Clinical, Radiological, and Microbiologic Characteristics of Patients with Noncystic Fibrosis Bronchiectasis in a Tertiary Center at Jordan.

BACKGROUND: Only a small number of the investigations that were carried out in the Middle East attempted to characterize patients with NCFB. In order to characterize patients with NCFB, as well as their etiologies, microbiological profiles, and outcomes, we therefore carried out this investigation. METHODS: This retrospective cohort study was carried out at the Jordan University Hospital (JUH), a tertiary facility located in Amman, Jordan. Non-cystic Fibrosis Bronchiectasis (NCFB) was defined as an HRCT scan typical for bronchiectasis along with a negative sweat chloride test to rule out cystic fibrosis. Patients' data were collected by the use of Electronic Medical Records (EMR) at our institution. Frequent exacerbation was defined as more than 2 exacerbations in 1 year of the onset of the diagnosis. RESULTS: A total of 79 patients were included, and 54.4% of them were female. The mean and standard deviation of the patient's age was 48.61 ± 19.62. The etiologies of bronchiectasis were evident in 79.7% of the sample. Asthma, Chronic Obstructive Pulmonary Diseases (COPD), and Kartagener syndrome were the most prevalent etiologies, accounting for related illnesses in 21.8%, 21.5%, and 13.9% of the patients, respectively. The most frequent bacteria cultured in our cohort were Pseudomonas and Candida Species. Moreover, 43 patients of the study cohort were frequent exacerbators, and 5 patients died. CONCLUSION: Our study supports the need to identify several bronchiectasis phenotypes linked to various causes. These findings provide information to clinicians for the early detection and treatment of bronchiectasis in Jordan.

The impact of COVID-19 on antibiotic resistance and clinical outcomes among critically ill patients.

BACKGROUND: There is conflicting evidence regarding the impact of the Coronavirus 2019 (COVID-19) pandemic on antimicrobial resistance, with few studies conducted in low- and middle-income countries. We investigated the impact of the COVID-19 pandemic on multidrug resistant organisms (MDROs) among critically ill patients and their clinical outcomes. METHODS: This was a retrospective observational study of patients admitted to the medical Intensive Care Unit at Jordan University Hospital and had blood, urine, or bronchoalveolar bacterial cultures taken during 2 time periods: prepandemic (ie, 1/2016 to 1/2019) and pandemic (ie, 1/2020 to 1/2023). We compared the clinical outcomes (ie, in-hospital deaths, the need for O2 devices, intubation, the length of hospital stay, and the occurrence of complications) and prevalence of MDROs between the 2 periods and conducted multivariate analyses. RESULTS: There were 1,254 patients (479 prepandemic and 775 postpandemic. The percentage of patients who had MDROs was significantly higher among patients with a culture taken during the pandemic (82.4%) compared to before it (17.6%) (P-value=.000). Multivariate analysis demonstrated that patients cultured during the pandemic were more than 3 times as likely to have an MDRO (odds ratio = 3.210; 95% confidence interval: 2.236-4.609). CONCLUSIONS: The increase in MDROs during the COVID-19 pandemic is an alarming threat to public health; thus, investigating the antibiotic resistance situation as the pandemic subsides is crucial.

Cardiovascular diseases across OSA phenotypes: A retrospective cohort study.

Background: Despite the considerable knowledge of Obstructive Sleep Apnea (OSA) implications for cardiac diseases, the evidence regarding cardiovascular complications across OSA phenotypes including Rapid Eye Movement OSA (REM-OSA) and Positional OSA (POSA) is limited. In this study, we aimed to evaluate the risk of cardiovascular diseases development and progression among patients with REM-OSA and POSA. Methods: Based on a retrospective cohort analysis, we included polysomnography studies done in the sleep lab at the Jordan University Hospital. Regarding cardiovascular diseases, primary outcomes were Heart Failure, and 1-years Major Adverse Cardiac Events while secondary outcomes were atrial fibrillation, pulmonary hypertension, other arrhythmia, metabolic profile, and echocardiographic measurements of the heart. Results: The total number of the included patients was 1,026 patients. POSA group had significantly lower percentage of patients with hypertension (P-value = 0.004). Additionally, systolic blood pressure and HbA1c were significantly lower among patients with POSA compared to the NPOSA group (P-value<0.050). Left ventricular end diastolic dimension was significantly higher among patients with POSA while ejection fraction was significantly lower (P-value<0.050). Patients with diabetes and mean HbA1c were significantly lower among patients with REM-OSA compared to patients with NREM-OSA (P-value = 0.015, P-value = 0.046). Multivariate regression analysis revealed that after adjusting for age, gender and preexisting comorbidities, POSA was significantly associated with lower ejection fraction and higher left ventricular diastolic diameter. Conclusion: In conclusion, our findings indicate that POSA might be associated with huge and clinically significant heart strain and poor cardiac functions, yet it might not have a clinically significant atherogenic effect. This study should guide clinicians to identify OSA phenotypes to imply the best treatment plan to reduce its detrimental impact on cardiac muscle.

