King Hussein Medical Center Research Articles

Evaluation of the Efficacy of Helicobacter pylori Eradication Regimens

Background: Several studies have been carried out to assess the effectiveness of current combination therapies for H. pylori infection. Usually, a PPI is combined with two antibiotics (triple therapy) or bismuth salts are added to these three medication agents (quadruple therapy). Antibiotic selection ought to be region-specific, taking into account local H. pylori resistance to those drugs. Aim of the Study: The objective is to evaluate and compare the efficacy of treatment regimens for H. pylori infection. Methods: A retrospective cohort study will be conducted at the Gastroenterology department at King Hussein Medical Centre in The Royal Medical Services, Amman, Jordan. Electronic health records (Hakeem) will be accessed for data extraction. Inclusion criteria will be patients who were diagnosed with H. pylori infection and received one of the two prescribed eradication regimens. Regimen A consists of two doses of 1 g amoxicillin capsules and 40 mg esomeprazole capsules twice a day for 14 days, in addition to a 500 mg levofloxacin tablet once a day while regimen B consists of 500 mg clarithromycin tablets, 500 mg metronidazole tablets, and 40 mg esomeprazole capsules taken twice daily. Exclusion Criteria include patients with incomplete medical records or those with contraindications to standard eradication therapies. Version 24 of the Statistical Package for the Social Sciences (SPSS) will be used to code and analyse the data. Results: We enrolled 62 patients in the levofloxacin-based regimen and in the clarithromycin-based therapy distributed equally among the two study groups. The former was successful in 27 patients (43.5%) and the latter in 20 patients (32.3%), using chi-square test (P < .05). Regimen A had greater eradication rates than regimen B in the current investigation, with 87% and 64.5% eradication rates, respectively. Conclusion: A levofloxacin–amoxycillin-based triple therapy has been proved to be acceptably effective as second- or even ..........

Incidence of Posterior Capsule Rupture During Phacoemulsification Cataract Surgery Among Patients Treated With Intravitreal Bevacizumab Injections.

To assess whether intravitreal bevacizumab injections increase the risk of posterior capsular rupture during phacoemulsification cataract surgery in diabetic patients. A retrospective study that included diabetic patients who underwent phacoemulsification cataract surgery at King Hussein Medical Center of the Jordanian Royal Medical Services during a one-year period from January 2023 until January 2024. Patients were categorized into four groups. The first group did not receive an intravitreal bevacizumab injection; the second group received only one injection; the third group received two injections; and the fourth group received three or more injections. Results from the four groups were compared with a control group for patients who underwent phacoemulsification surgery and were not known to have diabetes mellitus and did not receive previous intravitreal injections. All injections were received within a period of one year before the time of phacoemulsification surgery. Inclusion criteria for the study groups included diabetic patients with a history of diabetes of more than 10 years with the presence of diabetic retinopathy. Exclusion criteria included patients who received intravitreal injections other than bevacizumab, previous intraocular surgery or trauma, and the presence of ocular pathology that led to an increased risk of posterior capsular rupture. The incidence of posterior capsular rupture was compared among these groups. A p-value was used to assess statistical significance and was considered to be statistically significant if ≤0.05. The number of patients in the control group (group 0) was 1440 patients with a mean age of 64.9, and in the study groups were 1306 patients. Group 1 included 244 patients (18.7%) with a mean age of 62.4 years, compared to 306 patients (23.4%) in group 2 with a mean age of 66.1 years, 352 patients (27%) in group 3 with a mean age of 64.2 years, and 404 patients (30.9%) in group 4 with a mean age of 63.1 years. Posterior capsular rupture occurred more significantly in patients with group 4. It occurred in 21 patients, representing 5.2% of them, compared to four patients (1.6%) of group 1, six patients (2%) of group 2, and eight patients (2.3%) of group 3, while in the control group, the number of patients with posterior capsular rupture was 20 (1.4%). Intravitreal bevacizumab in diabetic patients is considered a risk factor for posterior capsular rupture in phacoemulsification cataract surgery in patients receiving more than three injections.

