National survey of barriers to colorectal cancer screening in Jordan.

Background: Colorectal cancer is among the leading malignancies globally and in Jordan. It causes significant morbidity and mortality. It can be detected early, but uptake of colorectal cancer screening in Jordan is substantially low. Aim: To determine the underlying barriers to the uptake of colorectal cancer screening in Jordan. Methods: A cross-sectional study was conducted in the northern, central and southern regions of Jordan using selfadministered questionnaire that evaluated the barriers and attitudes towards colorectal cancer screening among adults aged 45 years and above living in Jordan. The data was analyzed using SPSS version 25.0. Results: Of the 1477 participants enrolled in the study, 29.1% reported the lack of information about screening as a major barrier to uptake, followed by the fear of any potential complications due to the test (10%), embarrassment associated with colonoscopy (7.8%), and fear of the result (7.4%). Only 9% of the study participants had taken the colonoscopy test for colorectal cancer screening. Conclusion: Lack of information about colorectal cancer screening, misconceptions and embarrassment drive the low uptake of colorectal cancer screening in Jordan. There is a need for nationwide education and awareness on colorectal cancer screening to address the barriers reported in this study and increase screening uptake.

Echocardiography and pulmonary hypertension in patients with chronic obstructive pulmonary disease undergoing lung transplantation evaluation.

BACKGROUND: The use of echocardiography in pulmonary hypertension (PH) in advanced chronic obstructive pulmonary disease (COPD) is understudied. We aimed to compare the performance of echocardiography with right heart catheterization (RHC) in the diagnosis of PH in COPD patients undergoing lung transplant evaluation. METHODS: We included 111 patients with severe COPD who underwent RHC in a single center as part of lung transplantation evaluation. COPD-PH and severe COPD-PH were defined based on RHC per the 6th world symposium on pulmonary hypertension. Echocardiographic probability of PH was described according to the European Society of Cardiology guidelines. Summary and univariate analyses were performed. RESULTS: The mean age (±SD) was 62 (8) and 47% (n=52) were men. A total of 82 patients (74 %) had COPD-PH. The sensitivity, specificity, positive predictive, and negative predictive values of echocardiography in diagnosing COPD-PH were 43 %, 83 %, 88 %, and 34 % respectively and for severe COPD-PH were 67 %, 75 %, 50 %, and 86 % respectively. Echocardiography was consistent with RHC in ruling in/out PH in 53% (n=59) of patients. After controlling for age, sex. BMI, pack year, echocardiography-RHC time difference, GOLD class, FVC, and CT finding of emphysema, higher TLC decreased consistency (parameter estimate=-0.031; odds ratio: 0.97, 95%CI 0.94-0.99; p=0.037) and higher DLCO increased consistency (parameter estimate=0.070; odds ratio: 1.07, 95%CI 0.94-0.99; p=0.026). CONCLUSIONS: Echocardiography has high specificity but low sensitivity for the diagnosis of PH in advanced COPD. Its performance improves when ruling out severe COPD-PH. This performance correlates inversely with lung hyperinflation.

Career Regret and Health-Related Quality of Life among Medical Students: A Nationwide Cross-Sectional Study in Jordan.

OBJECTIVES: Medical students have a lower quality of life (QoL) when compared to the general population. This lower QoL is associated with multiple factors such as burnout and depressive symptoms. QoL can be reflected in the degree of career satisfaction and career regret. We aim to study the prevalence of career regret in Jordanian medical students and its association with QoL and other related factors. METHODS: This national cross-sectional study consisted of an anonymous online survey distributed to medical students enrolled in all six Jordanian medical schools over a period of 6 weeks. A validated tool was used to assess QoL and students were asked a series of questions related to their career satisfaction and career regret. RESULTS: A total of 544 medical students completed the survey. The mean age was 21.5 ± 1.63 years (range 17-29), with 45.6% being males. The overall mean physical health score was 45.9 ± 5.17, and the overall mean mental health score (mental component summary (MCS)) was 42.04 ± 5.52. 76.3% of students have regretted studying medicine, citing stress as the main reason. There was a significant relation between the year of study and the percentage of career regret. Additionally, mean MCS was significantly lower in students who were frequently or always thinking about dropping out of medical school. DISCUSSION: The high percentage of career regret and the low mental QoL in Jordanian students are alarming findings, highlighting an underlying source of psychological distress in Jordanians. This calls for further investigations into the psychological health of medical students, as well as interventions to prevent the development of consequences that can impact both students and their future patients.