The prevalence of anxiety and depression in bronchiectasis patients and their association with disease severity: a cross-sectional study.

Bronchiectasis is a chronic lung disease characterized by recurrent respiratory symptoms. Several studies demonstrated that psychological comorbidities are common in patients with bronchiectasis. The aim of this study is to investigate the prevalence of anxiety and depression in bronchiectasis patients and assess their association with disease severity. In this cross-sectional study, we included patients diagnosed with bronchiectasis. The study was conducted using an interviewer-administered questionnaire via phone calls and data collected from the electronic medical records at JUH. The questionnaire included patients' demographics and disease characteristics. Anxiety and depression were assessed using GAD7 and PHQ9 respectively. Bronchiectasis disease severity was assessed using BSI and FACED score. The total number of included patients was 133. Moreover, 53.4% of the participants were females while the rest were males (46.6%). PHQ9 demonstrated that 65.4% of the patients had depression. Regarding anxiety, GAD7 scale showed that 54.1% of the patients had anxiety. Pearson correlation showed that bronchiectasis severity index was significantly associated only with PHQ9 depression scores (r = 0.212, P value = 0.014). The prevalence of depression and anxiety is high among patients with bronchiectasis. We believe that patients affected with bronchiectasis should be screened for depression to improve their quality of life.

Bariatric surgery and obstructive sleep apnea: a systematic review and meta-analysis.

BACKGROUND: Several studies evaluated the effect of bariatric surgery on obstructive sleep apnea (OSA) but findings have been inconsistent. The aim of this study was to conduct an updated systematic review and meta-analysis to investigate the effect of bariatric surgery on OSA. METHODS: The databases for PubMed, CENTRAL, and Scopus were searched up to the 1st of December, 2021. Studies were included if they were cohort or case-control in design, included patients with diagnosis of OSA, the patients underwent any bariatric surgery, and the study performed postoperative polysomnography. RESULTS: The total number of the included patients was 2310 patients with OSA from 32 studies. Our analysis showed that bariatric surgery was associated with significant reduction in BMI (WMD = - 11.9, 95%CI: - 13.4, - 10.4), apnea-hypopnea index (AHI) (WMD = - 19.3, 95%CI: - 23.9, - 14.6), and respiratory disturbance index (RDI) (WMD = - 33.9, 95%CI: - 42.1, - 25.7). The rate of OSA remission after the surgery was 65% (95%CI: 0.54, 0.76). CONCLUSION: Our results suggest that bariatric surgeries are effective in reducing obesity among patients with OSA in addition to OSA severity measures. However, the low rate of OSA remission suggests that the main etiology of OSA is not only obesity but also includes other important variables such as the anatomy of the jaw.

Comparing the diagnostic value of the positional obstructive sleep apnea definitions.

