Monkeypox infection and pregnancy in lower and middle-income countries: Precautions & recommendations.

Monkeypox (MPX), an orthopoxviral disease endemic in Africa, is now a public health emergency of international concern (PHEIC) as declared by the World Health Organization in July 2023. Although it is generally mild, the overall case fatality rate was reported to be 3%, and the basic reproduction number (R0) is > 1 in men who have sex with men (MSM, i.e., Portugal (1.4), the United Kingdom (1.6), and Spain (1.8)). However, R0 is < 1 in other settings. In concordance with the smallpox virus, it is also expected to increase the risk of adverse outcomes for both the mother and the fetus. The outcomes of the disease in an immunocompromised state of pregnancy are scary, showing high mortality and morbidity of both mother and fetus, with up to a 75% risk of fetal side effects and a 25% risk of severe maternal diseases. Therefore, it warrants timely diagnosis and intervention. The reverse transcription polymerase chain reaction (RT PCR) test is the standard approach to diagnosis. We summarized the recent findings of MPX on pregnancy, and the associated risk factors. We also give recommendations for active fetal surveillance, perinatal care, and good reporting to improve outcomes. The available vaccines have shown promise for primary disease prevention.

The relationship between maternal health and neonatal low birth weight in Amman, Jordan: a case-control study.

This study aimed to examine the relationship between maternal health during pregnancy and low birth weight (LBW), as well as the impact of COVID-19 on the socio-economic status of pregnant women and its effect on LBW. The study was conducted in Amman, Jordan, and included 2260 mothers who visited Abu-Nusair comprehensive health center between January and December 2020. A matched case-control design was used with 72 cases and 148 controls selected for data collection through medical records and face-to-face interviews. Results showed that factors such as a monthly income of 400 JD or less, living with an extended family, exposure to passive smoking, maternal weight gain of 6-10 kg, maternal anemia, maternal hypertension, delivery by cesarean section, and previous history of LBW newborns were positively associated with an increased risk of LBW. Conversely, factors such as a monthly income above 700 JD, living with a core family, daily intake of iron, calcium, and vitamin D, prenatal visits, healthy food intake, and planning for pregnancy were associated with a lower risk of LBW. COVID-19 infection and its effects on work, family finances, antenatal care visits, and food supply were also positively linked with LBW. In conclusion, socioeconomic status, maternal health, COVID-19, and its impacts were significant risk factors for LBW.

Histopathological pattern of endometrial biopsies in patients with abnormal uterine bleeding in a tertiary referral hospital in Jordan.

BACKGROUND: Abnormal uterine bleeding (AUB) is a symptom that deviates from the normal menstrual cycle. AUB is characterized by changes in the frequency, volume, and duration of the menstrual flow. The etiology of AUB, which varies with age, may be attributed to both structural and non-structural causes. OBJECTIVES: Determine the histopathological pattern of endometrial biopsies in patients with AUB across different age and parity groups who have undergone dilation and curettage (D&C), along with the discrepancy between D&C and histopathological findings after hysterectomy. DESIGN: Retrospective chart review SETTING: Tertiary referral hospital PATIENTS AND METHODS: We collected data on all patients diagnosed with AUB between January 2015 and December 2020. Histopathological findings of all D&C endometrial biopsy samples were examined after being categorized by age and parity groups. Sensitivity, specificity, positive predictive value, and NPV were calculated to evaluate the diagnostic accuracy of D&C. MAIN OUTCOME MEASURES: Histopathological pattern of D&C endometrial biopsies by age and parity groups. SAMPLE SIZE: 3233 patients. RESULTS: Most patients were in the 18-39 year age group, with normal cyclical findings being the most common histopathological finding. Malignant lesions were observed in 42 patients with a majority being older than 50 years. In 13.3% (42/316) of patients, D&C failed to detect intrauterine disorder that was found on hysterectomy. The overall accuracy of D&C in determining the existence of normal versus pathological findings was 75.60%, the sensitivity was 72.90%, the specificity was 77.90%, the positive predictive value was 73.86% and the NPV was 77.05% in our patients. CONCLUSION: Normal cyclic changes account for the highest proportion of histopathological findings. However, hyperplasia and malignancies are important causes of perimenopausal and postmenopausal bleeding. While the use of D&C as a sampling tool for AUB cases remains questionable, the use of D&C in diagnosing premalignant and malignant cases is highly effective. LIMITATIONS: Single-center, retrospective design, incomplete medical records, and inter-rater reliability could not be determined. CONFLICT OF INTEREST: None.

Premenstrual Syndrome and Its Association with Perceived Stress: The Experience of Medical Students in Jordan.

