Rare histopathological finding of ovarian pseudotumor: A case report.

An inflammatory pseudotumor (IPT) is a benign, rare chronic inflammatory process that is destructive to normal histology of the involved organs. While IPT most frequently affects the lung and orbits, it can occur in almost any part of the body. Additionally, histopathological examination is often difficult to interpret, typically showing myofibroblasts and mixed inflammatory and spindle-shaped cells. The histopathological picture may resemble low grade fibrosarcoma with inflammatory cells, making the differentiation between benign and malignant diseases more difficult and potentially requiring specialized histopathological studies. In the present study, a 39-year-old healthy female patient with no history of sexual activity presented to The Specialty Hospital (Amman Jordan) in January 2023 with mild lower abdominal pain. A pelvic ultrasound scan showed a complex right ovarian cyst measuring 6.0x6.5 cm. Tumor markers were normal. The patient underwent laparotomy with an ovarian cystectomy and left ovarian, omental and peritoneal biopsies. The histopathology of the cyst was suggestive of IPT. Other histopathological results were normal. The patient was followed up for 1 year after surgery with no recurrence of the disease.

Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study.

BACKGROUND: Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions. OBJECTIVE: This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan. METHODS: We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL. RESULTS: A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice. CONCLUSIONS: DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction.

Correlates of higher anxiety scores reported by women admitted for elective caesarean section.

Background: An elective caesarean section (CS) has been associated with high anxiety scores, and there are associations between higher anxiety scores and younger age, primigravidae, higher educational level, and previous experience with anaesthesia. In this study, the aim is to measure anxiety scores associated with an elective CS using two measuring scales and identify women's characteristics and obstetrics variables that are associated with higher scores. Methods: A cross-sectional study was conducted between Nov 15, 2019 and Nov 15, 2020. Women were included if they were 18 years of age or more, had viable pregnancies, and were admitted for an elective CS. Anxiety scores were measured on admission using the visual analogue scale for anxiety (VASA) and then the State-Trait Anxiety Inventory (STAI-Y). Associated factors were studied using logistic regression analyses. Results: Three hundred women were recruited. Means (SD) for the participant's age and gestation age were 30.5 (5.7) years and 37.6 (1.4) weeks, respectively. Additionally, 29.3% of the participants having a CS were primigravidae and 62.3% were for maternal indications. Furthermore, 55%, 59%, and 61% of the women had scores above the means of VASA and STAI-S components 1 and 2, respectively.Variables that showed statistically significant associations with higher anxiety scores were that the woman's age was 25-34, the CS was for foetal indications, the choice of anaesthesia was general, and the source of information for the choice of anaesthesia was a layperson. Conclusion: Higher anxiety scores are prevalent among women admitted for an elective CS. STAI-Y and VASA correlated well, and the short VASA may replace the lengthy STAI-Y in clinical practice. Identification of women with risk factors may help in implementing strategies to reduce anxiety.

Impact of coronavirus 19 pandemic on contraception in Jordan.

The coronavirus 19 (COVID-19) pandemic has negatively impacted family planning services worldwide. There are no published reports from Jordan on the impact of COVID-19 pandemic on family planning methods. This was a web-based cross-sectional study between September and December 2020 with 519 participants; of these 43.5% did not use any method. The most used methods were intrauterine devices, coitus interruptus and male condoms. Furthermore, 38.2% of women changed methods due to limited access to services and non-availability of methods. While 82.1% of women preferred modern methods before the pandemic, 79.7% became more acceptant of traditional methods. Moreover, 35.3% of women got pregnant during the curfew, and 90% were unplanned with a statistically significant higher rate in women who changed their routine method, accepted traditional methods, have been married for less than 10 years and multiparous women. National health policy makers should consider the impact of large-scale pandemics on family planning services.IMPACT STATEMENTWhat is already known on this subject? Family planning services in Jordan have improved significantly over the last decade because of accessibility and availability of a wide range of contraceptive methods. Available methods are either traditional or modern. Because of the high failure rates of traditional methods, public health family planning programmes promote modern methods.What do the results of this study add? There are no published reports from Jordan on the impact of COVID-19 pandemic and curfew on family planning methods. This study aims to report on what family planning methods women used during the pandemic, reporting if women changed their preferred methods and the reasons, assess women's knowledge about the natural methods of family planning which is probably an alternative method in situations where services and accessibility to more effective methods are limited and estimate unplanned pregnancies.What are the implications of these findings for clinical practice and/or further research? National health policy makers should consider the impact of large-scale pandemics on family planning services. Additionally, the implementation of telehealth and home delivery of self-administered methods should be considered. Natural methods of contraception may be an option when access and availability to modern methods is limited.

Determining trainees' knowledge of surgical anatomy: A specialist's perspective.