Serial neutrophils count as a stratifying tool for early follicular tonsilitis remission

Background/Aim: This study examines the correlation between sequential serum neutrophil levels and the overall improvement status or reduction rate of intravenous antibiotic administration. This study seeks to identify a cost-effective and easily accessible biomarker that can accurately predict the need for hospitalisation in patients with acute tonsillitis who are receiving intravenous broad-spectrum antibiotics. The goal is to determine the patients' suitability for early discontinuation of intravenous antibiotics and discharge. Methods: This study was conducted at the King Hussein Medical Centre in Jordan, focusing on patients with severe acute tonsillitis who did not respond to oral antibiotics. Data was collected from the electronic medical record system (Hakeem) from January 2018 to May 2021. The study classified serial serum neutrophil measurements during the first week of hospital admission into four categories. The levels were compared between the non-penicillin Cohort (Group I) and penicillin Cohort (Group II) using an Independent-T Test. The outcomes of interest included a drop in neutrophil counts exceeding 50%, a decrease in the use of intravenous antibiotics in favor of oral antibiotics, and early eligibility for discharge. The study also examined serial neutrophil counts over the tested days and compared to the outcomes of positive and negative states using receiver operating curve analyses. The optimal cutoff operating point for each ROC curve was determined by selecting the highest Youden's index of each prognosticator day level. The analysis of all results was conducted using SPSS version 20 with a significance level set at p-value <0.05. Results: This study analyzed 1638 adult and elderly patients admitted to KHMC, RMS, Amman, Jordan between January 2018 and May 2021. The average age was 51.88±16.22 years, with patients dependent on intravenous penicillin being slightly older. The distribution of males and females was significant, with males making up 2.55 times the number of females. The odds ratio for positive outcomes was 4.12, with a high rate of poor outcomes in 1318 out of all eligible patients. A total of 994 (60.7%) medical patients were treated with intravenous administration, while 644 (39.3%) surgical patients were scheduled for a tonsillectomy procedure. The risk estimate for patients admitted from medical wards compared to surgical wards was an odds ratio of 0.562. The study also provided sensitivity analysis for the four tested serial neutrophil prognosticators at different day levels. Conclusion: The study supports the use of Somatic Nucleated Cell (SNC) as a reliable measure for evaluating EFR in cases of catarrhal acute tonsillitis. The maximum SNC count in Group one was 11,269 cells per cubic millimeter. Acute streptococcal infection often exhibits an ESR higher than 40, but this may be concealed by other complications. The SNC test has advantages like simplicity, quickness, and cost-effectiveness, but lacks specificity. Monitoring SNC and EFR fluctuations can initiate treatment cessation, preventing relapse and severe complications during recovery.

Hazard functioning modeling for dextrose fluids associated hemodilution; Cox-regressional analysis for patients’ Hematocrit Hemoglobin Ratio

Aims: This study looks at the cox-regressional relationships between hematocrit to hemoglobin ratio (HHR) and a group of outcomes of interest (cOI). These outcomes include death from any cause, acute myocardial infarction, stroke, and severe dilutional hyponatraemia incidence. Additionally other outcome of interest in this study will be prolongation of admission days, infection rate, acute kidney injury, and mandating the transition to the critical unit and mechanical ventilation intubation. The study also will investigate the performances of the tested ratio and will explore their sensitivity, specificity, and accuracy indexes. Methods: Between 2018 and 2022, a retrospective study was conducted at the King Hussein Medical Centre in Amman, Jordan, involving 926 patients. The study aimed to determine the potential risk of dilution of red blood cells in circulation caused by dextrose-containing fluids in patients with chronic kidney disease. The study aimed to determine the ideal threshold levels of the investigated ratio (HHR) to enhance clinical outcomes and safety margins, particularly in patients with severe renal impairment or chronic kidney disease in a hospital setting. The study included patients with fluctuating kidney function, renal replacement therapy, uncontrolled diabetes, and conditions necessitating specific fluid regimens. The study used binary logistic regression and cox-regression proportional hazard modelling to examine the correlation between the hematocrit to haemoglobin ratio and the composite outcomes of interest (cOI) in patients from Jordan. The findings suggest that higher cOI likelihood indicates a more advantageous condition, while lower values suggest a less advantageous condition. Results: A retrospective study at the KHMC in Amman, Jordan, involved 1306 patients from 2018 to 2022. The study focused on the hematocrit to haemoglobin ratio (HHR) and achieved correct classification rates of 70.8%. The best HHR was 2.555:1, with a 42.8% chance of occurring at this level. Cox-Regression Proportional Hazard Modelling revealed a censored percentage of 83.4% in HHR>2.555 stratum and 51.5% in HHR≤2.555 stratum. The study found a high percentage of HD patients processed in the analysis. Conclusion: Intravenous dextrose fluids associated hemodilutional state is linked to all-cause mortality in admitted medically and surgically patients and cardiovascular death. Low ratio increases the risk. Factors such as malnutrition and kidney function loss contribute to prognosis. Future studies should focus on mechanistic pathways, optimal targets, age, and sociodemographic factors.

