Jordan Medical Journal

Evaluating Fall Risk Factors in Community-Dwelling Older Adults Aged 65 and Over

2025-03-23T09:58:40+03:00

Background and Aims: Falls are a major public health concern among older adults, leading to morbidity and mortality. This study aimed to identify the risk factors for falls by investigating demographic, clinical, and functional characteristics in a cohort of community-dwelling elderly individuals.

Materials and Methods: This retrospective study of 191 older adults (≥65 years) was conducted in an outpatient physiatry clinic. The participants were divided into two groups: those with a history of falls (n=83) and those without (n=108). Demographic characteristics, handgrip strength, mobility (Timed Up and Go test (TUG), Tinetti Balance and Gait Assessment), depressive symptoms (Geriatric Depression Scale (GDS)), activities of daily living (Barthel Index (BI) and Instrumental Activities of Daily Living (IADL)), and cognitive function (Mini Mental State Examination (MMSE)) were collected. Logistic regression identified fall predictors, and analyses explored the relationships between risk factors, including cut-off points.

Results: Fallers were significantly older (mean age 77.75 vs. 70.46 years) and more likely to be female (63.9% vs. 36.1%) (p<0.05). Illiteracy (p<0.05) and widowhood (p=0.04) were also associated with falls. Fallers had lower grip strength, longer TUG times, lower Tinetti, BI, IADL, MMSE scores, and higher GDS scores, indicating impaired strength, gait, balance, functional independence, and increased cognitive impairment and depressive symptoms (p<0.05). Aging was associated with poor mobility, balance, mood, function, and cognition. Stronger grip was associated with better balance and cognition. Cut-off values for increased fall risk were: age >73 years, TUG time >19 seconds, Tinetti <21, GDS >21, IADL <6, BI <90, MMSE <21.

Conclusion: Falls in the elderly are linked to age, sex, mobility impairments, depression, and functional and cognitive decline. Comprehensive geriatric assessments can help prevent falls and improve the quality of life.

How Do Healthcare Professionals Perceive Continuous Professional Development? A Cross-Sectional National Study from Jordan

2023-07-06T11:26:05+03:00

Background: Continuous professional development is essential to enhance the knowledge and competency of healthcare professionals. However, no previous research from Jordan assessed the perception of healthcare professionals about continuous professional development.

Objective: This research aimed to investgate the perception of healthcare professionals about continuous professional development in Jordan.

Methods: A cross-sectional study was conducted in the period between December 2017 till April 2018 in multiple healthcare settings in Jordan. The perception of 2,204 healthcare professionals including physicians, dentists, pharmacists, nurses, and allied healthcare professionals was investigated using a structured self-reported questionnaire. Assessment of perception included the perceived preferences and expected benefits of continuous professional development activities.

Results: The most preferred continuous professional development activity was journal/internet reading activity, while research-based activity was the least preferred. Journal/internet reading activity was significantly preferred activity in the private sector (p=0.04). There was a significant difference in all the studied preferred continuous professional development activities between different HCPs (all p<0.05). The most perceived expected benefit of continuous professional development was enhanced knowledge while satisfying learning ambitions was the least. There was a significant difference in the expected benefits among health sectors and this included improving patients’ outcomes, improving personal skills, and enhancing personal knowledge (all p<0.05). There was also a significant difference in the expected benefits among healthcare professionals and this included improving the satisfaction of patients and their families, improving the clinical outcomes of patients, changing the current clinical practice, improving personal skills, and enhancing personal knowledge (all p<0.05).

Conclusions: The perception of continuous professional development is varied between different HCPs and health sectors in Jordan. Future measures to design an effective continuous professional development for Jordanian HCPs should consider this variation.

Clinical Trials on Intermittent Fasting Effects on Health and Diseases published from January 2022 to January 2024: A literature review

2025-01-08T07:52:26+03:00

Background: Intermittent fasting (IF) encompasses a variety of dietary methodologies, featuring well-recognized approaches such as the 16/8 or 5:2 diets, or alternate-day fasting (ADF), alongside various other regimens consisting mainly of alternate periods of fasting and eating. It has gained significant attention in recent years for its potential health benefits. This literature review explores the effects of intermittent fasting on health and diseases based on clinical trials published from January 2022 to January 2024.