Objective: To assess the prevalence of premenstrual and menstrual symptoms and to investigate premenstrual severity's association with perceived stress of premenstrual syndrome among medical students. Methods: This is a cross-sectional study. Data were collected between March and April 2021, a self-administered online questionnaire (Supplementary Material) was distributed to a sample of female medical students in Jordan (n=594). Results: The mean age was 21.6 ±2.2 years, and the mean body mass index (BMI) was 22.8 ±4.1 kg/m2. Most students were in their 5th and 6th university year, where 75.4% reported having dysmenorrhea, 45.8% used pharmacological agents for pain relief, while 54.2% used non-pharmacological means, and 58.1% occasionally skipped lectures. Most participants reported a constellation of physical and psychological symptoms. The mean for the premenstrual severity scale score was 29.3, and the mean for the perceived stress scale scores was 21.6. There was a statistically significant correlation between the premenstrual severity scale score and the perceived stress scale, between the premenstrual severity scale and absenteeism, between premenstrual severity scale and year of study, and between dysmenorrhea and the perceived stress scale, but not between the severity of symptoms and method of pain relief. Conclusion: Premenstrual and menstrual symptoms have a negative impact on students that affects their academic participation. More support should be given from universities to address the menstruation-related struggles of female students.

Awareness of polycystic ovary syndrome: A university students' perspective.

BACKGROUND: Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. Women with this syndrome may have infrequent menstrual periods or amenorrhea and excess androgen levels. The ovaries develop numerous small follicles and fail to ovulate on a regular basis, with subsequent subfertility in those women that wish to conceive.The etiology of polycystic ovary syndrome is unclear. Early diagnosis and treatment may reduce the risk of long-term complications such as type 2 diabetes and heart disease. OBJECTIVES: To assess the knowledge and attitude of university students towards polycystic ovary syndrome at two universities in the north of Jordan. METHOD: ology: This is a cross-sectional online survey that polled female students at two universities in the north of Jordan. The main outcome measures included average polycystic ovary syndrome awareness score, predictors of high awareness scores, and sources of information. RESULTS: Formal diagnosis of polycystic ovary syndrome was reported by 29.9% of the 1182 students, the average polycystic ovary syndrome awareness score was M = 11.59 (SD = 4.95). Being a 6th and 5th year college student were the strongest independent predictors for recognizing the term polycystic ovary syndrome, in addition to be a student in the majors of veterinary medicine, nursing, pharmacy, or dentistry. Age was a significant predictor of polycystic ovary syndrome awareness score. Being investigated for, or being diagnosed with polycystic ovary syndrome were significant predictors of higher scores. Body mass index was a weak predictor of polycystic ovary syndrome awareness. Participants who reported to have hirsutism, acanthosis nigricans, or acne scored significantly higher than others.Healthcare professionals were the most common source of information reported by participants. Lectures were most effective in increasing awareness score but were poorly utilized outside the curriculum. CONCLUSION: Although students in this study demonstrated a satisfactory level of polycystic ovary syndrome awareness and were more likely to seek information from healthcare professionals, this level of awareness should spread-out to other segments of the population.

Pre-Implantation Gender Selection: Family Balancing in Jordan.

PURPOSE: To find out whether couples with predominant female offspring have more chances to produce more female embryos during non-medical pre-implantation genetic diagnosis (PGD) for male sex selection. METHODS: A total of 125 couples who had three or more female offspring and underwent non-medical PGD for male sex selection between 2015 and 2019 were included. Nuclear DNA was analyzed by fluorescent in situ hybridization (FISH). Two-chromosome (X, Y), 3-chromosome (21, X, Y), and 5-chromosome (13, 18, 21, X, Y) probes were used for FISH. The standard protocol was followed for sperm processing and embryo culture for IVF and PGD. RESULTS: In 83.2% of the couples, the ratio of female embryos was higher than male embryos. Independent sample t-test showed that there is no significant difference between equal and unequal embryonic groups in patients' age, husbands' age, sperm count, sperm motility, total male embryos, total female embryos, normal male embryos, and normal female embryos. For patients with positive pregnancy outcome, 84.6% had unequal embryonic ratio while 15.4% had equal embryonic ratio. Similarly, patients who were treated by short protocol had 85% of unequal embryonic ratio and 15% had equal ratio. CONCLUSION: A greater variability in the female to male embryonic ratio is produced in couples having predominantly female offspring and seeking non-medical PGD for male sex selection.

The impact of COVID-19 pandemic on training and mental health of residents: a cross-sectional study.

