Royal Medical Services Research Articles

A Correlational Study of Hearing Loss and Severity of Diabetic Retinopathy Among Jordanian Patients.

Background Sensorineural hearing loss (SNHL) is a common complication of diabetes, but the underlying mechanisms and risk factors are not fully understood. This study investigatedthe relationship between several potential risk factors and SNHL in 118 individuals previously diagnosed with diabetes mellitus type 2 (DM2). Methods We did a cross-sectional analysis of data collected from 118 patients with diabetes mellitus at multiple tertiary hospitals in the Jordanian Royal Medical Services (JRMS). The mean age was 60.57 ± 12.8 years, with 56.8% males. Demographic and clinical data were collected, including age, gender, duration of diabetes, presence and duration of hypertension, diabetic retinopathy (DR) severity, tinnitus, and comprehension inability. In addition, a hearing assessment for SNHL was performed using pure-tone audiometry at 0.5, 1, 2, 4, and 8 kHz frequencies. Goodman and Kruskal's γ test and cumulative odds ordinal logistic regression were used to analyze the relationship between these factors and hearing assessment results for SNHL. Results Goodman and Kruskal's γ test showed a statistically significant moderate and positive association between diabetic retinopathy severity and sensorineural hearing loss. Further analysis using logistic regression revealed that retinopathy severity, age, and gender were all significant predictors of hearing loss level in this population. The odds of having a higher level of hearing loss increased by 9.1% for each additional year of age and were higher for males than females. In terms of DRseverity, a worsening SNHL had lower odds in individuals with no DR or mild nonproliferative DR compared to those with proliferative DR. Conclusion Our findings have important implications for managing SNHL in individuals with diabetes. They indicate that healthcare providers must closely monitor and manage therisk factors in patients with diabetes. Further research is needed to generalize better the relationship between these risk factors and SNHL, including the potential role of other factors, such as exposure to loud noise or certain medications.

The safety of levothyroxine use with respect to bone mineral density

Background: Previous studies on bone mineral density (BMD) abnormalities associated with hypothyroidism are scarce and not conclusive. The effect of thyroid hormone therapy on BMD has shown mixed results. Aim: This study aimed primarily to determine the association between the positive history of levothyroxine administering and the risk of osteoporotic fracture in Jordanian cohort of both genders, including post-menopausal women, who were attended to our rehabilitation clinic. Methods: This study trial was an observational study, which was conducted retrospectively at Prince Rashid bin Al-Hasan Military Hospital, Royal Medical Services, Irbid, Jordan. The Binary Logistic Regression (BLgR) analysis was conducted for the 2 contrarily Levothyroxine (Tx) comparative group; Tx dependent cohort (Cohort II) versus Non-Tx dependent cohort (Cohort I), against the probability of being on the higher (versus lower) risk of femoral hip osteoporotic fracture (fHOPF). The studied patients were dichotomously categorized into 2 comparative cohorts; non-Levothyroxine dependent cohort [Cohort I] versus Levothyroxine dependent cohort [Cohort II]. A Chi Square test was processed across these 2 dichotomized cohorts to express the comparison results as Number (Percentages), strength of associations (odd ratios), Pearson chi-square statistic (χ 2), Goodness of Fit (G-Test of independence), and Pearson (r) and Spearman (ρ) correlations. Results: The BLgR analysis results revealed that the unadjusted risk ratio for the higher probability of fHOPF in our investigated patients, who were on Thyroxine therapy [Tx dependent cohort, Cohort II] compared to the Tx independent cohort [Cohort I], was 10.969 (95% CI; 4.615-26.072). The explained variations in the fHOPF risk related Tx dependent status on our model of this BLgR based model ranged from 17.9%-23.8% (depending on the inferential Cox & Snell R2 or Nagelkerke R2 methods, respectively) and correctly classified approximately 61.2% of the overall cases. The constructed BLgR model was formulated as {e (-0.627+2.395×Tx)/[1+ e (-0.627+2.395×Tx)]}. Conclusion: We revealed that the patients who were used thyroxine therapies (Cohort II patients) had significantly higher proportional distribution of higher risk of fHOPF compared to Cohort I patients [41 (85.4%) vs 55 (34.8%), respectively] with an odd ratio of 10.969 (95% CI; 4.62-26.07) and significant positive correlation of 0.429±0.057, χ2=37.889, p-value=0.000.