Comparison of Baseline and Test Day Cardiovascular Parameters, Anxiety Scores and Coffee Consumption Among Medical Students Undergoing Objective Structured Clinical Examinations in Jordan.

Introduction: Objective Structured Clinical Examinations (OSCEs) are considered an integral part of the assessment process of many schools of medicine worldwide. Close monitoring by examiners, scrutinized interactions with patients, and fear of the unknown, among other factors have been reported to cause psychological stress among students during the examinations period. In this study, we aimed to assess changes in cardiovascular parameters, anxiety scores, and lifestyle patterns of medical students during their OSCEs as compared to their baseline. Materials and Methods: We recruited healthy medical students from our institution's medical school. General demographics, academic, and baseline lifestyle characteristics were collected 1-2 months before the OSCE day. The Generalized Anxiety Disorder 7-item (GAD-7) scale was used to measure anxiety symptoms. Data related to coffee consumption in addition to systolic, diastolic blood pressure and heart rate measurements were collected both at baseline and on OSCE day. Results: This study included 325 students (144 (44.3%) males and 181 (55.7%) females). The mean systolic blood pressure, diastolic blood pressure, and heart rate measurements were significantly higher on OSCE day as compared to the baseline. In addition, the daily consumption of coffee increased significantly during OSCE day as compared to the baseline. Although the anxiety score increased during OSCE day compared to the baseline, the difference was not statistically significant. However, the change in anxiety score (OSCE day - baseline) was significantly higher in females compared to males. Conclusion: In our study, we observed significant increases in blood pressure, heart rate, and coffee intake on the day of the test compared to baseline measurements. These findings underscore the significance of implementing measures to reduce the harmful effects of stress on students during exam preparations and medical school assessments.

Stapler Pharyngeal Repair Versus Conventional Suturing After Laryngectomy in Jordanian Laryngeal Cancer Patients.

Background: The use of staplers in surgical repair of the pharynx after laryngectomy has gained traction in recent years, with differing results. Objective: In this study, we compare the use of stapler suturing (SS) after laryngectomy in comparison with the manual suturing (MS) technique in laryngeal cancer patients regarding pharyngocutaneous fistula (PCF) formation, operative time, blood loss, margin status, and length of hospital stay. Methods: We conducted a retrospective cohort study of laryngeal cancer patients undergoing pharyngeal repair after total laryngectomy by either a stapler or manual suturing. Demographic data, stage of disease, postoperative complications, duration of hospital stay, and operative time were collected. Results: A total of 59 laryngeal cancer patients were included, of which 22 underwent SS and 37 had MS. Our cohort was predominantly males (98%), and similar mean ages were observed across both suturing groups (60.5 vs 59.9, P = 0.83). Negative margins were more frequent with SS (100% vs 86.5%, P = 0.13) yet this difference was not statistically significant, whereas preoperative tracheostomy procedure was present more in MS patients (43.2% vs 0, P = 0.003). Lymph node involvement was higher in the manual suturing cohort, yet this difference was statistically insignificant (41.2% vs 25%, P = 0.49). The muscle flap procedure was significantly higher in the MS cohort (70.3% vs 20%, P = 0.001). In both groups, comparable PCF rates were noted (13.3% vs 10.8%) and there was no association between salvage laryngectomy and PCF occurrence in the entire cohort. For surgery details, there was no statistical difference between both groups in blood loss, hospitalization length, or oral feeding start. Only surgical time was significantly lower in the stapler cohort (277 vs 372.6 minutes, P = 0.000). Conclusion: Both suturing techniques did not show any statistically significant difference in PCF rates. However, was markedly reduced with stapler use in comparison to manual suturing. Further randomized studies with larger sample size are needed to validate the role of stapler suturing for pharyngeal repair.