Objective: Through a critical appraisal of recent clinical trials, this review aims to provide insights into the efficacy, safety, and mechanisms underlying intermittent fasting as a dietary intervention for promoting health and combating diseases in adult population.

Methods: A comprehensive analysis of the latest clinical evidence is conducted. An electronic search was performed on trials using PubMed and Google Scholar as the main databases. Studies involving religious fasting, animal studies, studies conducted on neonates, infants, or children, were excluded.

Results: After reviewing 23 articles which discussed the IF in many health and disease domains, Intermittent fasting assumes a crucial role in promoting weight loss, managing diabetes, controlling blood pressure, offering potential benefits for individuals vulnerable to heart and liver diseases, and enhancing immune system in addition to potential positive impact on cancers.

Perceptions of Family Planning among Jordanian Men and Women: A Qualitative Study

2025-01-22T08:47:55+03:00

Background: The perception of individuals regarding family planning significantly influences their decision-making process and actual use of contraceptive methods. Understanding these perceptions is essential for designing effective family planning programs.

Purpose: To explore how the perceptions of family planning among Jordanian men and women influence their contraceptive behaviors and decision-making processes.

Methods: A phenomenological qualitative design was employed, and thematic analysis was utilized for data evaluation. Data saturation was achieved through in-person, in-depth interviews conducted with a total of 30 participants, which included 11 males and 19 females.

Results: A thematic inductive analysis identified three primary themes related to family planning and contraceptive methods. The first theme, influence of social, cultural, gender, and religious factors, includes subcategories such as the importance of procreation, family size and composition, preference for consecutive childbearing, expectations of conception within the first year of marriage, use of contraceptives after the first child's birth, and attitudes towards abortion.

The second theme focuses on the decision-making process, includes subcategories such as factors influencing choices, sources of information, motives and criteria for selecting contraceptive methods, and comparisons of modern and traditional methods.

The final theme, conflicting views, includes subcategories such as management of side effects, effects on marital relationships, concerns regarding reproductive health, and advice given to others.

Conclusion: The study revealed that Jordanian men and women's perceptions of family planning impact contraceptive behaviors, including decision-making, method uptake, and discontinuation, necessitating careful design and implementation of family planning programs.

Change In Bone Mineral Density After Total Ankle Replacement: A Two Year Follow Up

2025-01-12T08:54:01+03:00

Background: Bone strength around the components is critical for arthroplasty survival. Literature is scarce on changes in bone mineral density (BMD) around total ankle arthroplasty (TAA) designs. This study quantified BMD changes around the components of the uncemented Mobility™ prosthesis preoperatively and postoperatively, while evaluating clinical outcomes.

Methods: This prospective study included patients undergoing TAA between March 2008 and April 2009. BMD was measured using the DEXA Hologic® scanner at seven regions of interest (ROIs) around the prosthesis preoperatively and at 1- and 2-year follow-ups. AOFAS scores were also recorded.

Results: Twenty-three patients were included. A significant mean BMD decrease (17%, p<0.01) was observed in the lateral malleolus, while the medial tibial metaphysis showed a 7% increase, though not statistically significant. BMD changes at other ROIs were minimal. AOFAS scores improved significantly over the 2 years (p<0.05).

Conclusion: Significant BMD loss occurred in the lateral malleolus, likely due to stress shielding. Minimal changes in other regions suggest a stable mechanical environment. Long-term follow-up is necessary to determine the clinical impact of these changes.

Insulin-induced Hypoglycemia after Implementing Hyperkalemia Protocol at Emergency Departments: An Updated Systematic Review

2025-06-02T11:56:26+03:00

Background: Addressing the critical gap in managing hyperkalemia in emergency settings, emphasizing the balance between effective potassium reduction and hypoglycemia prevention. The findings highlight the need for standardized protocols and further research to enhance patient safety and treatment efficacy. This review aims to determine the optimal intravenous insulin dose, the necessary dextrose administration, and the appropriate timing for glucose-level monitoring to prevent hypoglycemia in adults undergoing hyperkalemia treatment in emergency departments.