Several definitions were proposed to diagnose Positional Obstructive Sleep Apnea (pOSA). However, the comparison between these definitions according to their diagnostic value is scarce in the literature. Thus, we decided to conduct this study to compare between the four criteria according to their diagnostic value. Between 2016 and 2022, 1092 sleep studies were performed at the sleep lab at the Jordan University Hospital. Patients who had an AHI <5 were excluded. pOSA was described according to the four definitions; Amsterdam Positional OSA Classification (APOC), supine AHI twice the non-supine AHI (Cartwright), Cartwright plus the non-supine AHI <5 (Mador), and overall AHI severity at least 1.4 times the non-supine severity (Overall/NS-AHI). Furthermore, 1033 polysomnographic sleep studies were retrospectively analyzed. The prevalence of pOSA according to the reference rule was 49.9% among our sample. The Overall/Non-Supine definition had the highest sensitivity, specificity, positive predictive value, and negative predictive value, which were 83.5%, 99.81%, 99.77%, and 85.88% respectively. The Overall/Non-Supine definition also had the highest accuracy among the four definitions (91.68%). Our study showed that all the criteria had a diagnostic accuracy above 50%, indicating that they were accurate in forming the diagnosis of pOSA. The Overall/Non-Supine criteria had the highest sensitivity, specificity, diagnostic odds ratio, and positive likelihood ratio as well as the lowest negative likelihood ratio, indicating the superiority of this criterion over the other definitions. Choosing the right criteria for diagnosing pOSA would result in fewer patients being assigned to CPAP and more being assigned to positional therapy methods.

Mortality, Intensive Care Unit Admission, and Intubation among Hospitalized Patients with COVID-19: A One-Year Retrospective Study in Jordan.

COVID-19 is a public health crisis that has caused numerous deaths, necessitated an increased number of hospital admissions, and led to extended inpatient stays. This study aimed to identify the factors associated with COVID-19 mortality, intensive care unit admission, intubation, and length of hospital stay among Jordanian patients. This was a one-year retrospective study of 745 COVID-19 patients admitted to Jordan University Hospital. Data regarding the patients' demographics, clinical and co-morbid conditions, imaging, laboratory parameters, mortality, intensive care unit admission (ICU), and intubation were collected from their medical records using a coding manual. The data revealed that the overall rates of COVID-19-related mortality, ICU admission, and invasive intubation were 23.0%, 28.3%, and 10.8%, respectively. Chronic kidney disease (CKD), troponin, lactate dehydrogenase (LDH), and O2 saturation <90% were significantly associated with the mortality rate. The variables that were significantly associated with ICU admission were heart failure and the use of remdesivir. However, O2 saturation <90% and gastrointestinal (GI) symptoms were the only variables associated with invasive intubation. The findings of this study suggest that study-related health outcomes can be used to predict the severity of COVID-19, and they can inform future research aiming to identify specific populations who are at a higher risk of COVID-19 complications.

Characteristics of inpatients with atopic asthma in a tertiary center: do age and gender have an influence?

Background: Several studies have demonstrated gender influence on asthma prevalence, being higher among males during early childhood. Little is known about the impact of gender and age on asthma exacerbation characteristics in pediatrics. This study aimed to determine the differences in acute asthma between males and females in three different age groups regarding perinatal characteristics of asthmatic patients, comorbidities, medication adherence, level of blood eosinophils, and pattern of hospitalization. Methods: The medical records of 130 pediatric patients with asthma, who presented to the emergency department at Jordan University hospital with asthma exacerbations, were retrospectively reviewed. Demographic information and clinical characteristics were collected. Results: The mean age of patients was 10.7±4.7 years. The age at diagnosis and gestational age were significantly higher in older children. Furthermore, younger children were significantly more likely to experience winter exacerbations and more emergency presentations. Male patients were considerably younger than their female counterparts and were diagnosed younger. In addition, male patients were more likely to have eosinophil levels higher than 3% than female patients. Conclusion: Gender plays a role in the development and outcome of asthma exacerbations at different ages of pediatrics. A better understanding of gender-based and age-based differences in asthma dictates a personalized approach to treatment.

New symptoms and prevalence of postacute COVID-19 syndrome among nonhospitalized COVID-19 survivors.

The aim of this study was to assess postacute coronavirus disease 2019 (COVID-19) syndrome (PACS) symptoms according to the onset of the infection while evaluating the effect of COVID-19 vaccination on the symptoms of PACS. We conducted a retrospective single-center cohort study in which nonhospitalized COVID-19 survivors and healthy controls were compared for the occurrence of PACS. The total number of patients in this study was 472. At 6-12 and > 12 months after the infection, COVID-19 survivors had a significantly higher incidence of posttraumatic stress disorder (PTSD) and anxiety than the non-COVID-19 cohort. Furthermore, depression, cognitive deficit, tics, impaired quality of life and general health impairment were significantly more prevalent among COVID-19 survivors at < 6 months, 6-12 months and > 12 months than in the non-COVID-19 cohort. However, respiratory symptoms were significantly more prevalent among COVID-19 survivors only in the first 6 months after infection. In addition, cognitive deficit (OR = 0.15; 95% CI 0.03-0.87) and impaired quality of life (B = - 2.11; 95% CI - 4.21 to - 0.20) were significantly less prevalent among vaccinated COVID-19 survivors than among nonvaccinated survivors. Longitudinal studies are needed to establish the time that should elapse after COVID-19 infection for the symptoms of PACS to appear. Randomized clinical trials are needed to assess the possibility that COVID-19 vaccines might relieve PACS symptoms.