Prediction quality of patients’ composited outcomes of interest and how much variations on the outcomes explained by the patients’ sodium levels

Background: Hypernatremia can be caused by medications, glucose/urea-related hyperosmolarity, overdiuresis, compartmental fluid distribution imbalances, iatrogenic hypertonic saline excess, renal concentrating performance defects, overdiuresis, and hypermetabolic states. Patients who are in critical condition, encompassing ailments of the heart, liver, lungs, brain, and kidneys, frequently manifest hyponatremia (sodium < 135 mEq/L). Similar to hypernatremia, hyponatremia signifies the severity of the illness and a bleak prognosis. Hyponatremia is less lethal than central pontine myelinolysis, which overcorrects sodium concentrations urgently. Aim: The objective of this research endeavour was to investigate the strength of correlations, the extent to which the independent variables account for the overall variability in the dependent variable, and the accuracy of the dependent variable's predictions. In addition, the purpose of this test was to extract the coefficients required to present the Binary Logistic Regression models that were investigated. Methods: Between May 2018 and May 2021, this study examined two Na-based prognosticators for overall mortality in critically ill patients admitted to the King Hussein Medical Centre. An investigation was conducted on 2155 cases utilising Receiver Operating Characteristic (ROC) and Sensitivity Indices Test analyses to ascertain the most effective cut-off points, specificities, sensitivity, predictive values, likelihood ratios, Youden and accuracy indices, and mortality rates. The research discovered that serial termination points with lower values suggested more robust evidence for a positive actual state, whereas higher values suggested less robust evidence for a negative actual state. A Binary Logistic Regression (BLgR) test was performed to examine correlations, the extent of total variations in the dependent variable, and the accuracy of the prediction for each Na-related mortality prognosticator in relation to overall mortality. The analysis was conducted utilising version 25 of SPSS for Windows. Results: The research revealed that the AUROC for cNa was considerably greater in magnitude compared to its prognosticator that is genealogically related to Na. 129.35 mEq/l and 131.05 mEq/l were the optimal cut-off points, TPRs, TNRs, PPVs, NLRs, YIs, and AIs for the two comparative Na investigated statutes. The BLgR models were developed in order to simulate the relationship between the corrected and measured Na levels of patients and their overall mortality rate. For critically ill patients, the probabilities of overall mortality at the optimal cutoff operating Na levels were 79.59 and 81.62 percent, respectively.

Modeling adjusted for age and menopause statuses dependent on PET/CT scan for ovarian cancer diagnosis and staging

Aims: The main objective of this observational study is to develop a linear regression model that incorporates age, menopausal status, and family history to predict the risk and severity of ovarian cancer. Methods: In early 2023, the King Hussein Medical Centre's gynaecological clinic began using PET/CT scanning and histopathological analysis to identify ovarian cancer cases. The data was then used to strategize interventions for each patient. The study aimed to assess the probability of ovarian cancer in female patients by analysing their age, menopausal onset, and family history. Patients were classified as pre-menopausal or post-menopausal, and PET/CT scan results were converted into FIGO classifications. Histopathological findings were analysed using ROC and binary logistic regression analyses. The study also used multiple linear regression to determine correlations and variations in the estimated Federation of Obstetrics and Gynaecology (FIGO) grade for females with suspected ovarian cancer. The research developed a pragmatic model to forecast ovarian cancer likelihood and severity levels. Results: The study examined 105 patients with suspected ovarian cancer at King Hussein Medical Centre between 2021 and mid-2023. Only 97 patients (92.38%) had matched FIGO-derived PET/CT scans with biopsy-based histopathological positivity. The optimal FIGO grade was 3.5, with a sensitivity of 77.2%, a specificity of 76.92%, a positive predictive value of 95.95%, a negative predictive value of 32.26%, an accuracy index of 77.14%, and a Youden index of 54.10%. Conclusion: A regression-based model was developed to triage the risk of ovarian cancer. This model enables us to early prioritise suspected females who should undergo PET/CT at the clinic level, with a high positive predictive value of over 90%.

Post -contrast Three -dimensional MP RAGE T1WI Sequence Compared to Brain MRV Sequence for Diagnosing Brain Sinus Venous Thrombosis.

Dural sinus thrombosis is considered as a one of the clinical and radiological emergencies that require special attention and high index of suspicion and needs combined effort of both the treating physician and the radiologist to obtain proper diagnosis and subsequently proper management. The aim of this article was to compare the accuracy of MRV TOF and post contrast MP-RAGE sequences in diagnosis of cerebral sinus venous thrombosis. After all informed consents were obtained and upon ethical committee approval from the ethical committee in Joradanian Royal medical services in Amman we perform this study as a retrospective study done on 50 patients with cerebral sinus venous thrombosis with 50 pateints control group done at king Hussein medical center in Amman Jordan. The guidelines and regulations of studies conducted in Royal medical services were followed. 68 females and 32 males with age range between 19 and 52 years. All patients underwent brain MRI for evaluation of cerebral sinus thrombosis, all studies were done on seimens skyra 3 Tesla machine with standardized protocol including 2 D TOF MRV, axial T2WI, axial FLAIR, Axial T1, SWI and diffusion weighted images along with 3D MP-RAGE post contrast. Images were reviewed by two well experienced neuroradiologists (Maysoon and Qamar) in separate sessions, each MRI sequence was reported separately without knowing patients name or clinical history. Conclusion: The results for T2 WI, SWI, MRV TOF and MP-RAGE post contrast were reported. We used a confidence level score to standardize the results. Then the results were analyzed using simple statistical methods.

