Caudal regression syndrome: Postnatal radiological diagnosis with literature review of 83 cases.

Caudal regression syndrome (CRS) is a rare congenital disorder characterized by arrest of caudal spinal growth and associated with wide spectrum multisystemic anomalies. Herein, we presented a case of a newborn baby who did not pass meconium due to imperforated anus and was referred to the pediatric surgeon for urgent diverting loop colostomy. The conventional X-ray, abdominal ultrasound and abdominal pelvic magnetic resonance imaging (1.5 T) at 2-month-old age revealed right kidney agenesis, sacrococcygeal agenesis, vertebral bodies dysraphism and the spinal cord ends at D12-L1 with anterior and posterior bands of the terminating filaments. The diagnosis of CRS was confirmed. Through this case report, we hope to draw attention to this rare syndrome and the wide range of associated anomalies, also to consider this syndrome on the top of differential diagnosis list once the newborn has anorectal malformation mainly imperforated anus.

The clinical elective course and its effects on medical students and graduates of Jordanian medical schools.

BACKGROUND: The elective course is part of the 6th-year medical school curriculum in Jordan. Students choose the specialty in which they wish to spend 8 weeks and choose their location even if it is outside their university's affiliated hospitals. In this study, we try to understand student choices regarding the country of elective, chosen specialty, type of placement (observership/clerkship), and elective general value from participants' perspectives. METHODS: This paper used a cross-sectional study. The survey was distributed through social media platforms (mainly Facebook and WhatsApp) targeting 6th-year medical students and doctors who graduated from one of the 5 Jordanian medical schools (the University of Jordan, Jordan University of Science and Technology, Mutah University, Yarmouk University, and Hashemite University). RESULTS: The majority of participants had an international elective (69.6%), mainly in the USA, followed by the UK. Internal medicine was the primary field of interest for 14.8%, followed by general surgery. Of these, 241 (62.6%) actively participated in work at their chosen hospitals as they had a clerkship/hands-on experience. In contrast, 142 (36.9%) were observers. The majority indicated that the elective is worth the time, money, and effort. Moreover, they had adequate supervision throughout the course and could achieve their preset objectives. CONCLUSIONS: The elective course gives a unique experience to our students. General satisfaction is an indicator of the success of the course in actively exposing medical students to clinical practice.

Diabetic foot ulcer in Southern Jordan: A cross-sectional Study of Clinical and Microbiological Aspects.

Background: Diabetes mellitus (DM) is a common metabolic disorder that significantly affects public health. Diabetic foot ulcer (DFU) is one of the serious complications of diabetes. DFU has a wide spectrum of bacterial isolates comprising Gram-positive, Gram-negative, aerobic bacteria and anaerobes. In the last two decades there has been an increase in the multidrug-resistant isolates (MDR). Materials and methods: This cross-sectional prospective observational study was conducted in southern Jordan among patients with DFU. The included variables are sociodemographic and clinical information. Isolates from swab culture of ulcers and antimicrobial susceptibility pattern are also recorded. Results: A total of 64 diabetic patients with DFU were included in this study. Most patients included in the study were males with male-to-female ratio of (2.2:1). The mean age was 54 years (SD ± 10.7). The mean duration of DM was 16.4 years (SD ± 7.5) and the mean HbA1c was 9.9% (SD ± 2.1). Neuropathy and anemia were noted in 72% and 44% of patients, respectively. The most frequent bacterial isolates were gram negative bacteria accounts for 29 isolates (45.3%). About 37.5% (24) of bacterial isolates showed MDR pattern. Previous antibiotic use in the last 30 days showed significant association with MDR bacteria (p-value <0.05). Previous history of amputations, presence of neuropathy, renal impairment, retinopathy, presence of anemia, limited joint mobility and presence of foot deformity were significantly associated with Wagner's grade ≥ three. Conclusion: Many factors affect and increase the risk of having high grade diabetic foot ulcer. The most frequent bacterial isolates from diabetic foot ulcers were gram negative bacteria. High rates of MDR in this study reflect the loose implementation of regulations in Jordan regarding antibiotics dispensing.

Screening of Glypican-6 Expression in Benign, Primary and Metastatic Colon Cancers.