Effects of COVID-19 pandemic on medical students in Jordanian universities: A multi-center cross-sectional study.

BACKGROUND: There are serious concerns regarding the effectiveness of medical education in its current format during serious crises like the COVID-19 pandemic. OBJECTIVE: To explore academic, financial, psychological, & hygienic impact on medical students. METHODS: A cross-sectional, questionnaire-based study of students at different medical schools in Jordan. It included both basic and clinical years. RESULTS: There were 415 responses. Females constituted 51.8%. Around 50% of the participants were from the 6th year (n = 194, 46.7%). University of Jordan students represented around 40% of the responders. 60% of the students have GPA (Grade Point Average) of less than 3 points. Nearly half of the students indicated that their academic grades were affected during the pandemic. Clinical years' students (51.0%) were more likely to be negatively affected than students in basic years (36.1%), P value 0.026. Sixty three percent reported that they sanitize their hands before touching eyes, nose, or mouth. More than two thirds (70.4%) of students indicated that their mental health was affected in the pandemic. Financial influence was a major aspect in around 53% of students and 34% of students were not able to pay the university fees due to the pandemic. The pandemic affected the elective training course location of 70.9% of respondents. Mental health was affected in 70.9% of students and 65.1% became more anxious or depressed with no significant difference among gender and academic years (P values 0.256 and 0.516, respectively). Students in the clinical years were more afraid of getting the infection than students in the basic years, however this difference was not statistically significant (p = 0.084). CONCLUSIONS: Covid-19 Pandemic negatively affected the academic course of the medical students especially at the clinical training years' level across Jordanian universities. COVID-19 pandemic left a negative impact on psychological & mental health of the students, too, rendering them more anxious, depressed, and afraid of coming to the hospital and handling patients.

Spectrum of uropathogens and their susceptibility to antimicrobials in pregnant women: a retrospective analysis of 5-year hospital data.

OBJECTIVE: Urinary tract infections (UTI) are common during pregnancy. Identification of antimicrobial susceptibility patterns of microorganisms in pregnant women is important to select the most appropriate antimicrobial. We assessed common uropathogens in pregnant women with UTI and antimicrobial susceptibility, to guide empirical antibiotic selection. METHODS: In this retrospective study, we analyzed mid-stream urine culture and antibiotic susceptibility data from pregnant women who attended Jordan University Hospital during 2014 to 2018. Data were collected from patients' charts and urine cultures, and sensitivity results were extracted from the laboratory electronic system. We calculated descriptive statistics and determined correlations among pathogens and antibiotics. RESULTS: We examined 612 positive urine cultures from 559 pregnant women, including 163 (29.2%) inpatients. Escherichia coli (29.4%) was the most frequently identified microorganism, followed by coagulase-negative staphylococci (CoNS) (21.6%). All bacterial isolates were sensitive to aztreonam, chloramphenicol, fosfomycin, ofloxacin, pefloxacin, piperacillin, and colistin sulfate; 87.5% were sensitive to amikacin. Only 15.79%, 18.93%, and 17.91% were sensitive to oxacillin, nalidixic acid, and erythromycin, respectively. CONCLUSION: E. coli and CoNS were the most commonly identified microorganisms in this study. We found increased antibiotic resistance in Enterobacter species. The chosen antimicrobial therapy in pregnancy should be determined by sensitivity/resistance and fetomaternal safety.

CPAP treatment in REM-related obstructive sleep apnea: a distinct clinical phenotype of sleep disordered breathing.