Methods: A systematic review was conducted following PRISMA guidelines. Full-text articles published in English between 2016 and 2024, were selected from MEDLINE (PubMed), Science Direct, CINAHL, Cochrane Database, and Google Scholar. The inclusion criteria comprised studies involving adult patients treated for hyperkalemia in emergency departments, focusing on insulin and dextrose administration protocols. The review was registered on PROSPERO (CRD42023399719). Data extraction and synthesis involved assessing study quality, insulin doses, dextrose administration, and timing of glucose monitoring.

Results: The review included 16 studies, with 11 patients involving renal disease. Hyperkalemia was defined by 12 studies (75%) as a potassium level exceeding 5 mmol/L. The prevalence of hypoglycemia ranged from 15-20%. There was variability in the initial glucose monitoring time post-insulin administration, with 10 studies (63%) opting for a 6-hour mark. The most reported insulin dose to prevent hypoglycemia was 5-10 units. Additionally, 50% of the studies recommended administering 25 g of dextrose (D50%) to prevent hypoglycemia.

Conclusions: Although optimized insulin therapy regimens have shown promise in reducing hypoglycemia risk, effective management of potassium levels remains a challenge. Future research must inform treatment guidelines and clinical practice, ensuring safer and more effective care for hyperkalemia patients.

Single-Nucleotide Polymorphism in Iraqi patients of TNF-α-308G/A(rs1800629) Susceptibility to Asthma

2025-02-23T13:40:44+03:00

Objectives: The study examined the effects of genetic variations in TNF-α-308G/A, as well as TNF-α gene variants, using PCR-SSP to analyze individual characteristics.

Method: Researchers used molecular and immunological methods to investigate genotypes and alleles associated with asthma incidence, including 50 asthma patients and 40 healthy individuals.

Results: It was demonstrated that polymorphisms and the risk of developing asthma were correlated among asthma patients. The findings showed that, in comparison to the control group, asthma patients had considerably (P<0.05) greater levels of TNF-α-308G/A alleles than GA heterozygotes (TNF-α-308G/A).

Conclusion: Gene promoter polymorphisms may affect asthma sensitivity to TNF-α-308G/A, as evidenced by the strong association between the GG and AG gene genotypes and cytokine levels and disease development.

The development of asthma and immunological markers (TNF-α) are closely related. One perspective holds that there is a correlation between allergic rhinitis and the development and risk of asthma. It has been successful to use HDM immunotherapy to assist patients in establishing long-term clinical and immunological tolerance.

Complex Multiorgan Penetrating Abdominal Trauma During Gaza conflict – A Case Report

2025-04-13T13:36:06+03:00

Penetrating abdominal trauma can be a complex challenge for clinicians and requires concurrent resuscitation and urgent decision-making, particularly in war settings with limited medical resources. We report the case of a 32-year-old female who sustained a penetrating abdominal injury during the Gaza conflict, resulting in severe intra-abdominal injuries, including a grade I liver capsular injury, near-complete gastric transection, Grade V splenic injury, left renal cortical laceration with active bleeding, and multiple large bowel injuries with complete laceration of the duodenojejunal junction. She arrived hemodynamically unstable with signs of peritonitis, necessitating an emergent laparotomy. A retained 6 cm tank machine gun bullet was identified behind the liver. Due to resource limitations, ICU admission and full damage control protocols were not feasible. Postoperative complications included delayed renal hemorrhage requiring embolization, which could not be performed due to lack of interventional radiology. Despite these challenges, the patient was stabilized and discharged. This case highlights the challenges of managing complex abdominal trauma in war zones, emphasizing the need for adaptability when standard trauma protocols cannot be applied.

Unveiling Coarctation: A Case of Early Onset Hypertension Unravelling a Late Diagnosis of an Aortic Defect

2025-01-31T22:13:17+03:00

Background: Coarctation of the aorta (CoA) is a congenital heart defect occurring in approximately 6–8% of live births with congenital heart diseases. It is characterised by narrowing of the aorta, and although often diagnosed during infancy or childhood due to its impact on blood pressure (BP) regulation, some cases may not be identified until adolescence.

Case: We report a case of a 25-year-old male who presented to the ER with non-exertional chest pain, palpitations, and facial plethora. He has a history of undiagnosed hypertension, an average BP of 150/90, a significant BP gradient between upper and lower limbs (>40 mmHg), and radio-femoral delay on physical examination.