Drug-Drug Interaction Knowledge among Healthcare Professionals

Background: The healthcare professionals who are closest to patients receiving medication include medical doctors, nurse practitioners, and pharmacists. To develop new strategies to lower drug drug interactions (DDIs), it is crucial to comprehend the extent to which these providers can recognize an interaction and identify a suitable management strategy. The scant information that is currently available suggests that there is little DDIs understanding of medical doctors, nurse practitioners, and pharmacists. Aim of the study: It's critical to evaluate healthcare providers' understanding of drug-drug interactions and common sources of information on these interactions in order to increase patient medication safety. Method: A cross-sectional study design will be applied. More than twenty drug combinations will be given to participants, and they must categorize them as "no interaction," "may be used together with monitoring," "contraindication," or "not sure." The study will be carried out in the King Hussein Medical Center at the Royal Medical Services for two months after obtaining the ethical approval. The target population will be all physicians, nurses, and pharmacists working at KHMC whereas the sample will be all physicians, nurses, and pharmacists who agree to participate in the study and provide a consent form. Utilizing SPSS for Windows version 24 statistical software, data will be analyzed. Means will be used to describe continuous variables in descriptive analysis, whereas frequency distributions (such as percentages) will be used to describe categorical variables. For categorical variables, Fisher's exact test will be applied, and for continuous variables, Student's t-test will be employed. To describe the results of possible drug/drug interaction questions, the mean will be computed. Results: The study was done by enrolling 350 healthcare professionals among whom 60 were Physician, 40 Pharmacist, 200 Nurses and 50 allied healthcare providers. ..........

The Kaplan-Meier survival analysis of the dual sodium related comparative Jordanian critically ill cohorts whose major administered antibiotics were beta-lactams

Background: Abnormal serum sodium levels in various diseases increase mortality; however, hyperglycemia depresses serum sodium concentration significantly. Aim: This study aimed to evaluate the clinical impact of measured serum sodium levels and corrected sodium levels among Jordanian critically ill cohorts whose major administered antibiotics were Beta-Lactams Methods: This study was retrospectively conducted in the Intensive Care Unit (ICU) to primarily investigated the 2 proposed Na-based prognosticators against the overall mortality for the admitted critically ill patients in the Intensive Care Unit (ICU) at the King Hussein Medical Center between Jan 2018 and May 2021, after approval by the Royal Medical Services, Jordan local Institutional Review Board committee (IRB). A Kaplan-Meier test was conducted on the tested critically ill patients to explore the "time-to-event" during their admission days in the ICU and to determine if there were differences in the survival distribution for the different types of the 2 investigated dual different Na-related comparative cohorts [Measured Na related Events Cohort vs Measured Na related Censored Cohort and Corrected Na related Event Cohort vs Corrected Na related Censored Cohort]. Also, the Survival Kaplan-Meier test was used to plot the Survival functions’ illustrations for each tested Na-related mortality prognosticator. Results: The survival distributions for the 2 investigated dual comparative cohorts were statistically significantly different [χ2 (3) = 30.454, p-value=0.000 and χ2 (2) = 23.411, p-value=0.000, respectively] at Mean±SEM overall LOS of [21.444±0.138 days (95% CI; 21.173-21.714) and 21.444±0.138 days (95% CI; 21.173-21.714), respectively] and Number (%) of both Event and Censored cohorts of [1715 (79.6%) vs 440 (20.4%), respectively]. Conclusion: Our study revealed that both the measured and corrected hyponatremia had significant prognostic performances regarding major clinical outcomes when critically ill patients were studied regardless of their blood levels.