PURPOSE: REM-related obstructive sleep apnea (REM-OSA), as defined using revised apnea-hypopnea index (AHI) criteria, might represent a specific OSA phenotype. However, there is a lack of data on outcomes of treatment in this population. This study evaluated the effects of CPAP treatment over 12 months on clinical outcomes for patients with the polysomnography phenotype of REM-OSA. METHODS: We conducted a prospective observational study with the following inclusion criteria: subjective sleepiness and diagnostic polysomnography demonstrating AHIREM≥15 events/h, AHINREM<5 events/h, and ≥ 30 min of REM sleep. Clinical outcomes assessed included Epworth Sleepiness Scale (ESS), psychomotor vigilanc test reaction time (PVT-RT), and CPAP adherence at baseline, 1, 3, 6, and 12 months; Functional Outcomes of Sleep Questionnaire (FOSQ) and Depression Anxiety Stress Scales (DASS-21) at baseline, 1, 3 and 12 months. The reason is the first 3 outcomes (ESS, PVT, adherence) were assessed at baseline, 1, 3, 6, and 12 months, while the next 2 outcomes (FOSQ, DASS) were assessed at baseline, 1, 3, and 12 months. The edited version is not as clear in separating these outcomes into 2 groups; Functional Outcomes of Sleep Questionnaire (FOSQ); and Depression Anxiety Stress Scales (DASS-21) at baseline, 1, 3, and 12 months. Linear mixed effects models were used to investigate the joint effects of time and average CPAP adherence on our outcomes of interest. RESULTS: Twenty participants completed a minimum of 1 month of CPAP treatment and were included for analysis. During the trial, 8 participants discontinued CPAP (4 before 3 months, 1 before 6 months, 3 before 12 months), and 19 participants completed 12 months of treatment. Baseline ESS was elevated at 12.6 units. Average CPAP usage for all 27 participants over 12 months was 2.9 ± 2.4 h. There was a significant decrease in ESS and increase in FOSQ at all time points, and the decrease in ESS was only seen in the CPAP-adherent subgroup. Decreases in DASS-21 and PVT-RT were not sustained. CONCLUSIONS: CPAP treatment in sleepy patients with moderate to severe REM-OSA is associated with reduced sleepiness and improved quality of life. TRIAL REGISTRATION: The trial was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12620000576921, 18/05/2020 (retrospectively registered).

Clinical Evaluation of Respiratory Rate Measurements on COPD (Male) Patients Using Wearable Inkjet-Printed Sensor.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that causes long-term breathing problems. The reliable monitoring of respiratory rate (RR) is very important for the treatment and management of COPD. Based on inkjet printing technology, we have developed a stretchable and wearable sensor that can accurately measure RR on normal subjects. Currently, there is a lack of comprehensive evaluation of stretchable sensors in the monitoring of RR on COPD patients. We aimed to investigate the measurement accuracy of our sensor on COPD patients. METHODOLOGY: Thirty-five patients (Mean ± SD of age: 55.25 ± 13.76 years) in different stages of COPD were recruited. The measurement accuracy of our inkjet-printed (IJPT) sensor was evaluated at different body postures (i.e., standing, sitting at 90°, and lying at 45°) on COPD patients. The RR recorded by the IJPT sensor was compared with that recorded by the reference e-Health sensor using paired T-test and Wilcoxon signed-rank test. Analysis of variation (ANOVA) was performed to investigate if there was any significant effect of individual difference or posture on the measurement error. Statistical significance was defined as p-value less than 0.05. RESULTS: There was no significant difference between the RR measurements collected by the IJPT sensor and the e-Health reference sensor overall and in three postures (p > 0.05 in paired T-tests and Wilcoxon signed-rank tests). The sitting posture had the least measurement error of -0.0542 ± 1.451 bpm. There was no significant effect of posture or individual difference on the measurement error or relative measurement error (p > 0.05 in ANOVA). CONCLUSION: The IJPT sensor can accurately measure the RR of COPD patients at different body postures, which provides the possibility for reliable monitoring of RR on COPD patients.

Sarcoidosis in Jordan: A Study of the Clinical Phenotype and Disease Outcome.