Prevalence of Undiagnosed Hypertension and Its Predictors in Jordan: A Cross-Sectional Study.

Introduction: Hypertension is an important cause of morbidity and mortality worldwide. Undiagnosed hypertension is a serious issue that leads to increased morbidity and mortality. In this study, we aim to identify the prevalence of undiagnosed hypertension in the healthy Jordanian population, as well as identify predictors of high blood pressure readings in presumably healthy Jordanians. Materials and Methods: We recruited healthy visitors accompanying patients at our Jordan University Hospital Clinics ranging from 18 to 80 years of age. We measured each participant's systolic and diastolic blood pressure at our outpatient clinics on two different days, one week apart. We also obtained demographic data, weight, height, smoking status, and family history of hypertension and cardiovascular diseases. Results: A total of 896 participants were included in this study with a mean age of 48 years. The median of systolic blood pressure readings was 125 mmHg, and the median of diastolic blood pressure readings was 83 mmHg. 38.5% had undiagnosed stage 1 hypertension and 30.5% had undiagnosed stage 2 hypertension according to the American College of Cardiology/American Heart Association guidelines. On the other hand, 25.4% had undiagnosed grade 1 hypertension and 5.1% had undiagnosed grade 2 hypertension according to the European Society of Hypertension guidelines. Conclusion: According to the ACC/AHA guidelines, 68.5% of previously healthy Jordanians met the criteria to be diagnosed with hypertension. Predictors of high systolic blood pressure were age, BMI and family history of CAD, while female gender is associated with a lower systolic blood pressure. For diastolic blood pressure, only BMI and family history of CAD were associated with significantly higher diastolic blood pressure, while female gender and exercise were significantly associated with lower diastolic blood pressure.

Parents' attitude towards pneumococcal vaccine: an online survey from Jordan.

OBJECTIVES: In developing countries, the pneumococcal conjugate vaccine (PCV) has not been incorporated into the national immunization schedule, and the vaccination rate is low. This study aimed to examine parental knowledge, attitudes, and barriers to children receiving the PCV in Jordan. METHODS: This was a questionnaire-based cross-sectional study. The online survey was written in Arabic and consisted of three main sections. The questionnaire was distributed via social media platforms, such as Facebook, Twitter, and WhatsApp. RESULTS: In total, 720 responses were analyzed. Only 149 (20.7%) of the parents' children were vaccinated with the PCV. However, almost half 356 (49.4%) of the respondents were willing to vaccinate their children. Most (563, 78.1%) parents stated that the vaccine would protect their children from pneumococcal disease. More than two thirds (516, 71.6%) of them strongly agreed or agreed that the cost of the PCV is high. Parents who had vaccinated their children had a higher monthly income than parents who had not vaccinated their children. CONCLUSIONS: This study shows a lack of knowledge regarding pneumococcal infection and the PCV among Jordanian parents. This is the main barrier to vaccinating children. Therefore, improving parental knowledge would increase the rate of vaccination among Jordanian children.

Diagnostic accuracy of ultrasonography compared with magnetic resonance cholangiopancreatography in the detection of choledocholithiasis.

PURPOSE: The aim of this study is to compare the diagnostic accuracy of ultrasonography (US) with magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of choledocholithiasis in context of laboratory blood test values. METHODS: This retrospective study included patients who underwent both MRCP and US as part of their choledocholithiasis workup. MRCP findings, reviewed by two board-certified radiologists, laboratory findings, and US reports were collected. RESULTS: Our study included 243 patients. On US examination 74 cases were found dilated (30.5%), while 94 cases showed dilation (38.7%) by MRCP. The overall accuracy of US was 76.1%, where 185 patients had similar MRCP and US findings, 7.8% had false positive ultrasound, and 16% had false negative ultrasound finding. The accuracy of ultrasound was significantly higher in males (p = .013). In addition, a significant difference in duct dilatation as found by ultrasound and accuracy of diagnosis (p = .01). CONCLUSION: Although US has a relatively low accuracy, its properties of being cost-effective and non-invasive make it an ideal first step in the diagnosis of choledocholithiasis. If a patient has elevated liver enzymes or a high risk of choledocholithiasis, we recommend that MRCP be performed even no dilation was seen on US.