Norepinephrine corrected shock index as an innovative hemodynamic based prognosticator in critically ill patients

Background: Hemodynamic instability in critically ill patients can be assessed by various hemodynamic valid indicators. One of these approved hemodynamics’ prognosticator is the Shock Index (SI), which integrates both the heart rate and systolic blood pressure in one composite indicator. Arbitrarily, higher vasopressor rate indicates poorer prognostic. Whatever, Norepinephrine, the preferred vasopressor in most shock related scenarios, has a tendency to increase heart rate beside its vasoconstriction associated systolic blood pressure augmentation. Aim: In this study, we primarily aim to investigate the predictive power of a newer proposed composite hemodynamic prognosticator which integrates the average Norepinephrine infusion rates with the assessed patients’ Shock Indexes, and to explore its Sensitivity Indices regarding the critically ill patients’ major outcomes. Methods: This study trial was a non-funded, non-sponsored, observational study, which was conducted retrospectively on the Intensive Care Unit (ICU) at King Hussein Medical Center, Royal Medical Services, Amman, Jordan, over 60 months between Jan 2018 and Dec 2022. Exclusion criteria including but not excluded to, admission days less than 24 hours and missing data more than 80%. All eligible investigated critically ill patients were dichotomously divided into 2 comparative NE×SI products’ cohorts; lower product’s (NE×SI<14.835 µg.bpm/min. mmHg) cohort (Cohort I) versus higher product’s (NE×SI≥14.835 µg.bpm/min. mmHg) cohort (Cohort II). A Chi Square test were conducted across these 2 dichotomized cohorts. The Binary Logistic Regression (BLgR) analysis was conducted for the tested patients’ prognosticator (NE×SI) against the probability of being allocated to the Non-Survivors State (The Positive State) rather than to the Survivors State (The Negative State). The Receiver Operating Characteristic (ROC) and Sensitivity Analysis were processed to explore the area under the ROC curves (AUROC±SEM), optimal cut-off points, and the other sensitivity indices. Results: Actually, 2528 and 3217 cases were processed as positive actual states (Positive OI, Non-Survivors) and as negative actual states (Negative OI, Survivors) respectively. The AUC±SEM for the NE×SI was significantly determined at 0.944±0.003 (95% CI; 0.938-0.949). The probability of the positive OI was 66.12% at the optimal operating cutoff point of 14.84 µg.bpm/min. mmHg. In this study, we constructed a BLgR model to prognosticate the admitted ICU patients’ mortality and was formulated as [e (-6.986+0.516× NE.SI) /1+ e (-6.986+0.516× NE.SI)]. Conclusion: Our results revealed that our proposed an innovative hemodynamic composited product had a reasonable constructed area under the curve with an interesting sensitivity index for prognosticating the admitted critically ill patients’ mortality rate.

Glucometer derived glycemic variability as an early spot prognosticator for insulin dependent critically ill patients

Background: Glycemic variability, as mathematically defined by higher fluctuation rate or higher gap between the maximum and minimum values. In critically ill patients, the blood glucose readings are highly susceptible to fluctuation owing to multi-dimensional confounders. Aim: In this study, we primarily aim to investigate the prognostic utility of the glucometer derived glycemic variability regarding the overall mortality. Also, we aim to explore the optimal operating cutoff point and the binary logistic regression correlation for the glycemic variability versus mortality. Methods: A retrospective study was conducted for tested critically ill patients who were admitted in the Intensive Care Unit at King Hussein Medical Center between 1 Jan 2018 and 31 Dec 2022. Patients who had primarily missed data>20% was excluded from our study. Firstly, a receiver operating characteristic and sensitivity analysis was conducted to explore the area under curve and sensitivity indices of the tested mortality prognosticator. A binary logistic regression was also used to explore the association of the glycemic variability with the 28-day overall ICU mortality rate. All statistical analysis will be conducted with p-value <0.05 as a level of significance via SPSS version 25. Results: Actually, 2528 and 3217 cases were processed as positive actual states (Positive OI, Non-Survivors) and as negative actual states (Negative OI, Survivors) respectively. The AUC±SEM (95 C) for the GLK_BG_Var (%) was significantly higher than that of the GLK_BG Avg 0.829±0.006 (95% CI; 0.817-0.841) versus 0.597±0.008 (95% CI; 0.582-0.612) The probabilities of our investigated admitted ICU patients’ mortality were binary logistically correlated to the GLK_BG_Var% and GLK_BG_Avg via the following constructed BLgR models [e (-5.152+10.8×GLK_BG_%Var) /1+ e (-5.152+10.8×GLK_BG_%Var) and e(-5.416+0.025×GLK_BG_Avg) /1+ e (-5.416+0.025×GLK_BG_Avg), respectively]. Also, the probabilities of the critically ill patients’ mortality at the explored 2 tested BG prognosticators; Var% and Avg, were identified at 48.1% and 43.96% at the optimal thresholds of 47% and 206.94 mg/dl, respectively. Indeed, the explained variations in the dependent variable based on the 2 aforementioned adopted independent investigated mortality’s predictors ranged significantly from 26.1%-35% and 3.4%-4.6% depending on whether you reference the Cox & Snell R2 or Nagelkerke R2 methods, respectively, and they correctly classified approximately 80.1% and 48.4% of the cases, χ2(8) = 926.992 and1232.19, respectively. Conclusion: that the first investigated glucometer-based BG mortality’s prognosticator [GLK_BG_Var%] had higher AUROC, predictive utilities than its comparative average related prognosticator. Also, we revealed a strong correlation between the poor critically ill patients’ outcomes and the higher variability in BG values, notably when the variation exceeding 47%.

