to produce an acoustic distinction between both fricatives. Children with CIs produced the fricatives with lower spectral mean and higher skewness and kurtosis. The sources for inter-group differences in the acoustic measures appeared to be due in part to limitations in the quality of auditory input provided by CIs as well as reduced motor experience in speech production. Results suggest that VOT and spectral moments are sensitive to changes in perceived sound quality. Spectral moments analysis appears to give details on subtle aspects of fricative production at the phonetic level beyond that available using perceptual judgments.

Risk assessment of comorbidities on 30-day avoidable hospital readmissions among internal medicine patients.

RATIONALE, AIMS AND OBJECTIVES: Reducing the rate of hospital readmissions, particularly avoidable ones, has significant implications on patient outcomes, cost containment, and quality of care. Given that the reason of readmission may differ from the patient's main diagnosis in the index admission, this study aims to assess the influence of index comorbidities on the primary readmission diagnoses and explore the risk of deemed avoidable readmission because of prior comorbidities. METHODS: A retrospective review of 3962 discharges was conducted at a 527-bed teaching hospital in Jordan, utilizing data related to 2025 internal medicine patients. RESULTS: Among all discharges, 29% were followed by a 30-day readmission, of which 13% were identified as potentially avoidable. Of all readmissions, 36% of patients were readmitted because of one of the comorbidities that had been identified at index admission. In addition, 47% of the potentially avoidable readmissions had a main diagnosis that was one of the index comorbidities. The results also showed an association between readmission for one of the index stay's comorbidities and being avoidable, with an adjusted odds ratio of 2.12 (95% confidence interval, 1.65-2.72). Overall, the presence of certain diseases, being identified as one of the preceding comorbidities, was found to have a substantial influence on the risk of potentially avoidable readmission. These diseases included digestive, circulatory, respiratory, genitourinary systems, and infectious and parasitic diseases (adjusted relative risks = 1.57, 1.49, 1.36, 1.30, and 2.30, respectively). CONCLUSION: To help reduce the rates of readmission, potential gains seem available if hospitals adopt clinical practices that support the patient's care during the post-discharge transition. This implies that health care providers need to pay more attention to the comorbidities of high-risk patients to be closely monitored after discharge.

Vagus nerve stimulation therapy in a developing country: a long term follow up study and cost utility analysis.

PURPOSE: To evaluate clinical outcomes, quality-adjusted life years (QALY), cost effectiveness and cost utility associated with VNS therapy in children with refractory epilepsy in a developing country. METHODS: Retrospective review of all children who underwent VNS implantation at King Abdullah University Hospital and Jordan University Hospital in Jordan. RESULTS: Twenty eight patients (16 males) had implantation of the VNS therapy system between the years 2007 and 2011. Mean age at implantation was 9.4 years. Mean duration of epilepsy prior to implantation was 6.5 years. The most common seizure type was generalized tonic clonic seizures. Fifteen patients showed a 50% or more reduction in seizure frequency. There was a significant reduction in total number of seizures (p=0.002) and emergency room (ER) visits (p=0.042) after VNS therapy. Atonic seizures were more likely to respond than generalized tonic clonic seizures, p=0.034. Direct hospital costs prior to VNS implantation were analyzed in relation to ER visits and intensive care unit (ICU) admissions. Cost savings per patient did reduce the financial burden of the device by about 30%. There was a QALY gain per lifetime of 3.78 years for children and 1 year for adolescents. CONCLUSION: Response to VNS implantation in Jordan was favorable and similar to what has been previously reported. QALY gain and cost per QALY analysis were encouraging. Cost savings were related to reduction in seizure severity. In circumstances of limited resources as in developing countries, targeting patients with frequent utilization of health services would improve cost effectiveness.