Evaluating the physical, psychosocial and ergonomic burden of lead aprons among Jordanian interventionists: a nationwide study.

Objectives. This study assessed the physical and psychological burden of lead apron use on Jordanian interventionists and investigated the attitudes and knowledge of interventional personnel toward ergonomic guidelines and practices. Methods. A cross-sectional investigation of a randomly sampled Jordanian cohort of interventional personnel was conducted using a self-administered questionnaire.Results. A nationwide sample of 130 practitioners with a mean 9.3 ± 8.1 years of experience in interventional procedures participated. Practitioners were aware of their apron's weight but not of its lead equivalence (71.5%). More than 60% of respondents complained of back pain. While 66.9% did not develop musculoskeletal pathologies, 64.3% of those with already established musculoskeletal pathologies experienced worse pain due to apron usage. Despite believing in the effect of lead aprons on muscular strain and work performance, 78.5% adhere to its usage. In terms of ergonomics, only 39.2% were aware of ergonomic guidelines; however, 90.0% believe that ergonomic practices are essential as 49.2% have experienced discomfort due to bad ergonomics. In terms of psychological burden, anxiety and depression were suggested in 16.4 and 21.6% of the sample.Conclusion. Jordanian interventionists portray positive attitudes toward lead aprons; nevertheless, their awareness of ergonomic practices warrants the implementation of evidenced-based interventions.

Association between neutrophil to lymphocyte ratio and mortality among community acquired pneumonia patients: a meta-analysis.

The neutrophil to lymphocyte ratio (NLR) is an emerging biomarker used in the prognosis of many conditions. We aimed to conduct a meta-analysis to assess the prognostic accuracy of the NLR in determining mortality in patients with community acquired pneumonia (CAP). The PubMed, EBSCO, and Scopus databases were searched to find all relevant articles; 10 articles with 5220 patients were included. The pooled area under the curve (AUC) of NLR admission levels to predict 30-Day mortality of CAP patients was 0.706; 95% CI (0.631 to 0.781), while the pooled AUC of NLR levels taken at 3-5 days was 0.882; 95% CI (0.818 to 0.945). Meta analysis also showed a significant difference in the NLR between the survivors and 30-day non-survivors. This difference was greater when NLR levels were taken at 3-5 days; standardized mean difference (SMD) = 1.646; 95% CI (0.451 to 2.840) compared to NLR levels at admission SMD = 1.139; 95% CI (0.514 to 1.764). These results show that the NLR has potential to be incorporated in the routine assessment and stratification of CAP patients, especially in the early-stage evolution (3-5 days), keeping in mind the availability and cost effectiveness of this test.

The utility of whole-exome sequencing in accurate diagnosis of neuromuscular disorders in consanguineous families in Jordan.