The Efficacy of Combined Povidone Iodine 1% and Dexamethasone 0.08% Prepared Eye Drops in Treating Post Viral Corneal Sub Epithelial Infiltrates Compared to Other Modalities of Treatments

Purpose: To Evaluate the efficacy of combination povidone-iodine 1.0% eye drops and dexamethasone 0.08% eye drops in the treatment of post viral corneal Sub Epithelial Infiltrates (SEIs). Materials and methods: A prospective, randomized, controlled, comparative study was conducted at king Hussein medical center between 2020-2021. Patients who attended to the ophthalmology department suffering from SEIs were enrolled in the study; a written Informed consent was obtained from all enrolled patients. Inclusion criteria include; ≥ 18 years of age, SEIs duration more than one month and less than 6 months, one eye per patient were included in the study and naive eye. Exclusion criteria include; a history of thyroid disease, allergy to iodine or study medications, ocular surgery within the past 3 months, corneal dendrites, conjunctival membrane or pseudo membrane, active conjunctivitis, corneal ulceration, corneal abrasion, corneal foreign body, anterior chamber inflammation or pregnancy/lactating mother. Patients were randomly divided into three groups and treated for two weeks. In the first group, patients received combined povidone iodine 1% and dexamethasone 0.08% prepared eye drops with lubricant eye drops, the second group received dexamethasone 0.08% eye drops and lubricants eye drops and the third group received povidone iodine 1% eye drops and lubricant eye drops. The patients were followed up and evaluated at day zero, 2 weeks, 6 weeks, 6 months’ post treatment regarding; Best Corrected Visual Acuity (BCVA), Intraocular Pressure (IOP), symptoms (visual blurring, photophobia, and foreign body sensation) and corneal sub epithelial infiltrates according to our scoring scale. Results: After conducting the inclusion and exclusion criteria, 45 eyes were included in the study (15 in each group). Povidone iodine 1% was well tolerated and safe in first and third groups. In first study group, a dramatic improvement in patients’ symptoms and SEIs scoring scale was observed (p < 0.05) in addition to a significant improvement in BCVA after 2 weeks of treatment. On the other side, no significant improvement has been achieved (p > 0.05) regarding BCVA, symptoms or SEIs scoring scale in the second and third groups. Conclusion: Combined povidone iodine 1% and dexamethasone 0.08% prepared eye drops can improve signs and symptoms of SEIs in addition to a significant improvement in BCVA and speeding up the recovery compared to the other modalities of treatment used in this study.

Guideline Implementation for Improved Asthma Management and Treatment Adherence in Children in Jordan.

Asthma imposes a significant social burden on children, their families, and society at large. As a chronic health condition, effective management could greatly benefit from consistent adherence to guidelines. Despite this, minimal effort has been exerted to examine the impact of asthma management guidelines and adherence to treatment on children with asthma and the mothers caring for them. This study was designed to evaluate the influence of asthma management guidelines on the knowledge and treatment adherence among children with asthma and their mothers. A quasi-experimental design was utilized, and the study was conducted at two large hospitals in Jordan: Princess Rahma Hospital and King Hussein Medical Center. A purposive sample of children aged 6-12 years (n = 100) who were accompanied by their mothers (n = 100) were recruited for this study. Data were collected using a structured questionnaire and an observation checklist before and after the implementation of guidelines. Statistical analyses were performed using SPSS. The results revealed a statistically significant improvement in knowledge related to asthma among children and their mothers (p < 0.001). Additionally, a statistically significant difference was observed in the children's adherence to their treatment regimen before and after the implementation of asthma management guidelines (p < 0.001). Moreover, the improvements in knowledge and practice related to asthma were sustained in the follow-up assessments. In conclusion, the guidelines had a beneficial effect on the children's adherence to their treatment regimen both before and after their implementation. Thus, asthma patients should adhere to conventional guidelines at various health services to manage their condition effectively.

