Jordan Medical Journal

Role of Biochemical and Inflammatory Markers in Monitoring of Covid-19 Patients Vaccinated by Pfizer-BioNTech in Kirkuk City/Iraq

2024-06-26T08:54:15+03:00

The coronavirus disease 2019 (COVID-19) pandemic has killed millions of people and infected millions more. Thus, there was an urgent worldwide need for the scientific community to create vaccines. A retrospective observational study was performed in Azadi teaching hospital from the period of June 2020 to December 2021 on 250 patients (106 female and 144 male patients). The cases were followed up at two different time points, firstly before receiving the vaccine, then after receiving two doses of the vaccine. Lactate dehydrogenase (LDH) enzyme, D-Dimer, CRP, S. Ferritin, S. Creatinine B. Urea and Lymphocyte %, were measured for all patients enrolled in the study before and after vaccination. The concentration levels of B. Urea, S. Creatinine, LDH, D-Dimer, S. Ferritin, and CRP were lower post vaccination. Lymphocyte percentage exhibited the highest concentration levels post vaccination. There were significant differences (P< 0.05) between the concentration levels of all the biomarkers pre and post vaccination with the exception of the concentration levels of S. Creatinine, and B. Urea that showed non-significant variances after vaccination. These results were true for both male and female patients. In conclusions Pfizer-BioNTech vaccines have a significant role in down regulating of some inflammatory biomarkers such as: LDH, D-Dimer, S. Ferritin, and CRP and upregulating of lymphocyte percentage. Generally, the vaccine has an insignificant impact on renal function tests in both male and female patients. The Pfizer- BioNTech COVID-19 vaccine might prompt mild side effects after the first and/or second shot.

The Effect of Probiotic Supplementation on Serum Interleukin -23 Levels among Ulcerative Colitis Patients: a Pilot Study and Secondary Output

2024-09-24T07:03:11+03:00

Background and aims: Interleukin (IL)-23 has gained particular attention as a proinflammatory cytokine playing key roles in the pathogenesis of ulcerative colitis. Recently, probiotics have been used more frequently in treating ulcerative colitis for induction and maintenance of remission. This study aimed to evaluate the effect of probiotic supplementation on IL-23 levels after remission induction in mild-to-moderately active ulcerative colitis patients in Jordan.

Methods: This is a pilot, multicenter, randomized, placebo-controlled, double-blind parallel-arms study. Twenty-four ulcerative colitis patients (11 men, 13 women) were randomly assigned to receive 3×10¹⁰ probiotic 10 billion active cells or three capsules of placebo daily for six weeks. Partial mayo score and serum level of IL-23 were measured at baseline and after six weeks.

Results: There was a significant difference in the mean Partial Mayo score between the probiotic group and the placebo group at the end of the study (1.33 ± 0.49 vs 3.42 ± 1.78) (p<0.001). The probiotics' IL-23 level was insignificantly reduced compared to the placebo group (p>0.05). Similarly, there were no significant differences in the mean or percentage change in the IL-23 level between the two groups (p>0.05).

Conclusions: Probiotic supplementation had an insignificant suppressive effect on IL-23 levels. However, it still offered a beneficial therapeutic effect for patients with ulcerative colitis, as evidenced by an improvement in the Partial Mayo score.

Acupuncture and Related Therapies for Nausea and Vomiting among Patients with Cancer: A Systematic Review

2024-10-31T08:03:48+03:00

Aims: This systematic review aims to evaluate the effectiveness of acupuncture in reducing chemotherapy-induced nausea and vomiting in cancer patients.

Methods: A comprehensive search was conducted for relevant randomized controlled trials (RCTs) published between 2017 and 2022, focusing on acupuncture as a treatment for nausea and vomiting, using multiple databases, including PubMed, CINAHL, MEDLINE, and Ovid, to ensure an inclusive approach. A total of eight studies met the inclusion criteria.

Selection Criteria: This systematic review exclusively included RCTs conducted in English language, involving adult patients with cancer. The scope was limited to acupuncture as a treatment for nausea and vomiting.

