Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has emerged as a pandemic for more than 2 years. Autopsy examination is an invaluable tool to understand the pathogenesis of emerging infections and their consequent mortalities. The aim of the current study was to present the lung and heart pathological findings of COVID-19-positive autopsies performed in Jordan. METHODS: The study involved medicolegal cases, where the cause of death was unclear and autopsy examination was mandated by law. We included the clinical and pathologic findings of routine gross and microscopic examination of cases that were positive for COVID-19 at time of death. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed through molecular detection by real-time polymerase chain reaction, serologic testing for IgM and electron microscope examination of lung samples. RESULTS: Seventeen autopsies were included, with male predominance (76.5%), Jordanians (70.6%), and 50 years as the mean age at time of death. Nine out of 16 cases (56.3%) had co-morbidities, with one case lacking such data. Histologic examination of lung tissue revealed diffuse alveolar damage in 13/17 cases (76.5%), and pulmonary microthrombi in 8/17 cases (47.1%). Microscopic cardiac findings were scarcely detected. Two patients died as a direct result of acute cardiac disease with limited pulmonary findings. CONCLUSIONS: The detection of SARS-CoV-2 in postmortem examination can be an incidental or contributory finding which highlights the value of autopsy examination to determine the exact cause of death in controversial cases.

The association between antihypertensive medications and mental health outcomes among Syrian war refugees with stress and hypertension.

BACKGROUND: Little is known about the association between antihypertensive drugs with mental health outcomes. We examined the association between the antihypertensive classes and other clinical patient features with symptoms of depression, anxiety, insomnia, and Post-Traumatic Stress Disorder (PTSD) in a cohort of Syrian war refugees with stress and hypertension residing in Jordan. METHODS: This cross-sectional study recruited hypertensive Syrian refugees with stress. Depression severity was assessed using the Patient Health Questionnaire-9, anxiety was measured by The General Anxiety Disorder-7, the Insomnia Severity Index was used to evaluate sleep quality and PTSD was measured using Davidson Trauma Scale. To investigate the association between the different classes of antihypertensive medication and mental health outcomes we used multivariable regression models. RESULTS: Of the 492 participants, 251 were men (51%), 234 (47.6%) were on ß-blockers, 141 (28.7%) on diuretics, and 209 (42.5%) on Angiotensin Converting Enzyme Inhibitors (ACEIs)/Angiotensin Receptor Blockers (ARBs). Although the multivariate regression revealed the different classes of antihypertensives are not associated with mental health symptoms, however, physical activity is associated with lower adjusted odds for symptoms of depression (0.68 (0.46-0.99), p = 0.04), anxiety (0.60 (0.42-0.85),p = 0.005), insomnia (0.63 (0.44-0.91),p = 0.01) and dyslipidemia (3.48(0.29-6.69),p = 0.03) is associated with higher PTSD symptoms. LIMITATIONS: The study subjects were not assessed for psychiatric diagnoses clinically. Further, we used a cross-sectional design that does not allow to measure longitudinal changes. CONCLUSIONS: The association between antihypertensive drugs and mental health symptoms was not evident in the present study. Follow-up future studies are required.

Presentation of a large pseudoaneurysm of the brachial artery: A case report.

Brachial artery pseudoaneurysms (PSA) are considered uncommon, but they can be limb and life threatening. Most etiologies are related to iatrogenic injury or following a fracture. Here we present a 37-year-old male complaining of a large swelling in his right upper arm that was gradually increasing in size for the last 7 months. It started with a sudden onset of pain while lifting heavy boxes at his daily job. Ultrasound and MRA showed a pseudoaneurysm of the right brachial artery. Resection of the PSA was performed with a vein interposition graft. This case illustrates the significance of considering PSA as a differential diagnosis in patients presenting with upper arm swelling without history of obvious trauma.

The impact of the Covid-19 pandemic on emergency surgery in a tertiary hospital in Jordan. A cross sectional study.

BACKGROUND: Since the emergence of COVID-19 pandemic, governments around the world reacted by implementing curfews and sometimes nation-wide lockdowns intended to control the spread of the disease and help the already overwhelmed healthcare systems from imminent collapse. The Jordanian government was one of those countries that implemented a complete nation-wide lockdown which lasted for 3 months during the peak months of 2020. The aim of this study is to shed the light on the impact of this lockdown on the surgical emergency practice at a tertiary referral center in Amman, the capital of Jordan. METHODS: A retrospective review of the medical records of the patients who were admitted to the hospital through the emergency department over the lock-down months in 2020 and compare them to the records of the patients admitted within the same period in 2019. RESULTS: A total of 143 patients were admitted in the 2020 group, compared to 201 patients in the 2019 group, marking a 28% reduction in admission rate. The average duration of symptoms before the ER visit was significantly longer in the 2020 period compared to 2019 (95.32 ± 148.62 min, 57 ± 64.4 min respectively, p = 0.01) which resulted in a Significant increase in the ICU admission in the same period (P=.00001). As for the type of management, there was no difference between the two groups with similar percentage of surgeries performed in the two periods (p = 0.333). Additionally, the average length of stay did not also differ (p = 0.141). CONCLUSION: The COVID-19 pandemic has negatively affected the health care systems around the world to the point of collapse in some countries. This study has demonstrated its effects on the emergency surgery practice at our institution which was mainly related to the delay in getting medical care caused by the strict lock-down laws implemented in the country. Thus, we recommend that special measures should be taken to improve the access to medical care during future events that may require limiting the movement of people and vehicles in the country.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement.

PURPOSE: To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. METHODS: Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. RESULTS: During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). CONCLUSION: This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Right coronary sinus of valsalva aneurysm with rupture into the right ventricle.

We report a case of right coronary sinus of Valsalva aneurysm (SVA) with rupture into the right ventricle in a 23-year-old man. The problem was successfully managed with surgical closure of both ruptured SVA and the ventricular defect with cardiopulmonary bypass through median sternotomy.