BACKGROUND: Residency programs have been impacted by the Coronavirus disease 2019 (COVID-19) pandemic. In this study we aim to investigate and evaluate the impact of the pandemic on residents as well as residency training programs. METHODS: This was a cross-sectional study including a survey of 43 questions prepared on Google forms and electronically distributed among a convenience sample of residents training at a tertiary center in North Jordan during the COVID-19 pandemic. Data were collected in the period between October 30th and November 8th of 2020. The survey included questions that addressed the impact of the pandemic on residents' health as well as training programs. The study participants included residents in training at KAUH in 2020 and were stratified according to the type of residency program (surgical residents (SRs) and non-surgical residents (NSRs)). Statistical methods included descriptive analysis, Chi-square or Fisher's exact test, Mann Whitney U test, and Cramer's V and r statistics as measures of effect sizes. RESULTS: Of all 430 residents, 255 (59%) responded to the survey. A total of 17 (7%) of residents reported being infected with COVID-19 and a significant difference was reported between SRs and NSRs (10% vs 4%, V = .124 "small effect" (95% CI; .017-.229), p = 0.048). Approximately, 106 (42%) reported a decrease in the number of staff working at the clinic and 164 (64%) reported limited access to personal protective equipment during the pandemic. On a 4-point Likert scale for the feeling of anxiety, the median was 2 (2-3 IQR) in the NSRs group, vs 2 (1-2 IQR) in the SRs groups, with the NSRs being more likely to feel anxious (r = 0.13 "small effect" (95% CI; 0.007-0.249), p = .044). Similarly, the proportion of residents who reported feeling anxious about an inadequacy of protective equipment in the work area was significantly greater in the NSRs group (90.3% vs 75.2%; V = .201 "small effect" (95% CI; .078-.313), p = .001), as well as the proportion of residents who reported feeling increased stress and anxiety between colleagues being also significantly higher in the NSRs group (88.1% vs 76%; V = .158 "small effect" (95% CI; .032-.279), p = .012). CONCLUSION: The burden of the ongoing pandemic on the mental health status of residents is very alarming and so providing residents with psychological counseling and support is needed. Also, critical implications on the flow of residency training programs have been noticed. This necessitates adapting and adopting smart educational techniques to compensate for such limitations.

Association of single-nucleotide polymorphisms in the ESR2 and FSHR genes with poor ovarian response in infertile Jordanian women.

OBJECTIVE: Poor ovarian response (POR) refers to a subnormal follicular response that leads to a decrease in the quality and quantity of the eggs retrieved after ovarian stimulation during assisted reproductive treatment (ART). The present study investigated the associations of multiple variants of the estrogen receptor 2 (ESR2) and follicle-stimulating hormone receptor (FSHR) genes with POR in infertile Jordanian women undergoing ART. METHODS: Four polymorphisms, namely ESR2 rs1256049, ESR2 rs4986938, FSHR rs6165, and FSHR rs6166, were investigated in 60 infertile Jordanian women undergoing ART (the case group) and 60 age-matched fertile women (the control group), with a mean age of 33.60±6.34 years. Single-nucleotide polymorphisms (SNPs) were detected by restriction fragment length polymorphism and then validated using Sanger sequencing. RESULTS: The p-value of the difference between the case and control groups regarding FSHR rs6166 was very close to 0.05 (p=0.054). However, no significant differences were observed between the two groups in terms of the other three SNPs, namely ESR2 rs1256049, ESR2 rs4986938, and FSHR rs6165 (p=0.561, p=0.433, and p=0.696, respectively). CONCLUSION: The association between FSHR rs6166 and POR was not statistically meaningful in the present study, but the near-significant result of this experiment suggests that statistical significance might be found in a future study with a larger number of patients.

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years' Experience in a Tertiary Center.

OBJECTIVE: To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy. METHODS: This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (ß-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups. RESULTS: The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment ß-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a ß-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor. CONCLUSION: The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment ß-HCG level is a significant predictor of the treatment outcome.

A descriptive study of the clinico-pathological and surgical characteristics of patients with primary epithelial ovarian cancer. A cross sectional study.

OBJECTIVE: To study the clinical, pathological and surgical features of primary epithelial ovarian cancer treated at our institution. METHODS: fifty-nine patients with primary epithelial ovarian cancer were included. Clinical data collected included patient's age, presenting symptoms, laboratory and tumor markers results as well as preoperative imaging reports. Pathological and surgical findings included were: spread of the disease, histologic type, stage of the disease, type of surgical procedure and amount of residual disease. RESULTS: Mean age of the patients was 54.5 years. Lower abdominal pain was the most common presenting symptom, followed by abdominal distension. The commonest histopathological type was high grade serous carcinoma (72.9%). In our study, majority of patients were diagnosed with stage III disease, accounting for 69.5% of the total number of patients. Complete cytoreduction with no gross residual disease was achieved in 77.3% of patients with stage 3-4 disease. CONCLUSION: clinical and pathological features of primary epithelial ovarian carcinoma in our populations are similar to what is reported worldwide. We have also documented that our surgical approach to the management of ovarian cancer is comparable to the international consensus.