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.

Knowledge and Compliance With Standard Precautions Among Nurses.

The spread of microorganisms is caused by direct or indirect contact, respiratory droplets, and airborne transmission. Knowledge and compliance with standard precautions are crucial in preventing infection in the hospital. To assess the level of knowledge and compliance with standard precautions among registered nurses who work in military hospitals and the factors affecting compliance with standard precautions. A descriptive cross-sectional study was conducted. Four hundred and eight registered nurses at three Jordanian Royal Medical Services hospitals completed an online self-report questionnaire using a convenience sampling technique. The statistical package for social sciences (SPSS) version 25 was used to analyze the data. The level of knowledge of standard precautions among nurses was excellent, with an overall mean score of 15.59 ± 2.22 out of 20; around half (54%) of them had an excellent level. Nurses' compliance with standard precautions was intermediate, with an overall mean score of 59.65 ± 14.57 out of 80. Forty-seven percent of nurses had a high degree of compliance. Compliance with standard precautions was correlated positively with age, working experience in years, total knowledge score, training in standard precautions, and availability of personal protective equipment, and negatively with exposure to sharp injuries. Nurses play a key role in preventing and managing hospital infections through their responsibility for a large proportion of patient treatment and care. Therefore, efforts should be made to improve nurses' perceptions of the basic elements of standard precautions. Even so, results showed that compliance with standard precautions was intermediate. This highlights the need to take the necessary measures to raise the level of compliance. Even so, results showed that compliance with standard precautions was intermediate. This highlights the need to take the necessary measures to raise the level of compliance.

The effectiveness of a cognitive-behavioral therapeutic program in reducing social phobia disorder among a sample of patients attending psychiatric clinics at the Royal Medical Services

هدفت الدراسّة إلى الكشف عن فاعلية برنامج علاجي معرفي سلوكي في خفض اضطراب الرهاب الاجتماعي لدى عينة من مراجعي العيادات النفسية في الخدمات الطبية الملكية، على عينة مكونه من (30) فرداً موزعين على مجموعتين متكافئتين هما: عينة تجريبية عددها (15) وعينة ضابطة عددها (15) تّم اختيارهم بطريقة العينة العشوائية المتيسرة خلال عام 2014 ، حيث تكون مجتمع الدراسة من المرضى المراجعيين لمستشفيات الخدمات الطبية الملكية بشكل عام خلال عام 201 والبالغ عددهم (100) مريض.

Epidemiology of human brucellosis in military hospitals in Jordan: A five-year study

Brucellosis is a zoonotic disease with significant impacts on livestock and human health. It is a severe community health burden in the Middle East with an estimated 2000 times higher prevalence than in North America and Western Europe. To date, there are limited studies on human brucellosis and risk factors for infection in Jordan. Our study aimed to analyze documented brucellosis cases in Jordan and use geographic and socio-demographic data to better understand its prevalence and transmission. This retrospective study examined electronic medical records describing 1,497 cases of febrile illness that were tested for brucellosis at Royal Medical Services hospitals between 2016 and 2020. A total of 465 confirmed brucellosis cases, aged 0 to 80 years were included. Serum samples were screened for anti-Brucella antibodies, and positive samples were additionally tested for antibody titer using the Wright tube agglutination test. Our results showed that 31.1% (456/1497) of the febrile diseases were brucellosis. We found that young adults and working age, northern governorates, rural location of residency, occupations involving regular contact with livestock, and Spring/Summer season were highly significant as risk factors. Seropositivity was highest among dairy factory workers with 64.4%. This study adds to our understanding of human brucellosis in Jordan and its impact on public health. These data will be useful in the prevention of brucellosis and will inform reliable disease control policies.