OBJECTIVES: Intraoperative identification of anatomical structures can potentially reduce the risk of surgical complications. This study aims to report specialists' perspectives about the anatomical structures that third-year residents should be able to identify during surgical operations. In addition, the factors which may influence specialists' opinions are discussed. MATERIALS AND METHODS: This qualitative cross-sectional study was conducted on obstetricians and gynaecologists between 1/2/2019 and 30/10/2019. The specialists practising in a hospital with a residency programme were included, and were asked to rate the importance of structures that a third-year resident should be able to identify during operations. We performed a comparison of responses based on specialists' age, gender, practice type, years of experience, and surgical workload. RESULTS: One hundred and sixty-five specialists were recruited with a response rate of 69.3%. The mean age of respondents was 46.1 years, and they had a mean experience of 13.4 years. Furthermore, 86.6% of specialists rated all the anatomical structures as "more important". The importance of surgical structures, as rated by specialists, was not related to gender, years of experience, or surgical workload. The importance of 63% of the anatomical structures was rated higher by junior specialists than senior specialists. CONCLUSION: Knowledge of anatomical structures is vital for gynaecologic residency training. Specialist's perceptions of the importance of various anatomical structures reflect their understanding of the training requirements. Our results highlighted the important anatomical structures that third-year residents are expected to identify during surgical operations. Future research may establish a reference for the core anatomy knowledge essential for each training year.

Bladder sensations in women with nocturia due to overactive bladder syndrome.

OBJECTIVES: Nocturia is the number of times urine is passed during main sleep. This definition tells us that it is a need to void; it does not tell us what triggers it. The aim of this study is to report bladder sensations that wake up women with nocturia (N). Descriptions of sensations in relation to various overactive bladder (OAB) symptoms, most bothersome symptoms, urinary incontinence (UI) and urodynamic findings are examined. MATERIALS AND METHODS: A prospective study of women > 18 years old presenting with OAB and nocturia. Data collected included presenting and most bothersome symptoms, descriptions of bladder sensations associated with nocturia, number of frequency and nocturia episodes, nighttime UI and urodynamic findings. RESULTS: One hundred fifty women were recruited with mean age 52 years, mean duration of symptoms 10.5 months and mean number of nocturia episodes 4.5. All women reported multiple presenting and bothersome symptoms. Fifty-five per cent had detrusor overactivity (DO). "Multiple" and "more intense" bladder sensation descriptions of nocturia were associated with advanced age, more frequent nighttime UI, when nocturia was considered most bothersome and in the presence of DO. The most frequent single description was "strong desire to void". The most frequently used combination was "strong desire to void, sudden compelling desire to void, bladder pain and full bladder". CONCLUSION: Descriptions of bladder sensations associated with nocturia in women with OAB were diverse and overlapping. It is important to report clinically and in research why patients have nocturia as this will have bearing on its treatment.

Jordanian women's attitudes towards cervical cancer screening: has the pattern changed?

The objective of this study was to report the current Jordanian rate of cervical smear test uptake, and study changes in women's attitude to the smear test since the last published report in 2002. A prospective cross-sectional study of Jordanian women who at the time of the study were living in Jordan. The study period was from December 1 2018 to December 31 2018. Six hundred and twelve women were recruited, and the mean age was 36 years. Thirty-eight percent of the women in the study said they had had a smear test before. Of those who had ever had a test, 88% did so as a routine test. Of women who had never had a smear test, 61% said they had heard about the test, 50% of them did not give a 'logical' reason for not having a test. While the current rate is less than in 2002, more women recognised the test as being important. While the rate of cervical smear test uptake in Jordan remained low (38%), it is better than the rate in 2002 of 25.5%. Severe deficiencies in the knowledge of the test exist. Implementing a national cervical screening programme supported by media-led health education and promotion is likely to increase the test uptake and reduce incidence of cervical cancer.Impact statementWhat is already known on this subject? The incidence of cervical cancer (CC) in high income countries has reduced through the implementation of cervical screening programmes, with subsequent early detection and treatment of precancerous lesions. Globally, 85% of the CC burden is in low income countries. Furthermore, the implementation of screening programmes has not been successful due to limited resources and a lack of infrastructure. The rates of cervical screening test uptake vary widely among different countries. Jordan's smear test uptake was 25% in 2002.What the results of this study add? The rate of cervical smear test uptake in Jordan has remained low (38%) compared to the rates in the developed countries. In addition, 12% of the cervical smears in our study were opportunistic. Our study recognised deficiencies in relation to public awareness of the importance and the details of the test.What the implications are of these findings for clinical practice and/or further research? In clinical practice and in the absence of national screening programme, health care workers are encouraged to perform more opportunistic smears. This study provides education on the test. Researchers may consider investigating the barriers to cervical screening and therefore increase cervical screening uptake.

Conservative management of spontaneous rupture of the urinary bladder.

We report a very rare case of intra-peritoneal spontaneous rupture of the urinary bladder which was successfully managed conservatively in a 77-year-old woman, who presented with lower abdominal pain, acute urinary retention and pelvic organ prolapse (POP). Computed tomography raised the suspicion of bladder rupture which was later confirmed by cystoscopy and cystogram. Following 8 weeks of urinary catheterisation, the bladder healed spontaneously. A subsequent sub-total abdominal hysterectomy and sacrocervicopexy were performed to treat the POP. The management of bladder rupture is discussed.