OBJECTIVES: This study aims to evaluate the clinical phenotypic features of sarcoidosis in a single-center academic hospital in Jordan. PATIENTS AND METHODS: A retrospective file review was performed at an academic medical center in Jordan that included all patients diagnosed with sarcoidosis between January 2000 and December 2018. A total of 150 patients with sarcoidosis (38 males, 112 females; mean age 47.8±11.7 years; range, 17 to 79 years) were evaluated. Clinical data extracted from the files included the sex of the patient, the age at time of diagnosis, diagnosis date, the season during which the diagnosis was established, and smoking history. Biopsy histopathology, spirometry, nerve conduction, echocardiography, and imaging reports including plain radiographs, ultrasonographic, magnetic resonance and computed tomography reports were reviewed. Data including laboratory values, medication usage, clinical outcomes, and morbidity/mortality were collected. Pulmonary function tests including spirometry and lung volumes along with the diffusing capacity for carbon monoxide were reviewed for the presence of restriction, obstruction or reduction in the diffusion capacity of carbon monoxide. Identification of extra-thoracic organ involvement was determined in each patient in accordance with the criteria suggested by the updated World Association of Sarcoidosis and Other Granulomatous Disorders. RESULTS: A total of 77.3% of the patients were diagnosed by biopsy. One case of Lofgren's syndrome was identified. Of the patients, 18.0% had isolated pulmonary sarcoidosis, 75.3% had pulmonary and extra-pulmonary sarcoidosis and 6.7% had isolated extra-pulmonary sarcoidosis while 81.3% had respiratory symptoms, mostly shortness of breath and cough. Extra-thoracic organ involvement mostly involved the musculoskeletal system (33%) followed by the skin (20%). Female patients had more extra-thoracic involvement but the sex difference was only statistically significant for cutaneous involvement. Of the patients, 84% received treatment while 20% had disease remission during the first two years after diagnosis and 70% required treatment beyond two years after diagnosis. CONCLUSION: Various sarcoidosis clinical phenotypes are seen among Jordanian patients. Jordanian females are more affected by the disease and have more extra-thoracic involvement compared to male patients. A large number of the study patients received treatment.

Additive evidence of the competence of pregnancy-adapted YEARS algorithm in reducing the need for CTPA, Q and/or V/Q scintiscan.

OBJECTIVE: To determine whether a pregnancy-adapted clinical and D-dimer-based algorithm, termed the "YEARS algorithm," can reduce the need for radiological imaging, including lung scintigraphy in pregnant women with suspected pulmonary embolism (PE). PATIENTS AND METHODS: This retrospective study included all pregnant women with suspected PE between January 2014 and September 2019 who have undergone D-dimer testing and radiological imaging (computed tomography pulmonary angiography or lung perfusion scans) at presentation. Three criteria from the YEARS algorithm were assessed: clinical signs of deep vein thrombosis, haemoptysis, and whether PE was clinically considered as the most likely diagnosis. Patients who did not have to undergo imaging per the YEARS algorithm were defined as those with no YEARS criteria and a D-dimer of <1µg/mL (group 1) and those with 1-3 YEARS criteria and a D-dimer of <0.5µg/mL (group 2). Patients who had to undergo imaging were those with no YEARS criteria and a D-dimer ≥1µg/mL (group 3) and those with 1-3 YEARS criteria and a D-dimer ≥0.5µg/mL (group 4). Women with symptoms of deep-vein thrombosis had to undergo Doppler ultrasound: If positive, they were anticoagulated and excluded from this analysis, and if negative, they were evaluated further for the need of imaging based on other YEARS criteria and D-dimer level. RESULTS: Of 117 pregnant women with suspected PE analyzed according to the YEARS algorithm five had confirmed deep-vein thrombosis by Doppler ultrasound, were anticoagulated and excluded from the analysis. Of the remaining 112 women (mean age; 30.4±5.7 years), 50 underwent computed tomography pulmonary angiography (CTPA), 54 lung perfusion or ventilation-perfusion (V/Q) scan and eight both; PE was diagnosed in 7 (6.25%), two by CTPA, two by lung perfusion or V/Q scan and three by both. Thirty-three of the 112 women (29.5%) were in groups 1+2 and could, therefore, have avoided CTPA or lung perfusion scans per the YEARS algorithm. None of those 33 women had PE by CTPA or lung perfusion scans vs. 7/79 patients (8.9%) who required CTPA or lung perfusion scans per the YEARS algorithm. CONCLUSION: The pregnancy-adapted YEARS algorithm can safely rule out PE in about one-third of pregnant women with suspected PE without the need for radiological imaging.