Gastrointestinal manifestations in patients with COVID-19 it’s correlation with overall clinical outcomes

Background: The coronavirus disease 2019 (COVID-19) is not just a disease of the respiratory system. The virus can affect the gastrointestinal (GI) tract as well. Recognizing the various manifestations in every organ system is important because these manifestations can contribute to community-based transmission. Aim: The aim of this study is to report the impact of gastrointestinal associated with coronavirus disease (COVID-19). Methods: A retrospective study was conducted in our COVID-19 isolation department at Queen Alia Military Hospital, Royal Medical Services, Amman, Jordan between Mar 2020 and Sep 2021 for all eligible COVID-19 infected hospitalized patients. Because of the retrospective nature of our research, a sign consent form was waived. All admitted COVID-19 infected patients, who were admitted for at least 3 days and whose retrieved data from our electronic medical record system (Hakeem) were available, were grouped into either Higher Liver Disease Status (Status I) and Lower Liver Disease Status (Status II). Higher versus lower liver disease statuses were based on Child-Pugh Score ≥8 or <8, respectively. An independent T-Tests was used to analyze the non-parametric and parametric outcomes’ data.

Capacity Building for Health Technology Assessment in Jordan: Institutionalization and Its Use in Pricing and Reimbursement Decisions

ObjectivesThis study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions. HTA capacity buildingUniversity-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA institutionalization and its use in pricing and reimbursement decisionsInstitutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration’s pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet. Recommendations and future directionsOver the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.

Women’s contribution to medicine in Bahrain: leadership and workforce

BackgroundWomen make up a significant proportion of workforce in healthcare. However, they remain underrepresented in leadership positions relating to healthcare for a multitude of reasons: balancing personal and work duties, favoritism toward men, lack of support from colleagues and mentors, as well as other factors. This study aims to recognize the contribution made by women in the Bahraini healthcare sector by determining the gender distribution in Bahrain’s medical schools, government hospitals, Ministry of Health, and National Health Regulatory Authority.MethodsData were collected from the Bahraini Ministry of Health, National Health Regulatory Authority, Salmaniya Medical Complex, King Hamad University Hospital, Bahrain Defence Force Royal Medical Services, the College of Medicine and Medical Sciences in the Arabian Gulf University, and the Royal College of Surgeons in Ireland-Bahrain. Only physicians who held a Bachelor of Medicine and Surgery and a valid license to practice from NHRA were eligible to participate. Descriptive statistics were used to derive the frequencies and percentages of physicians with the following leadership positions: (1) top administrative positions (e.g., Chief executive officer); (2) heads of departments; (3) heads of committees; and (4) academic positions (e.g., Professor). Data were also collected from the two medical schools in Bahrain to see the trend in female enrollment into medical schools since 2004.ResultsThe results of the study indicated that leadership positions were mostly held by males in Bahrain (59.4% vs. 40.6%). However, Bahraini males and females equally dominated academic positions. Male physicians also dominated surgical specialties; however, female Bahraini physicians slightly surpassed male Bahraini physicians at the specialist and consultant levels (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Furthermore, more females were reported to have general licenses. A trend analysis since 2004 showed that female medical students’ representation was higher than males over the years.ConclusionsThis study highlights the increasing trend of women’s participation and contribution to medicine in Bahrain. The data indicated continued growth in the number of female medical students and physicians. As such, it is likely that females will have a bigger impact on healthcare in the future with potential to hold more leadership positions in Bahrain.

Outcome of Acute Mesenteric Ischemia in Patients with COVID 19 Infection Our Experience at Royal Medical Services

Objectives: To present our experience and outcome in the management of acute mesenteric ischemia (AMI) as a thromboembolic complication of COVID 19 infection at king hussein medical center/ Royal Medical Services. Methods: A retrospective single center study conducted on patients with active COVID 19 infection who presented with AMI between the period of March 2020 and December 2021. Results: 23 patients have presented to our vascular surgery department with AMI, mean age was 69 years old. 12 patient were males and 11 patients were females. 6 patients had abdominal pain with no peritonitis while 15 patients had physical signs of peritonitis. Two patients presented with sepsis and hemodynamic unstability. 8 patients were managed conservatively with mortality rate reaching up to 50% among them. 15 patients had exploratory laparatomy, 5 of them found to have total dead bowel and 10 patients were managened with superior mesenteric artery thromboembolectomy leading to a mortality rate as low as 10% among them. Including total number of patients, 10 has died while 13 survived successfully with the mortality rate reaching up to 43.4% all over. Conclusion: Early recognition and prompt management with subsequent revascularization has improved the survival rate of COVID 19 patients presenting with AMI.