Distance education during the COVID-19 outbreak: A cross-sectional study among medical students in North of Jordan.

INTRODUCTION: In the spot of the new emerging COVID-19 pandemic and its major impact worldwide on day-to-day activities many rules had to be changed in order to fight this pandemic. Lockdown started in Jordan and around the globe affecting several aspects of life including economy, education, entertainment, and government policies. Regarding education, the priority was to ensure the safety and progress of the educational process. Thus, new methods of teaching had to be applied using the online learning at Jordan University of Science and Technology (JUST), Faculty of Medicine. This study was done to assess (1) Class Experience (2) Students and Lecturers' Interaction (3) Online Learning Advantages & Disadvantages (4) Students' Preference. METHODS: A cross sectional study was conducted Convenience sampling technique was used to collect the data from the participants using a survey composed of 18 questions on Google Forms platform. A link was sent to the undergraduate medical students at the Jordan University of Science & Technology via their e-learning accounts (n = 3700). The form was available from May 22nd, 2020 to May 30th, 2020 for 8 days long. Data analysis was done using SPSS V 23. RESULTS: 2212 out of 3700 students responded, (55.8%) of them were in the basic years and (44.2%) of them were in the clinical years. (55.8%) of students started to take online lectures after 3 weeks. (45.7%) used the hybrid teaching method (asynchronous and synchronous), (31.4%) used live classes, and 22.8% recorded classes. Zoom was the most used platform. (48.7%) and (57%) of clinical students and basic students express their interaction as bad, while the others had good and excellent interaction. Maintaining social distance was the most advantage of online teaching, while poor technical setup and no direct contact were the most disadvantage, furthermore inability to have real clinical access was a significant problem for clinical students (p < .001). With reference to students' preferences 75% of students were not pleased with their experience and 42% of students prefer to integrate online learning with traditional learning. CONCLUSION: Most medical students at JUST preferred the traditional face-to-face teaching method over the solo online teaching methods with recommendations to convert to a more integrated educational system. Also, a well-established infrastructure should be done in involving online teaching.

Investigating Cervical Risk Factors that Lead to Cytological and Biopsy Examination.

INTRODUCTION: Cervical cancer ranks the fourth prevalent cancer in women at the global level, and the second in poor countries. The main objectives of the present study were to investigate the risk factors associated with cervical cancer and to study their possible association with the decision to take a cervical biopsy. AIM: The main objectives of this study were to investigate the risk factors associated with cervical cancer and to study their possible association with the decision to take a cervical biopsy. METHODS: It was cross-sectional study and we analyzed an online data posted on Kaggle. This Dataset is obtained from UCI Repository. A list of risk factors for cervical cancer leading to biopsy examination was included, such as age, number of sexual partners, first sexual intercourse, number of pregnancies, smoking variables, hormonal contraceptives, IUD, and sexually transmitted disease variables, Hinselmann, Schiller, Cytology, and Biopsy. The dataset was prepared for appropriateness through filtering invalid cases with missing data. RESULTS: The results of the study showed that the following variables were significantly associated with cytological examination: STD-Condylomotosis (p=0.035), STD-Pericondylomotosis (p=0.029), STD_HIV (p=0.006), Hinselmann (p<0.001), Schiller (p<0.001), and biopsy (p<0.001). the results also showed that the following variables were significantly associated with cytological examination. CONCLUSION: Taken together, cytological variables or biopsy examination variables if carried out at an early stage, lead to better diagnostic and therapeutic options.

Successful Management of the First Case of a Metastasized Complete Mole in Form of Twin Pregnancy in Jordan.

BACKGROUND A complete mole with a living fetus in a form of twin pregnancy that is a rare obstetric event. The development of metastatic gestational trophoblastic disease is the most important and serious complication. It is debatable whether to terminate the pregnancy or to continue. Another point is the validity of the conservative treatment of this type of neoplasm, especially in developing countries. CASE REPORT In this study, we report the first case of a twin pregnancy with complete mole and a living fetus in Jordan, which is a developing country. A 33-year-old woman presented with vaginal bleeding which was revealed to be due to a complete mole in the form of a twin pregnancy. A hystrostomy was performed with subsequent drop of ß-hCG level. However, the ß-hCG started to rise and the CT scan revealed multiple metastatic sites. Accordingly, she received 3 cycles of methotrexate, with a subsequent reduction in ß-hCG level. CONCLUSIONS This is the first case report of a complete mole in twin pregnancy in Jordan. To overcome the development of metastasis, close follow-up and immediate treatment are crucial when the conservative approach is being considered. This report highlights the importance of considering the diagnosis of complete mole for women with twin and vaginal bleeding.