Data Collection and Analysis: The included studies were appraised using the Eleven-item Critical Appraisal Skills Program tool, which evaluated aspects such as study design, methodology, and research results.

Results: Several studies have demonstrated that acupuncture is associated with a reduction in chemotherapy complications, particularly vomiting and nausea. Notably, in some studies, the incidence of nausea and vomiting was lower in the acupuncture group compared to the control group at the beginning of chemotherapy.

Conclusions: Acupuncture and related therapies have positively improved cancer-related outcomes and reduced nausea and vomiting in cancer patients.

Predictors of Depressive Symptoms among Patients with Heart Failure in Jordan. A Cross-Sectional Study

2024-08-04T12:52:03+03:00

Background and aim: Heart failure (HF) is a serious health problem in developed and developing countries. The prevalence of depressive symptoms (DS) among patients with HF is high and it might reach up to more than 96%. Depressive symptoms among patients with HF are associated with worse outcomes including recurrent admissions and poor quality of life. Identifying predictors of DS can help in controlling these factors and thereafter these DS leading to better outcomes for this population. This study aimed to identify the most important predictors of DS among patients with HF.

Materials and methods: A descriptive, cross-sectional correlational design was used with a convenience sample of 300 patients with a confirmed diagnosis of HF recruited from one governmental and one private hospital in Amman, Jordan. Depressive symptoms were measured using Beck Depression Inventory-II, while sociodemographic and clinical characteristics were collected either by patient interviews or medical records reviews. Logistic regression was used to determine the predictors of DS.

Results: 209 males and 91 females participated in this study. As independent predictors of DS, older people, females, higher levels of New York Heart Association, and a history of diabetes and hypertension increased the severity of DS. On the contrary, higher levels of Left Ventricular Ejection Fraction were protective against DS. Every unit increase in Left Ventricular Ejection Fraction decreased DS by 45%.

Conclusion: Identifying patients at risk for developing DS is critical to provide necessary assessment and management for them which might improve the quality of their lives, and prognosis.

Knowledge, Attitudes, and Practices of Medical University Students Toward Antibiotics and Antimicrobial Resistance

2024-10-29T13:06:55+03:00

Background: Antimicrobial resistance (AMR) is a growing concern worldwide. The inappropriate use of antibiotics leads to antibiotic resistance, which reduces their efficacy. Assessing awareness is, therefore, critical in the effort to confront the spread of antibiotic resistance. Medical students are potential antimicrobial prescribers and stewards following graduation as clinicians . The education of undergraduate students is likely to influence their practices. Assessing awareness is critical in the general effort to confront the spread of antibiotic resistance. Appropriate studies regarding the knowledge, attitudes, and practices of medical students in Jordan regarding antibiotic use and antimicrobial resistance are nonexistent. The aim of this study was to assess knowledge regarding antibiotic use and resistance among medical students in Jordan in their clinical years.

Methods: A cross-sectional study was performed, using a sampling frame of medical students of the 4^th, 5^th, and 6^th academic years at the Jordan University of Science and Technology. A total of 587 students were involved. The study was conducted from November 1^st, 2022 to February 1^st, 2023. The survey was anonymous and self-administered. The data were collected from an online survey questionnaire and analyzed.

Results: A total of 587 students responded; 42.9% were male (n=252) and 57.0% female (n=335). The response rate was 94%. 87% desired more education on antibiotic use and resistance. The majority (64.7%) of respondents had good knowledge of antibiotic use and resistance; however, 39% incorrectly answered that bacteria would cause common cold. Only 56.0% reported positive practice of antibiotic use. While 8.2% of respondents always consulted a clinician before starting an antibiotic, and 37.2% never discarded their remaining leftover medications. Knowledge was significantly associated with the academic year (p<0.0001)

Conclusion: This study provided the first prevalence data on antibiotic use and knowledge of antibiotics and AMR among medical undergraduate students in Jordan. The study results indicated that current medical education has appropriately influenced the quality use of antibiotics among medical students in Jordan.