Proper Timing for Administration of Prophylactic Intravenous Antibiotics for Elective Surgical Procedures

Background: Preoperative antibiotic prophylaxis is administering antibiotics before performing surgery to help decrease the risk of postoperative infections. The antibiotic selected should only cover the likely pathogens. It should be given at the correct time. The timing of antibiotic administration may vary, but the goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its highest at the start and during surgery. The literature supports at least 30 minutes, but no greater than 60 minutes before the skin incision is made to the optimal timing for the preoperative administration of most commonly used antibiotics. Aims and Objectives: To obtain precise information on the optimal time window for surgical antimicrobial prophylaxis (SAP). Methodology: A retrospective observational study design was used to investigate the effect of timing of SAP on the risk of surgical site infection (SSI) from September 2021 until September 2022. Patients with Inguinal hernia who performed elective inguinal hernia repair were eligible for enrollment in the study. The risk of SSI was compared between patients, categorized by the time interval between SAB administration and incision, and adjusted for confounding through Univariate Analysis logistic regression. Hakeem data base was used to collect the required data. This study was performed in King Hussein Medical Center (KHMC) at the Royal Medical Services in Amman/Jordan. Results: Data included in the current study was collected for the period between September 2021 until September 2022, in which 500 patients were randomly assigned into two arms; Patients in arm A received the in a time window of 60 to 30 minutes before the scheduled incision while Patients in arm B received the antibiotics in time window of less than 30 minutes to 0 minutes before the scheduled incision. In 52% of the procedures, SAP was administered within 60 minutes before incision Inpatient and ...........

Lower Respiratory Infections in Children With Febrile Neutropenic Leukemia: A Case in a Jordanian Hospital.

The study aimed to examine the prevalence of pneumonia in pediatric children diagnosed with leukemia at King Hussein Medical Center, Royal Medical Services, Amman, Jordan. The study was conducted from January 2019 to March 2020. A total of 100 hospitalized leukemia patients with febrile neutropenic episodes were evaluated for the presence of pneumonia. Samples were collected from all patients and tested for microbial growth. Univariate analysis revealed that age (P = .033) and packed cell volume (P = .006) were statistically significant risk factors, associated with the prevalence of pneumonia in leukemia patients with febrile neutropenia episodes. Similarly, as the absolute neutrophil count counts increased with an odds ratio and a 95% confidence interval of 2.386 (0.859-6.625), the odds of pneumonia in febrile neutropenic patients were more prevalent. The study reported the prevalence of pneumonia in immunocompromised febrile neutropenic patients with leukemia, which could lead to the development of evidence-based febrile neutropenic treatment protocol development. It will assure more responsive patient management and treatment.

Hirsutism in Jordanian Women

Objectives: The aim of this study was to assess clinical, hormonal profile, and causes of hirsutism in women who had attended the gynecology clinic at king Hussein medical center. Methods: A retrospective study where clinical information were collected from the medical records of 120 hirsute women, including age, age at onset of the symptoms, duration, rapidity of the onset of the symptoms, parity, menstrual cycle history, age of menarche, family history of hirsutism. Hirsutism was determined by the modified Ferriman-Gallwey index. Laboratory tests and ultrasound were done. Results: The mean age at presentation was 24±4.3 .The maximum hirsutism Ferriman Gallwey score was 20 with a range between10-20. Sixty women (50%) had score more than12. The face was the most common site, 67 women had menstrual abnormalities (55.8%) and 46 were obese (body mass index &gt; 25 kg/M2) (38.3%). A positive family history was obtained in 55women (45.8%). Polycystic ovary syndrome was assumed to be the cause of hirsutism in 68 women (56.8%), 4 women had microadenoma (3.3%) and 3 women had hypothyroidism ((2.5%). Conclusion: Polystic ovary syndrome and idiopathic hirsutism, which were evident in about 94% of the studied patients, are the main causes of hirsutism.

Retrospective analysis of patients with surgically proven ovarian torsion, our experience.

To study the patients who were admitted to our hospital with surgically proven ovarian torsion and were operated for the same and to study for whom detorsion was done. A retrospective analysis of the medical records and surgical notes of 150 patients with surgically proven ovarian torsion over a 10-year period between January 2011 and January 2021 was carried out. Surgical notes included details like mode of the surgery (laparotomy or laparoscopy), type of surgery (oophorectomy, detorsion, detorsion with cystectomy), whether fixation was done or not, size of mass/ovary, laterality, appearance of the torted ovary, color of the ovary, and number of twists. Histopathologic reports of the patients who underwent oophorectomy or detorsion with cystectomy were also recorded. During the 10-year study period, 88 (58.7%) patients had undergone laparotomy and 62 (41.2%) patients had undergone laparoscopy. Detorsion with cystectomy was done in 96 (64%) cases, detorsion alone in 14 (9.3%) cases, and oophorectomy was done in 40 (26.6%) cases. There was no significant difference in terms of increase in postoperative complications. Laparoscopic detorsion with cystectomy is the most common surgical procedure used for ovarian torsion at King Hussein Medical Center.