Evaluation of Asthma Management Outcomes

Background: Asthma is a serious global health problem with an estimated 300 million affected individuals. Clinical manifestations of asthma can be controlled with appropriate treatment. When asthma is controlled, severe exacerbations should be rare. The goal of treatment in Asthma is to reduce inflammation and to achieve¸ total control. Treatment with anti-inflammatory drugs can, to a large extent, reverse some of these processes; however, the successful response to therapy often requires weeks to achieve and, in some situations, may be incomplete. Objectives of the study: This study was performed to evaluate the outcomes of Asthma treatment amongst asthmatic patients on follow-up at King Hussein Medical Centre (KHMC) at the Royal Medical Services (RMS) in Jordan/Amman. Methods: A retrospective, observational study was designed and performed on the basis of the asthma patient medical files. The patients’ medical profiles of were revised and the results were assessed according global initiative for asthma (GINA) guidelines. The collected data was analyzed by using statistical Package for the Social Sciences (SPSS) version 22. Results: A total of 210 asthmatic patient’s profiles were revised, and amongst the patient's majority (62.6%) were males and the average age of the participants was 35.1 years with standard deviation (SD) of 9.4. The most (53.3%) have been prescribed asthmatic drug combination was fluticasone propionate and salmeterol xinafoate (Seretide®) for long term asthmatic symptoms management. Amongst the asthmatic patients, 58 % had used antibacterial for their respiratory tract infections (RTIs) and urinary tract infections (UTIs). Conclusion: This study has shown that, despite the existence of an effective medication for asthma, disease control is insufficient and falls short of the accepted global guidelines.

Factors affecting SARS-CoV-2 variant distribution in military hospitals in Jordan

The pandemic caused by SARS-CoV-2 has prompted a collaborative global effort to contain viral spread and improve health outcomes for those infected. The tracking of SARS-CoV-2 variants since the first sequence was published in January 2020 is an important part understanding the pandemic. There is limited data regarding SARS-CoV-2 circulation in Jordan. In this study we determined the prevalence of genetic variants of SARS-CoV-2 during June-September 2021 by sequencing the full genome of 213 viral samples from Jordanian Royal Medical Services military hospitals. Our analysis revealed the presence of 33 variants, with (B.1.617.2.AY.106) as the predominate strain. Six variants were present at a prevalence greater than 2%((B.1.617.2.AY.106), 52.8%; Delta (B.1.617.2), 7.0%; (B.1.617.2.AY.34.1), 5.6%;(B.1.617.2.AY.44), 2.8%; (B.1.617.2.AY.121), 2.33%; (B.1.617.2.AY.102), 2.33%). Variant prevalence varied significantly by region and (B.1.617.2.AY.106) variant tended to be associated with mild to moderate symptoms, on the other hand other variants were asymptomatic. We did not find significant associations of variants with other factors such as age, gender or vaccination status. These data help us to understand the occurrence of new variants in Jordan, their geographic distribution, and associations with demographic variables, vaccination status, and symptom severity. The sustained circulation of SARS-CoV-2 continues to lead to novel variant emergence. These findings highlight the need to continue tracking new variants, monitor the dynamics of variant prevalence, and future efforts will guide prevention, vaccination, and control strategies.

Understanding health costs in the Jordanian public health sector: analysis of the cost-to-charge ratio

Abstract Objectives To investigate the cost to charge ratios (CCRs) and understand the costs of procedures, laboratory tests and imaging in the public health sector in Jordan.. Methods CCRs were estimated using published public data and data obtained from the financial departments of the three main public health programs in Jordan including the Ministry of Health, Military Royal Medical Services , and university affiliated hospitals. CCR was estimated by dividing the total cost by total charges (CCR = Total Hospital [or Cost Centre] Cost/Total Hospital [or Cost Centre] Charges) for the fiscal year 2016–2017. The charges master lists of procedures, diagnostics, and lab services were analyzed. Costs of most performed procedures, diagnostics and lab services were estimated using CCR approach. The cost of service equaled the billing charge (unit price) multiplied by the overall CCR of a provider. Key findings CCRs for the Ministry of Health ranged between 1.09 and 2.3 and expenditures approximately overweight charges two times. CCRs ranged between 0.31–0.89 for the Military Royal Medical Services and ranged between 0.34–0.79 for university-affiliated hospitals. Costs for 187 of the most performed procedures, diagnostics and lab tests were estimated. Conclusions CCR methodology is considered uncomplex in practice and useful to approximate costs from charges. The cost to charge of MoH was too high reflecting the highly subsidized health services offered by MoH facilities. Sustaining health service delivery and quality might be unwarranted. Master charge lists are old dated and not calibrated annually. There is no evidence based records on how these been estimated. Investing in cost data collection and analysis is demanded to enhance healthcare management.