Perception and Confidence Levels of Undergraduate Dental Students at Jordan University in Key Dental Procedures and the Impact of Competency Implementation on Their Confidence Levels: Part 2

2024-08-05T10:00:29+03:00

Background and Purpose: A limited number of studies have assessed the level of confidence among final-year dental students regarding their ability to conduct key dental procedures. This study aims to assess the perception and confidence level of final-year dental students from the School of Dentistry at the University of Jordan to perform essential dental procedures across various dental disciplines and to assess the effect of competencies implementation in curricula on the confidence level of students.

Methods: Two cohorts of final-year dental students answered an electronic questionnaire: one group in 2016 before the implementation of the competency-based assessment system (group 1, n = 153), and the other in 2019 after the implementation of this system (group 2, n = 199). The two groups were compared regarding the degree of confidence in conducting key dental procedures. The data were analyzed using SPSS statistics.

Results: Statistically significant differences were found between the two groups regarding confidence levels in four out of nine endodontic procedures included in this study (anterior teeth root canal treatment (RCT), interpreting the results of vitality tests, placing rubber dam (RD), diagnosing irreversible pulpitis) and in five out of 15 oral surgery procedures considered herein (performing surgical extraction, local infiltration, simple extraction, simple suturing, prescribing medication for acute dental infection). These differences were all in favor of group 1 except for only one procedure (performing surgical extraction).

Conclusion: This study showed that the implementation of a competency-based system at the University of Jordan is largely not useful if not counter-productive with regard to the student's level of confidence when performing endodontic or surgical procedures. The results also showed that dental students generally have high confidence levels in doing simple dental procedures and less confidence in more complex ones. Thus, additional focus on such complex procedures is advised during post-graduation training and before entitlement for practice licensing.

New Insight in Etiology of Vitiligo, Association of IncRNA and some Immunological Parameters with Expression of Melanin Concentration Hormone and Sirtuin 1 Genes in Generalized and Segmented Vitiligo

2024-06-06T17:48:09+03:00

Background: Long non-coding RNAs (LncRNAs) represent a subset of genetic material exceeding 200 base pairs that lack protein-coding capacity, yet possess the unique capability to modulate gene expression. This study was conducted with the purpose of identifying the expression levels of LncRNA SIRT-1, LncRNA MCH, as well as the serum levels of IL-17, IL-33, and IFNγ in individuals with vitiligo. Furthermore, the investigation aimed to explore the potential correlation between long non-coding RNA and the parameters of study.

Methods: The investigation was carried out on a cohort consisting of 30 patients with Generalized Vitiligo (GV) - both treated and untreated, 30 patients with Segmented Vitiligo (SV) - also both treated and untreated, and 25 Healthy Controls (HC). Using ELISA, the serum levels of IL-17, IL-33, IFNγ, SIRT 1, and PMCH were measured. Additionally, a gene expression analysis of long non-coding RNA (LncRNA) SIRT-1 and LncRNA PMCH was conducted in patients with GV and SV in order to shed light on their potential implications in the pathogenesis of vitiligo.

Results: LncRNA SIRT-1 expression was significantly higher in GV compared to SV (p=0.030, Mann-Whitney test), with mean expression levels of 2.851 (SE: 1.052) and 0.507 (SE: 0.134), respectively. In contrast, no significant difference in LncRNA MCH expression was observed between the two vitiligo types.

Conclusion: After investigation of the association between lncRNA expression of the SIRT1 and MCH genes and their corresponding serum concentrations in vitiligo patients, this research elucidated the dysregulated manifestations of LncRNA SIRT-1 and LncRNA MCH in individuals diagnosed with vitiligo, indicating their potential contributions to the etiology of vitiligo. This mechanism could involve the down regulation of serum SIRT-1 and MCH, as well as the elevation of cytokines. `

The Prevalence of Attention Deficit Hyperactivity Disorder, Internet Gaming Disorder and Their Association Among Adults in Jordan: A Cross-Sectional Study

2024-12-02T10:05:10+03:00

Objective: This study investigates the prevalence of adult ADHD and Internet Gaming Disorder (IGD) among Jordanian students and graduates and examines their associations and determinants.