BACKGROUND: The development of colon cancer has been described as a multistep process of carcinogenesis. Understanding molecular and cellular changes underlying this process is required to determine potential biomarkers and therapeutic targets in colon cancers. Several molecular entities, including glypicans, are implicated in cancer development. Among these is glypican-6, which is overexpressed in a limited number of cancers. This study aims to characterise the glypican-6 expression in different types of colon cancer. METHODS: Immunohistochemistry was used to characterise glypican-6 expression in a panel of archived formalin-fixed, paraffin-embedded colon tissue types. These types included 39 normal colon tissues, 10 colon tubular adenomas, 60 colon adenocarcinomas without metastasis and 60 colon adenocarcinomas with metastasis. Glypican-6 expression relation to demographic and clinicopathologic features was also examined. RESULTS: Glypican-6 was strongly expressed in benign, primary and metastatic colon tumours. Normal tissue samples exhibited low to undetectable levels of glypican-6. A significantly high glypican-6 expression was displayed in colon cancers with lymph node metastasis, high depth of invasion, distant metastasis, high histological grades and late stages of the disease (P < 0.05). Importantly, a significant differential in glypican-6 expression was found between normal tissues and different types of colon cancer tissues. Moreover, the highest glypican-6 expression was more frequently found in metastatic tumours, followed by primary tumours and the least in benign tumours (P < 0.05). CONCLUSIONS: Selective expression of glypican-6 may establish a basis for potential use as a tissue biomarker or as a novel therapeutic target in treatment of colon cancer.

Burnout Syndrome during Residency Training in Jordan: Prevalence, Risk Factors, and Implications.

Burnout syndrome is common among healthcare professions, including resident physicians. We aimed to assess the prevalence of burnout among resident physicians in Jordan, and a secondary aim was to evaluate the risk factors associated with the development of burnout syndrome in those residents, including gender, working hours, psychological distress, training sector, and specialty. In this cross-sectional study, 481 residents were recruited utilizing multistage stratified sampling to represent the four major health sectors in Jordan. Data were collected using an online questionnaire, where the Copenhagen Burnout Inventory (CBI) was used to assess the prevalence of burnout. The prevalence, group differences, and predictors of burnout were statistically analyzed using STATA 15. Overall, 373 (77.5%) residents were found to have burnout. Factors associated with higher levels of burnout were psychological stress (ß = 2.34, CI = [1.88-2.81]), longer working hours (ß = 4.07, CI = [0.52-7.62], for 51-75 h a week, ß = 7.27, CI = [2.86-11.69], for 76-100 h a week and ß = 7.27, CI = [0.06-14.49], for >100 h a week), and obstetrics/gynecology residents (ß = 9.66, CI = [3.59-15.73]). Conversely, medical sub-specialty residents, as well as private and university hospital residents, had lower burnout levels. We concluded that decreasing the workload on residents, offering psychological counseling, and promoting a safety culture for residents might help in mitigating burnout consequences.

Heterotopic Pancreas in the Gallbladder: Case Report and Literature Review.

INTRODUCTION: Heterotopic pancreas (HP) is the congenital presence of pancreatic tissue outside its normal location in the absence of vascular and anatomical connection with the main pancreas. HP can affect any part of the gastrointestinal tract, and it is mostly encountered in the stomach. The gallbladder is a rare site of HP, and our literature review revealed that only 38 cases were reported. We present a case of HP in the gallbladder that was presented with a picture of acute cholecystitis. After the case presentation, we will discuss HP in the gallbladder by reviewing the literature. Case Presentation. A 49-year-old male presented to the emergency department complaining of progressively worsening right upper abdominal pain for the last 24 hours. After thorough history and physical examination, a provisional diagnosis of acute cholecystitis was made. Abdominal ultrasonography revealed a rim of edema surrounding the gallbladder wall with two stones impacted at the gallbladder neck. Laparoscopic cholecystectomy was performed with an uneventful postoperative course, and the patient was discharged the next day. Microscopic examination of the gallbladder showed that a heterotopic pancreatic tissue, composed of a large number of pancreatic acini and few ducts with the absence of islets of Langerhans, was found around the cystic duct. The patient was asymptomatic at the regular follow-up six months postoperatively. CONCLUSION: HP in the gallbladder is an extremely rare finding. Its clinical presentation is not different from other cholecystopathic diseases. Most cases were accompanied by cholelithiasis. Preoperative laboratory and imaging modalities are usually not helpful in the diagnosis of HP in the gallbladder. The definitive diagnosis is made by histological examination of the gallbladder specimen. Laparoscopic cholecystectomy is sufficing treatment.