The Patterns and Trends in the Surgical Fixation Modalities of Intertrochanteric Femoral Fractures

Objectives: To study the Intertrochanteric fractures patterns, distributions, and fixations modalities. In addition to assessing orthopedic surgeons’ tendencies toward implant choices according to the fracture morphology. Methods: This descriptive study reviewed the clinical and radiological records of 574 admitted with intertrochanteric femoral fractures in two hospitals of Jordanian Royal Medical Services from January - 2017 to December – 2020. Utilizing Picture Archiving and Communication System (PACS), patients’ radiographs were evaluated regarding the fracture patterns, surgical fixation technique, and indications. Results: Females accounted for 59.1% of patients. The mean age was equal to 76.40 ± 11.65 years, with an age range of 82 years (20 – 102 years). Comorbidities were found in 65.3% of patients. The majority of the fractures (54.5%) were of a simple fracture pattern, and the Dynamic Hip Screw (DHS) was the most commonly used surgical implant (51.9%). Preoperative mortality accounted for 2.3%. Conclusions: Understanding intertrochanteric femoral fracture patterns and proper implant choice improves outcomes and avoids complications. We found that DHS use was the first choice in stable fracture patterns. However, there is an increasing tendency to use PFN over other modalities in both stable and unstable intertrochanteric fractures. The use of other modalities to treat unstable fracture may be explained by the occasional non-availability of the superior PFN.

Empirical Piperacillin/Tazobactam versus Imipenem/Cilastatin in Covid-19 Infected Patients

Background/Aim: β-Lactam/β-lactamase inhibitors (BL/BLIs) and carbapenems are often considered for the treatment of sepsis when the main suspected pathogens are Gram-negative bacteria, because of their broad spectrum of coverage. Our aim was to compare the clinical outcomes of the two most widely used empirical broad-spectrum antibiotics in Jordanian SARS-CoV-2 infected patients. Methods: A single-center, retrospectively study was conducted in a specialized COVID-19 isolation center at Queen Alia Military Hospital of the Royal Medical Services (RMS) in Jordan. Over 19 months. All Jordanian mild/moderate-severe/critical SARS-CoV-2 infected patients aged 18 years and above, whose hospital admission days exceeded at least 3 days, and whose COVID-19 diagnosis were suspected or confirmed were included in our study. β-ABs were allocated to Non-PIP/TAZ group (Group I) and PIP/TAZ group (Group II). An Independent T and One –Sample T Tests, and Chi Square Test will be used to analyze the parametric and non-parametric outcomes’ data, respectively. Results: 718 eligible studied patients were finally included in this study (718/4183, 18.67%) in which 247 patients (31.6%) had suspected COVID-19 infection and 534 (68.4%) had confirmed COVID-19 infection. The mean age of the whole study cohort was 59.40±10.60. Insignificantly, males were distributed in the study in approximately 2.309:1 ratio compared to females. The main finding of our study was that an investigated overall 28-day SARS-CoV-2 infected patients’ mortality were insignificantly recorded between the two ABs based categorized cohorts [75 (19.8%) vs 80 (19.9%), p-Value=0.997] over also insignificantly overall hospital length of stay (LOS) [11.17±2.79 days vs 11.28±2.91 days, -0.11±0.20 days, p-Value=0.595] for Cohort I and Cohort II, respectively. Conclusion: In summary, our results demonstrate that there were insignificant differences between Piperacillin/Tazobactam and Carbapenems regarding overall clinical impacts, when they were empirically administered in SARS-CoV-2 infected patients. Also, we explored that significant higher %cNa12 in PIP/TAZ Cohort (Cohort II) may have positive clinical advantages over Carbapenems in Non-PIP/TAZ (Cohort I).