Method: A cross-sectional study was conducted using an online self-administered questionnaire comprising three sections: demographics, the Adult ADHD Self-Report Scale (ASRS), and an IGD assessment.

Results: Among 1989 participants, 25.6% screened positive for adult ADHD (average ASRS score: 7.25). Factors associated with Adult ADHD included male gender, younger age, lower GPA, and prior psychiatric diagnoses. Additionally, 14.7% met IGD criteria. Male gender, younger age, single marital status, and southern Jordan residence were significantly associated with risky gaming behavior and IGD. A significant connection between IGD and ADHD was observed.

Conclusion: This study underscores a significant prevalence of adult ADHD and IGD, emphasizing the need for heightened awareness and intervention strategies to address the psychological implications on individuals' well-being.

A Case Report: A Duodenal Polyp with Gastric Foveolar Metaplasia and Dysplasia

2024-09-05T10:37:07+03:00

Duodenal polyps are a common finding during endoscopic investigations, typically representing benign conditions such as regenerative or reactive changes and gastric heterotopia. Some regenerative changes can present as metaplasia, particularly of the gastric foveolar epithelial type. However, adenomatous changes associated with gastric foveolar epithelium are rare. This article presents a case of a gentleman whoexperiened dyspepsia and dysphagia. Endoscopy revealed a polypoid lesion that exhibited low-grade dysplasia with gastric foveolar metaplasia upon histopathologic examination. This case supports the hypothesis that metaplastic epithelium in the duodenum can serve as a precursor to neoplastic processes, underscoring the importance of vigilant surveillance and the necessity for further molecular investigations.

Mineral Supplements’ Prescribing Practices in Critically Ill Cancer Patients: A Study Investigating Physicians’ Prescribing Practices and Roles of Nutrition Support Pharmacists at a Tertiary Cancer Center

2024-08-18T08:15:34+03:00

Objective: This study aimed to explore physicians’ prescribing practices and roles of nutrition support pharmacists in managing mineral deficiencies in critically ill cancer patients admitted to intensive care units (ICU) at a tertiary cancer center.

Methods: A retrospective analysis of 9949 electronic records of critically ill cancer patients admitted to the ICU from January 2020 to December 2022 was performed. All mineral supplement prescriptions by physicians and nutrition support pharmacists’ interventions were recorded. Analysis was performed utilizing the Jamovi statistical package 2022

Results: The study population comprised pediatric patients and adult patients. Major minerals were most frequently prescribed in ICU cancer patients, followed by trace minerals. Potassium was the most prescribed mineral supplement, followed by Sodium, Calcium, and Magnesium. The least prescribed was Lithium. The most frequent intervention of pharmacists was initiating mineral supplement use, followed by discontinuing mineral supplement use. The acceptance rate of interventions by physicians was 88%.

Conclusion: Potassium was the most prescribed mineral supplement in critically ill cancer patients at a tertiary cancer center. Nutrition support pharmacists’ interventions were highly accepted by physicians. The prevailing intervention was the initiation of mineral supplement use. Further studies are needed to explore the barriers to implementing nutrition support services in different healthcare settings.

Clinical and Psychological Predictors of Acute Coronary Syndrome Symptom Severity

2024-08-05T12:56:01+03:00

Introduction: Egypt is a low-income country which accounted for 16% of the MENA region’s 1.3 million CVD mortalities in 2015. Traditional Egyptian cultural, social contexts and religious beliefs are different from those in high-income Western counties where most CVD research is conducted, which may have significant impacts on patients’ psychological responses to acute illness. Therefore, this study aimed to identify the clinical and psychological predictors early during ACS course of disease.

Method: In this cross-sectional study, the symptoms of 255 acute coronary syndrome patients at three university hospitals in Alexandria, Egypt, were measured using the Arabic Anxiety and Stress Subscales of Depression, Anxiety and Stress Scale (DASS-21) and Arabic Controlled Attitude Scale (CAS-R). Multiple linear regression analysis was used to identify clinical and psychological predictors of symptom severity.