Decision-making: Comprehensive tests were conducted; results included a negative troponin assay, an electrocardiogram (ECG) showing normal sinus rhythm with left ventricular hypertrophy (LVH) and a left bundle branch block (LBBB), an echocardiogram revealing a bicuspid aortic valve (BAV) and severe concentric hypertrophy of 1.7 cm with a low-normal ejection fraction, and a normal chest X-ray. Subsequently, a computed tomography angiography confirmed the diagnosis of severe CoA with extensive collaterals, which warranted catheterization. A covered Cheatham Platinum stent was implanted, and the patient was discharged on appropriate medications afterwards.

Conclusion: This rare case of a BAV with CoA presenting in adulthood underscores the significance of timely detection, intervention, and long-term management. The late onset of symptoms is noteworthy, with the extensive collateral circulation accounting for it. Further follow-up is essential to monitor his chest pain and hypertension.

The Impact of Parental Beliefs and Social Media-Driven Misconceptions on Pediatric Healthcare Decisions in Jordan

2025-06-02T10:28:38+03:00

Introduction: Pediatric healthcare decision-making is influenced by intersecting and often conflicting factors. The coexistence of traditional parental beliefs and the modern digital landscape has altered this process and produced a novel paradigm which greatly impacts regions where cultural heritage guides medical practices and behaviors. This paper examines how parental attitudes built on traditional beliefs and social media affect healthcare decisions for pediatric patients aged twelve and below.

Methods: The paper employs a structured 18-item questionnaire distributed to 200 Jordanian parents to gauge beliefs, digital health literacy, and online misinformation influence healthcare-seeking behavior.

Results: The results indicated a considerable influence of traditional beliefs, as 48% of parents favored traditional remedies, and 35% consulted family elders before seeking professional advice. On the other hand, 62% stated they frequented social media for information on child healthcare, while 55% had followed online advice without medical consultation. Moreover, only 45% of the parents expressed confidence in their ability to distinguish credible information from misleading content.

Discussion: The analysis through hypothesis testing indicated that lower education levels and higher social media usage rates significantly delayed medical consultations and were related to a reliance on unverified health advice. In contrast, high media literacy levels resulted in increased caution, leading to more professional-aligned decisions.

Conclusions: The paper suggests enhancing the digital presence of pediatricians to increase the credibility of online information. The paper recommends the integration of evidence-based health messaging in popular platforms such as WhatsApp and Facebook.

Evaluating Medical Students' Competence in Orthopedic Special Tests for Diagnosing Anterior Cruciate Ligament (ACL) Injuries

2025-06-02T21:46:11+03:00

Background: Competence in physical examination is essential for medical students, particularly in musculoskeletal assessment. Anterior Cruciate Ligament (ACL) injuries are common and typically evaluated through a combination of clinical history, imaging, and physical tests. This study aimed to assess the ability of medical students from two medical schools to perform three commonly used ACL tests: Lachman’s test, anterior drawer test, and Lever sign (Lelli’s test).

Methods: In this cross-sectional study, 200 fifth-year medical students from two medical schools in Jordan participated during their orthopedic surgery rotations. Each student performed the Lachman’s, anterior drawer, and Lever sign tests on two patients with MRI-confirmed ACL tears and two healthy control subjects. Student performance was evaluated based on correct execution of each test. Comparisons were made between institutions and against a senior resident benchmark. A simulated learning curve model was also generated to illustrate progression across training levels.

Results: A total of 200 fifth-year medical students were evaluated. Correct test performance was highest for the Lever sign (92.0%), followed by the anterior drawer (85.5%) and Lachman’s test (81.5%). No significant differences were observed between students from the two institutions (p = 0.192–0.731). Performance was higher on control subjects compared to ACL-injured patients. Senior residents demonstrated superior performance across all tests: Lachman’s (p = 0.004), (p = 0.001), and Lever sign (p = 0.027). Simulated learning curves indicated higher AULC values for the Lever sign (281.5) compared to the anterior drawer (270.8) and Lachman’s test (263.8), suggesting differences in the relative ease of skill acquisition.

Conclusion: Medical students performed ACL special tests with varying success, reflecting the differing technical demands of each maneuver. The Lever sign was most consistently performed correctly, while the Lachman’s and anterior drawer tests showed lower performance compared to senior residents. Simulated learning curves emphasized skill acquisition differences, supporting the need for structured, progressive training to improve orthopedic examination competency.