Curative pelvic exenteration: initial experience and clinical outcome.

in patients with advanced primary or recurrent gynecologic, urologic, or rectal cancers without metastatic disease, extensive aggressive surgery such as pelvic exenteration may be necessary for curative intent treatment. This study aims to present the initial experience and clinical outcome of curative pelvic exenteration procedures for advanced or recurrent pelvic cancer in our center. a retrospective cross-sectional study was conducted at the colorectal unit at King Hussein Medical Center in Amman, Jordan, between March 2014 and December 2021. All patients who underwent pelvic exenteration procedures were included in this study. Demographic characteristics, type of procedure, completeness of excision, postoperative complications, morbidity, and mortality were analyzed. a total of 30 patients underwent thirty-one operations. There were 22 females and eight males with a median age of 55 (range 25-86) years. Twenty-six surgeries were for advanced primary and 5 for recurrent malignancies. Twenty-nine operations were performed for colorectal and 2 for gynecological tumors. There were 19 posterior pelvic exenterations, 2 posterior pelvic exenterations with sacrectomy, and ten total pelvic exenterations. Completeness of tumor excision R0 was observed in 21 specimens, incomplete (R1/R2) in 6 specimens. The overall complication rate was 67.7% and 30-day mortality was 16.7%. Ten (33.3%) patients are disease free at a median follow-up of 22 months. in our study, pelvic exenteration provides above 40% overall survival at a median follow-up of two years. Gaining experience in this type of procedure, a multidisciplinary approach, careful patients' selection, and preoperative counseling will reduce postoperative morbidity and mortality.

Hydrocephalus classification in brain computed tomography medical images using deep learning

Recent technological advancements, like big data analytics, is driving the growing adoption of cyber-physical systems and digital twins in the area of healthcare. Congenital hydrocephalus is one important example of recent healthcare data analytics. Congenital hydrocephalus is a buildup of excess cerebrospinal fluid (CSF) in the brain at birth. Congenital hydrocephalus can be lethal without treatment and represents an urgent issue in present-day clinical practice. Congenital hydrocephalus has a significant effect on a human entire life since it causes damage to the brain. It is important to accurately diagnose hydrocephalus early, which will help in the early treatment of the infant by a surgical procedure called ventriculoperitoneal (VP) shunt which will reduce the damage caused by hydrocephalus on the brain. Deep Learning is an evolving technology that is currently actively researched in the field of radiology. Compared to the traditional hydrocephalus diagnosing techniques, automatic diagnosing algorithms in deep learning can save diagnosis time, improve diagnosing accuracy, reduce cost, and reduce the radiologist's workload. In this paper, we have used a novel dataset collected from king Hussein medical center hospital in Jordan that consists of CT scans for hydrocephalus and non-hydrocephalus infants, the dataset has gone through multiple stages in preprocessing which are; cropping and filtering, normalization, segmentation (three segmentation techniques have been applied), and augmentation. These data have been used to build deep learning and machine learning models that will help physicians in the early and accurate diagnosing of congenital hydrocephalus which will lead to a decrease in the death rate and brain damage. The results of our models were impressive with a 98.5% accuracy for congenital hydrocephalus classification in infants' brain CT images.

The Risk of Non-arteritic Ischemic Optic Neuropathy Post-intravitreal Bevacizumab Injection.

To report the incidence of non-arteritic ischemic optic neuropathy in diabetic patients treated with intravitreal bevacizumab injection. A prospective comparative analytic study was done in the King Hussein Medical Center during the period between June 2020 and June 2021. Inclusion criteria included diabetic patients who attended a retina clinic. Exclusion criteria included patients with pre-existing ischemic optic neuropathy. Patients were divided into two groups. The first group included diabetic patients who did not require bevacizumab injection and were treated either with follow-up visits or pan-retinal photocoagulation, and the second group included patients who were treated with intravitreal bevacizumab. Patients were followed up for a period of one year. Data collected in two groups included the total number of patients and the number of patients with non-arteritic ischemic optic neuropathy. Results were compared in both groups. A P-value was used to study the statistical significance and was considered to be statistically significant if ≤0.05. The mean age for patients in group 1 was 64.3 years, with a male to female ratio of 1.1 to 1. In group 2, the mean age was 66.2 years, with a male to female ratio of 1.2 to 1. The total number of patients in group 1 was 7375, among whom 68 patients had non-arteritic ischemic optic neuropathy. While in group 2, the total number was 2468 and 49 of them had non-arteritic ischemic optic neuropathy. Most cases of non-arteritic ischemic optic neuropathy were seen in patients who had received three or more injections. Conclusion: Intravitreal bevacizumab in diabetic patients is considered a risk factor for the development of non-arteritic ischemic optic neuropathy, especially in patients receiving more than three injections.