Inflammatory bowel disease and prostate cancer risk: A systematic review.

Objective: To evaluate the risk of prostate cancer (PCa) in patients with inflammatory bowel disease (IBD), focussing on ulcerative colitis (UC) and Crohn's disease (CD) separately. Methods: A systemic search was carried out using PubMed and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We retrieved a total of 349 articles. All the articles were in the English language and investigated the incidence of PCa in patients with IBD. Results: Nine studies met our inclusion criteria, with a total of 205 037 men. Two studies reported an increase in the risk of PCa in men with IBD in general. Five other studies reported an increased risk of PCa in men with UC or with CD specifically. On the other hand, two studies reported a decreased risk of PCa in patients with UC and patients with IBD treated with aminosalicylates. Conclusions: While men with UC appear to have higher risk of developing PCa, data on patients with CD are inconclusive. Therefore, patients with UC may benefit from earlier PCa screening. Our findings confirm a complex interplay between IBD and PCa, including factors such as genetic predisposition, systemic inflammation and treatment effects. The modulatory effect of treatment strategies for IBD on the development and progression of PCa might be of clinical significance. Abbreviations: CD: Crohn's disease; CRP: C- reactive protein; FOLH1: folate hydrolase 1; GIT: gastrointestinal tract; IBD: inflammatory bowel disease; IL-6: interleukin 6; NOS: Newcastle-Ottawa Scale; PCa: prostate cancer; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PSMA: prostate-specific membrane antigen; UC: ulcerative colitis.

A cross-sectional study of basic education influence on the clinical training: Attitudes and perception among Jordanian medical students.

BACKGROUND: Over the past century, the medical educational model has been static with no significant improvement. Studies show that students are leaning towards a more active, dynamic, learner-centered education model that fits their needs and encourages them to be more responsible for their learning. Thus, we conducted this study to investigate Jordanian medical students' perceptions and attitudes towards the value of basic sciences in their clinical training. METHODOLOGY: This was a cross-sectional study that utilized an online, self-administered questionnaire targeting medical students in their clinical years. The questionnaire comprises 5 domains targeting students' perceptions, attitudes, and suggestions of the medical educational system in general and basic sciences in specific. RESULTS: Overall, 578 medical students completed the survey with a male to female ratio of 0.7, and 56% of participants studied were studying at Mutah University, while 42% were at the University of Jordan. Approximately three-fourth (73.9%) of the students reported that basic medical sciences are critical to their development as physicians. Approximately, 82% believe that it is vital to integrate the clinical practice into basic science teaching. Besides, 82.4% of students agreed that faculty members' teaching style influences the educational content's delivery at the basic level. Moreover, 73% of students lean towards the inclusion of problem-based learning into their curriculums. On the other hand, 41.7% of students reject basic science questions in their written clinical exams. CONCLUSION: Our study highlights the positive attitudes of Jordanian medical students towards basic medical sciences. It also demonstrates that students are more comfortable with an active and dynamic educational model that fits their needs and qualifications. Thus, we recommend a student-centered medical educational model trail to maximize learning and teaching efficiency and develop competent medical practitioners.

Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: current situation, challenges, and perspectives.