Results: History of diabetes, hypertension, and hyperlipidemia, perceived control, anxiety, and stress scores were independent predictors for all studied symptoms (chest pain, fatigue, and dyspnea). The models described variance of 15% for chest pain, 29% for fatigue, and 16% for dyspnea.

Conclusion: This study revealed that anxiety and stress levels are predictors of increased symptoms severity, whereas history of DM, HTN, and hyperlipidemia, and perceived control level were independent predictors for all symptoms (chest pain, fatigue, and dyspnea).

The Correlation between Estimated Glucose Disposal Rate (eGDR) and the Severity of Nonalcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes

2024-11-19T11:17:38+03:00

Purpose: To correlate between the degree of insulin sensitivity and degree of nonalcoholic fatty liver disease (NAFLD) in type 2 Diabetes.

Methods: Our study included a total of 211 patients. For each participant, we calculated the Fibrosis-4 Index (FIB-4), an indicator for assessing the presence of advanced liver fibrosis, and the NAFLD score, which assesses the extent of liver fibrosis. These scores were then correlated with the estimated Glucose Disposal Rate (eGDR), a measure used to evaluate insulin sensitivity.

Results: The mean FIB-4 score was 1.22 ± 1.54, and the mean NAFLD score was -0.75 ± 1.46. Moderate to severe fibrosis was present in 2.8% of patients according to the FIB-4 score and in 10.9% according to the NAFLD score. The mean eGDR score was 4.58 ± 2.41. Spearman correlation coefficients demonstrated that eGDR was weakly but significantly correlated with the FIB-4 score (r = -0.143, p = 0.042). Additionally, eGDR showed a significant correlation with NAFLD scores (r = -0.344, p < 0.001). The FIB-4 score was also significantly correlated with NAFLD scores (r = 0.821, p < 0.001). ROC curves demonstrated that eGDR significantly predicted moderate-severe fibrosis indicated by FIB-4 (71.1%; 95% CI: 58.3%-83.8%) or NAFLD scores (73.4%; 95% CI: 63.0%-83.8%). The optimal cut-off point for eGDR to predict moderate-severe fibrosis indicated by FIB-4 was 4.07, achieving a sensitivity of 65.2% and specificity of 73.8%. For predicting moderate-severe fibrosis indicated by NAFLD scores, the optimal eGDR cut-off point was 5.34, with a sensitivity of 83.3% and specificity of 65.5%.

Conclusion: Our study demonstrated a significant correlation between eGDR scores and the severity of NAFLD. Based on our findings, we suggest considering a lower cut-off point for eGDR, specifically between 4.07 to 5.34, to enhance the prediction of NAFLD in the context of insulin resistance.

Clinicopathological Characteristics of Meningiomas: A tricentric Study

2024-12-31T07:18:27+03:00

Background and Aims: Meningioma is the most common brain tumor in Jordanian adults. This study aimed to analyze the macro- and microscopic features of meningiomas with emphasis on the correlation with tumor recurrence.

Materials and Methods: This retrospective study comprised all the meningioma cases diagnosed at three major tertiary care centers in Jordan in 2007-2021. The clinicopathologic data were retrieved from the patients’ records.

Results: A total of 690 cases were studied, with the peak age being 45 years. The female-to-male ratio was 2.3:1. Based on the available data for most patients among the cohort, tumor size ranged from 0.5 cm to 11.5 cm, and the most common site was the frontal lobe. The great majority of tumors were grade 1 (80.2%). Male sex was significantly associated with a higher tumor grade and a larger tumor size (p = 0.003 and 0.001, respectively). The 5-year follow up data was retrieved for 206 patients. The recurrence rate was about 28%. Recurrence was significantly associated with tumor size (p = 0.000). The tumor size was also significantly associated with the histologic grade (p = 0.003). Multivariate analysis showed that intracranial tumors were significantly more associated with recurrence than spinal ones (p = 0.017), and that mitotic index was significantly associated with recurrence (p = 0.002).

Conclusions: Our results were concordant with international reports. Spinal tumors showed less recurrence rate than intracranial ones, and the mitotic index and tumor size were significantly associated with a higher recurrence rate.