Perinatal events predicting retinopathy of prematurity in extremely pre-term infants.

BACKGROUND: Extremely preterm infants are peculiar in regard to their risk of retinopathy of prematurity (ROP). In this study, we aim to study insults that may affect extremely preterm infants, including prenatal, at birth, and postnatal insults and their effect on the development of ROP. METHODS: This study used the data from Prematurity and Respiratory Outcomes Program (PROP). All included infants with a gestational age of 23 0/7 to 28 6/7 weeks using best obstetrical estimate. We included stressful events and/or modifiable variables that may affect the normal development. We used multiple regression analysis in our statistical analysis. RESULTS: We included a total of 751 infants in our study. The mean birth weight for the included sample was 915.1 (±232.94) grams. 391 (52.1%) Infants were diagnosed with ROP. We found a significant negative correlation between ROP development and birth weight (p < 0.001), with a correlation coefficient of - 0.374. We found that the need for prophylactic indomethacin (OR 1.67), the occurrence of air leaks (OR: 2.35), ventilator-associated pneumonia (OR: 2.01), isolated bowel perforations (OR: 3.7), blood culture-proven sepsis (OR: 1.5), other infections (OR: 1.44), and receiving ventricular shunt (OR: 2.9) are significantly associated with the development of ROP. CONCLUSIONS: We believe this study included the largest number of factors studied in the largest sample of extremely premature infants. We recommend a screening program for extremely preterm infants that takes into account a scoring system with higher scores for complicated condition.

Influenza Altmetric Attention Score and its association with the influenza season in the USA.

Background: Altmetrics measure the impact of journal articles by tracking social media, Wikipedia, public policy documents, blogs, and mainstream news activity, after which an overall Altmetric attention score (AAS) is calculated for every journal article. In this study, we aim to assess the AAS for influenza related articles and its relation to the influenza season in the USA. Methods: This study used the openly available Altmetric data from Altmetric.com. First, we retrieved all influenza-related articles using an advanced PubMed search query, then we inputted the resulted query into Altmetric explorer. We then calculated the average AAS for each month during the years 2012-2018. Results : A total of 24,964 PubMed documents were extracted, among them, 12,395 documents had at least one attention. We found a significant difference in mean AAS between February and each of January and March (p< 0.001, mean difference of 117.4 and 460.7, respectively). We found a significant difference between June and each of May and July (p< 0.001, mean difference of 1221.4 and 162.7, respectively). We also found a significant difference between October and each of September and November (p< 0.001, mean difference of 88.8 and 154.8, respectively). Conclusion: We observed a seasonal trend in the attention toward influenza-related research, with three annual peaks that correlated with the beginning, peak, and end of influenza seasons in the USA, according to Centers for Disease Control and Prevention (CDC) data.

H1N1 Infection in Pregnancy; A Retrospective Study of Feto-Maternal Outcome and Impact of the Timing of Antiviral Therapy.

BACKGROUND AND OBJECTIVE: H1N1 infection carries an increased risk in pregnancy. Our aim was to study the feto-maternal outcome and the effect of early initiation of therapy. METHODS: This is a retrospective descriptive study. Confirmed infected cases were included. Maternal age, parity, gestational age at diagnosis, presenting symptoms, the time between presentation and starting therapy, ICU admission, and maternal and perinatal outcome were evaluated. RESULTS: Nineteen confirmed patients were included. Most patients are 31 years old or more. Multiparous patients were 73.68%, and 57.89% were in the third trimester. Most of our patients presented with cough, fever, and chills. Two patients were admitted to the ICU. One of them was a case of maternal mortality. 42.10% of patients were started on therapy only one day after the clinical onset of symptoms. 26.31% delivered before 37 completed weeks. 73.68% delivered beyond term. Around one third delivered vaginally. 45% of babies weighed more than 3 kg. Four babies weighed less than 2 kg. Ninety percent had APGAR scores more than 8 at 1 and 5 minutes after delivery. Twenty-five percent were admitted to the NICU with no neonatal mortalities. CONCLUSIONS: H1N1 influenza A infection in pregnancy is associated with adverse maternal and perinatal outcomes. Medical and public awareness, low threshold for testing suspected pregnant patients, very early initiation of antiviral therapy, and a multidisciplinary approach in our series decreased the overall adverse effects of this infection.