BACKGROUND: Neuromuscular disorders (NMDs) encompass a large group of genetic and acquired diseases affecting muscles, leading to progressive muscular weakness. These disorders are frequently inherited in an autosomal-recessive (AR) pattern with extreme heterogeneity and various clinical presentations. Consanguinity increases the likelihood of AR disorders, with high rates of cousin inbreeding in Jordan and other Arab countries. In Jordan, the implementation of genetic diagnosis is limited, with delayed or misdiagnosis of genetic disorders. Thus, the lack of genetic counselling and specialized treatment options is frequently encountered in the country. METHODS: Whole-exome sequencing (WES) was conducted for eleven probands from ten Jordanian families who have been formerly diagnosed with limb-girdle dystrophy (LGMD) and Charcot-Marie-Tooth disease (CMT). The previous diagnoses were established principally on clinical examination in the absence of genetic testing. Additionally, Sanger sequencing and segregation analysis were used to validate the resulted pathogenic variants. RESULTS: Multiple variants were identified using WES: For DYSF gene, a missense variant (c. 4076 T > C, p.Leu1359Pro) in exon 38; a nonsense variant (c. 4321C > T, p.Gln1441Ter) in exon 39; a single-nucleotide deletion (c. 5711delG, p.Gly1904AlafsTer101) in exon 51. Other variants included a missense variant (c. 122G > A, p.Arg41Gln) in exon 3 of MPV17 gene, a single-nucleotide deletion (c. 859 delC, p.Lue287Ser fs14*) in exon 6 of SGCB gene, a missense variant (c. 311G > A, p.Gly104Asp) in exon 2 of SLC25A46 gene, a nonsense variant (c. 496C > T, p.Arg166Ter) in exon 5 of SGCG gene, and a nonsense variant (c.3202C > T, p.Gln1068Ter) in exon 13 of SH3TC2 gene. CONCLUSION: Utilization of WES is helpful to facilitate rapid and accurate NMDs diagnosis, complementing a thorough clinical evaluation. This approach can be invaluable to aid in the identification of genetic risks among consanguineous couples. Subsequently, well-informed genetic counselling and potential individualized treatment can be provided.

Determinants of the willingness of the general population to get vaccinated against COVID-19 in a developing country.

PURPOSE: Vaccination is a cost-efficient intervention to slow the spread of the coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the population's willingness to take the COVID-19 vaccine in Jordan and investigate potential determinants of their acceptance. MATERIALS AND METHODS: This study used an online survey distributed in November 2020, before introducing the vaccine, with items investigating socio-demographic characteristics, seasonal flu vaccination history, COVID-19 vaccine acceptance once available, and factors affecting their decision-making. Also, "COVID-19 risk perception" and beliefs toward COVID-19 vaccine benefits and barriers were assessed. RESULTS: A total of 2,208 participants completed the survey with a participation rate of 13.1%. The mean±standard deviation age was 33.2±13.5, and 55.7% were females. Study participants were almost equally distributed between willingness, unwillingness, and indecision to take the COVID-19 vaccine (30.4%, 36.4%, and 31.5%, respectively). Younger adults, males, and those who were not married, do not have children, have a bachelor or higher education, employees or being students, healthcare workers, and those who reported receiving flu vaccine had higher rates of COVID-19 vaccine acceptance compared to their counterparts (p<0.001 for each category). COVID-19 risk perception, and perceived vaccine benefits, and barriers were significant predictors of intention. Among those undecided or unwilling to take the COVID-19 vaccine, its safety and side effects were the most common concerns. CONCLUSION: The low rate of COVID-19 vaccine acceptance in a developing country is alarming, and a significant proportion are indecisive. Interventions to elevate vaccine acceptance by addressing its safety and efficacy and targeting vulnerable groups are recommended.

Generation and characterization of induced pluripotent stem cell (iPSC) line (JUCTCi002-A) from a patient with ataxia with oculomotor apraxia type 1 (AOA1) harboring a homozygous mutation in the APTX gene.

Ataxia with Oculomotor Apraxia Type 1 (AOA1) is an autosomal-recessive cerebellar ataxia characterized by early-onset cerebellar atrophy and axonal sensorimotor polyneuropathy. AOA1 is related to mutations in the aprataxin (APTX) gene encoding for the aprataxin protein. The aprataxin protein has been reported to be involved in DNA single-strand break repair (SSBR) machinery and it localizes to the mitochondria to preserve the mitochondrial function. Here, we demonstrate the generation of induced pluripotent stem cell (iPSC) line (JUCTCi002-A) from AOA1 patient's skin dermal fibroblasts. The selected line showed normal karyotype, expression of pluripotency markers and the ability to differentiatie in vitro into the three germ layers.