BACKGROUND: As COVID-19 has been declared as a pandemic disease by the WHO on March 11th, 2020, the global incidence of COVID-19 disease increased dramatically. In response to the COVID-19 situation, Jordan announced the emergency state on the 19th of March, followed by the curfew on 21 March. All educational institutions have been closed as well as educational activities including clinical medical education have been suspended on the 15th of March. As a result, Distance E-learning emerged as a new method of teaching to maintain the continuity of medical education during the COVID-19 pandemic related closure of educational institutions. Distance E-Learning is defined as using computer technology to deliver training, including technology-supported learning either online, offline, or both. Before this period, distance learning was not considered in Jordanian universities as a modality for education. This study aims to explore the situation of distance E-learning among medical students during their clinical years and to identify possible challenges, limitations, satisfaction as well as perspectives for this approach to learning. METHODS: This cross-sectional study is based on a questionnaire that was designed and delivered to medical students in their clinical years. For this study, the estimated sample size (n = 588) is derived from the online Raosoft sample size calculator. RESULTS: A total of 652 students have completed the questionnaire, among them, 538 students (82.5%) have participated in distance learning in their medical schools amid COVID-19 pandemic. The overall satisfaction rate in medical distance learning was 26.8%, and it was significantly higher in students with previous experience in distance learning in their medical schools as well as when instructors were actively participating in learning sessions, using multimedia and devoting adequate time for their sessions. The delivery of educational material using synchronous live streaming sessions represented the major modality of teaching and Internet streaming quality and coverage was the main challenge that was reported by 69.1% of students. CONCLUSION: With advances in technologies and social media, distance learning is a new and rapidly growing approach for undergraduate, postgraduate, and health care providers. It may represent an optimal solution to maintain learning processes in exceptional and emergency situations such as COVID-19 pandemic. Technical and infrastructural resources reported as a major challenge for implementing distance learning, so understanding technological, financial, institutional, educators, and student barriers are essential for the successful implementation of distance learning in medical education.

The Association Between Personality Traits and Specialty Preference Among Medical Students in Jordan.

AIM: To assess the association between personality traits by the five-factor model and specialty choice preference among medical students and immediate medical graduates in Jordan and to identify if there were any significant differences in personality profiles between those planning to pursue different career pathways. METHODS: This is a cross-sectional study including fifth- and sixth-year medical students and post-graduate internship doctors at five universities in Jordan. An online survey was used to collect data from participants, which included their general characteristics, their personality profile using the Big Five Inventory-2, and questions about their most preferred specialty choice. RESULTS: One thousand and twelve participants were enrolled in this study. Only 4.9% were interested in pursuing a specialty in basic medical sciences, and about 12% wanted to be non-practicing medical doctors. Almost half of all participants wanted to pursue a career in surgery-oriented specialties. Those were more extraverted, more conscientious, and had less negative emotions than students who chose medicine-oriented specialties. Students who decided to pursue clinical specialties and students who wanted to be practicing doctors were more extraverted and more conscientious. CONCLUSION: Medical students and fresh medical graduates from Jordan who exhibited higher extraversion and conscientiousness and lower negative emotions preferred to be practicing clinicians. They were more inclined to pursue a career in surgery-oriented specialties. These findings might be helpful in understanding the preferences of young doctors and in counseling them about their career paths. Medical educators may wish to incorporate personality trait evaluation in planning post-graduate programs.

Case report of traumatic intrapericardial diaphragmatic hernia: Laparoscopic composite mesh repair and literature review.

INTRODUCTION: Traumatic rupture of the diaphragm with herniation of abdominal viscera into the pericardium is a rare injury. We present a case of intrapericardial diaphragmatic hernia after one year of thoracoabdominal trauma. This case is the 106th in the literature and only the fifth treated by the laparoscopic approach including this case. After case presentation, we will discuss post-traumatic intrapericardial diaphragmatic hernias by reviewing the literature. CASE PRESENTATION: A 48-year-old male presented to our outpatient clinic with a history of thoracoabdominal trauma due to a motor vehicle accident one year ago. The patient complained from abdominal pain and constipation over the last year. After a thorough history and physical examination, thoracoabdominal computed tomography (CT) was performed. The CT scan revealed herniation of the transverse colon and omentum through a large anterior diaphragmatic defect into the pericardial sac. Laparoscopic composite mesh repair was done. The patient had an uneventful postoperative course and was discharged home on the second postoperative day. The patient was asymptomatic at regular follow-up six months postoperatively. CONCLUSION: Late presentation of intrapericardial diaphragmatic hernia is rare. Chest computed tomography is the most useful diagnostic tool. Delayed diagnosis of Intrapericardial diaphragmatic hernia does not preclude laparoscopic repair by primary closure or with mesh according to the size of the defect.