EPISTAXIS: CLINICAL REVIEW OF 176 PATIENTS

Objective: To carry out a retrospectively review and analyze the general data, incidence, etiological and clinical findings as well as treatment options for epistaxis patients. Patients and Methods: We reviewed the files of 176 patients with epistaxis who were treated at department of otolaryngology of the Royal Medical services of Jordan between 2017 and 2021. Data regarding Age, sex, concomitant medical disorders, medications, directly identifiable causes, epistaxis seasonal variation, and the type of management received were all recorded. Results: Epistaxis occurred in 0.52 percent of all cases and 3.2 percent of patients with nasal problems. The patients ages ranged from 5 to 85 years old, with a mean age of 43.3 years. The ratio of males to females is 1.5:1. Majority of patients (89.8%) presented with unilateral nasal bleeding and 10.2% with bilateral nasal bleeding. Intermittent nasal bleeding was recorded in 73%. In 63 cases (35.8%), the exact etiological cause couldnt be identified while in the rest of patients we could identify a causal factor infection (32.4%), hypertension (18.2%), trauma (6.8%), blood dyscrasias (2.8%), uremia (2.3%) and tumor (1.7%). Regarding the bleeding sites, more than 70% were from the anterior part of the nasal cavity. Regarding the modalities of treatment for epistaxis, anterior nasal packing being the most common technique 91 cases (51.7%) and conservative management in terms of anterior, posterior nasal packing and local cauterization of bleeding site was effective in majority of cases. Conclusion: Epistaxis is a common otolaryngologic emergency. To be able to undertake optimal care, otolaryngologists and general physicians should know the causes and features of patients and diseases, particularly in their own area of practice.

Impact of Social Distancing on Geriatric Hip Fractures Among Jordanian Population During COVID-19 Pandemic.

Background:There were serious concerns about delivering the care and support to the elderly population in Jordan during the full lockdown period. In turn, this raised concerns about how this group of population will care for themselves and if this change in the situation will increase the risk of falls and related geriatric hip fractures. Hip fractures are a significant cause of morbidity and mortality in the geriatric population. Jordan has been affected by the coronavirus disease, COVID-19; pandemic like other parts of the world. The Jordanian authorities acted early to prevent the infection from spread, and lockdown along with social distancing measures were implemented early and enforced. Even though these measures successfully slowed the spread of the virus, some concerns were raised about the delivery of care by the family and caregivers to Jordanian geriatric population.Objective:We studied the effect of lockdown and social distancing in Jordan on hip fracture incidence among the geriatric population during the lockdown period.Methods:This retrospective observational study was conducted at two Jordanian Royal Medical Services (JRMS) hospitals, King Hussein Medical Center and Prince Rashid Hospital. Patients who were treated surgically for traumatic hip dislocation during lockdown (15th March to 30th April 2020) were compared with patients during the corresponding period in 2019 regarding the incidence of geriatric hip fractures.Results:The lockdown group included 102 trauma patients, 68 patients (66.7%) had geriatric hip fractures. On the other hand, the non-lockdown group included 144 patients, 45 (31.3%) had hip fractures. Thus, the proportion of patients with geriatric hip fractures in the lockdown group was significantly higher than the non-lockdown group (P=0.034). However, the geriatric hip fractures male to female ratio were the same in lockdown and non-lockdown groups (1:1.5).Conclusion:During the complete lockdown and social distancing due to COVID-19, the epidemiology of surgically treated fractures changed; there is a decrease in the total number of trauma patients and an increase in the proportion of geriatric hip fractures.

Flow Cytometry Study of Biomarkers in Chronic Lymphocytic Leukemia Patients Treated at the Royal Medical Services, Jordan

Flow Cytometry Study of Biomarkers in Chronic Lymphocytic Leukemia Patients Treated at the Royal Medical Services, Jordan

Factors Predictive of Papillary Thyroid Cancer (PTC) Recurrence Post Total Thyroidectomy and Radioiodine Ablation : A Single-Center Experience in the Jordanian Royal Medical Services

Factors Predictive of Papillary Thyroid Cancer (PTC) Recurrence Post Total Thyroidectomy and Radioiodine Ablation : A Single-Center Experience in the Jordanian Royal Medical Services