Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

Background: Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. Materials and methods: This retrospective study included 65 patients who were born to mothers with Prolonged PPROM <34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. Results: The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P < 0.05). Conclusion: Prolonged PPROM before the 34th gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system

Prevalence of Bacterial Lower Respiratory Tract Infections at a Tertiary Hospital in Jordan

Background: Lower respiratory tract infections (LRTI) are a major cause of morbidity and mortality globally. The World Health Organization (WHO) estimates that LRTI are the most common global cause of death from infectious diseases. &nbsp;However, the specific etiologic agent associated with LRTI is often unknown. Aims: We determined the bacterial infections and seasonal patterns associated with LRTI among hospitalized cases at Jordan University Hospital (JUH) for a period of five years. Methods: We conducted a multi-year study among hospitalized patients in Jordan on LRTI-associated bacterial etiology. Results: We found bacterial infections among 105 (21.1%) out of 495 LRTI patients. The most frequently identified bacteria in the LRTI patients were Staphylococcus aureus (7.7%) followed by Pseudomonas aeruginosa (5.1%). Most of the LRTI patients (95.2%) had at least one chronic disease and many were admitted to the Intensive Care Unit (16.8%). Of the 18 (3.64%) patients with LRTI who died at the hospital, 2 had a bacterial infection. We noticed a seasonal pattern of bacterial infections, with the highest prevalence during the winter months. Conclusions: Our findings suggest that early identification of bacterial agents and control of chronic disease may improve clinical management and reduce morbidity and mortality from LRTI

Attitudes of Middle Eastern Societies towards Organ Donation: The Effect of Demographic Factors among Jordanian Adults

Background: Organ donation gives thousands of patients a renewed chance at living full and active lives. Unfortunately, the need for organs does not match their availability. This study aims to analyze the effect of demographic factors on the knowledge and awareness of the Jordanian society towards organ donation. Methods: This cross-sectional study was conducted using a self-administered online questionnaire. We included 1041 adult Jordanians from all the governorates of the Hashemite Kingdom of Jordan. Results: Of the 1041 participants, only 124 (11.9%) had previously singed organ donation card. Overall, 827 (79.4%) were fully accepting organ donation. Among 782 participants in the medical field, 639 (81.7%) fully accepted organ donation, compared to 188 out of 259 (72.6%) in the non-medical field (p= 0.002), with no significant effect of any demographic factor on the willingness to sign organ donation card. There was significant difference in the acceptance of donation from brain dead donors (p< 0.001), with participants from medical field and male participants having higher acceptance rates when compared with non-medical and female participants, respectively. The main barrier for organ donation was found to be the desire to be buried as a whole (58.2%), followed by traditional beliefs (47.4%), and family refusal (42.2%). Conclusions: In conclusion, an educational strategy can improve organ donation awareness from an early age by spreading actionable information through social media and conducting nationwide public campaigns

The Influence of Body Mass Index on the Outcomes of Video-assisted Thoracoscopic Sympathectomy for Primary Hyperhidrosis Patients

Background: Primary hyperhidrosis (PH) is an autonomic disorder described as having excessive sweating in greater amounts than physiologically needed for thermoregulation. The aim of this retrospective study is to investigate the effect of body mass index (BMI) on surgical outcomes of bilateral video-assisted thoracoscopic sympathectomy (VATS) for PH patients from Arabian ethnic group. Methods: Between January 2009 and December 2018, a total of 79 patients underwent VATS as a treatment for PH at Jordan University Hospital. Postoperative assessment was done via patients’ subjective reporting of their satisfaction with the outcome of performed procedure. Results: The mean age of the studied population was 23.2 ± 4.5 years, of which 34 (43%) were males and 45 (57%) were females. Satisfaction with the outcome of VATS was significantly associated with having dry palms as a desirable outcome (p < 0.001), and with older age (p = 0.002). BMI was neither significantly associated with their satisfaction (p = 0.128), nor with compensatory hyperhidrosis (CH) (p= 0.859).Conclusion: VATS is considered an effective treatment for PH, with high rates of patient’s satisfaction. Neither the level of satisfaction nor the occurrence of CH was associated with patients’ BMI

The Etiology of Viral Lower Respiratory Tract Infections at a Tertiary Hospital in Jordan over Five Years

Background Lower respiratory tract infection (LRTI) is the most common condition treated in primary care and is considered the third leading cause of death worldwide. The objective of our study is to determine the etiological agents that cause viral LRTI in Jordan, aiming to help physicians to choose the appropriate treatment strategy. Materials and Methods We conducted a retrospective study on patients who were admitted with the diagnosis of LRTI between January, 2011 and January, 2016. We used Fast-track Diagnostics (FTD)® Respiratory 21 Kit (Fast-track Diagnostics, Luxembourg) real-time PCR to determine the viral etiology of LRTI, and we investigated pandemic H1N1 2009 swine flu virus using rapid test PCR. Results This study involved 495 patients with a mean age of 57.79 ± 18.43 years. The causative agents were identified in 157 patients out of 495 patients (31.7%). FTD real-time PCR was done for 170 patients, and the test was positive for seasonal Influenza A virus in 7.1% of patients, influenza B in 4.1%, RSV in 4.7%, metapneumovirus in 4.1%, adenovirus in 4.1%, corona 229E/NL63 in 4.1%, parainfluenza virus in 7.6%, and rhinovirus in 3.5%. The percent of cases who were positive for pandemic H1N1 2009 swine flu virus was 4.2%. The rate of ICU admission was 16.8%, and the mortality rate of LRTI was as low as 3.64%. Conclusions Viral LRTI is more common in winter season in Jordan, especially in January. Remarkably, Influenza A and Parainfluenza viruses were the main viral causative agents for LRTI in our study

Knowledge, Misconceptions and Attitudes towards Labor Regional Analgesia in a University Hospital: A Cross-Sectional Study

Background: Pain relief in labor is considered an important concern in the management of pregnant females in childbirth. The aim of this study is to assess the knowledge and attitudes of Jordanian females towards various regional analgesic techniques. Methods: We conducted a cross-sectional survey on 652 Jordanian women with a mean age of 32.9 (±8.17). Data collection took place at the gynecological and obstetrics clinics between December, 2017 and September, 2018. Results: Subjects with higher educational levels tend to have better knowledge about regional analgesia (p-value = 0.003), are less likely to ask for general anesthesia (GA) (p < 0.001), and have more previous regional analgesia 47.9% (p < 0.001). Moreover, multiparous women had better knowledge about regional analgesia and higher tendency to ask for it as an efficacious analgesic method during delivery (p < 0.05). Conclusions: In conclusion, even though higher educational levels and multiparty were significantly associated with better knowledge and acceptance rate of regional analgesia, sources of information about regional analgesia plays an important role, emphasizing on the significant role of anesthesiologists and obstetricians in increasing the awareness levels in our society

Trends of antimicrobial resistance in Escherichia coli isolates from urine cultures of women in Jordan: A 10-year retrospective study

Background: Urinary tract infection (UTI) is a common medical condition among women. E.coli is the most common causative organism. Appropriate understanding of the development of antimicrobial resistance over the past helps to establish efficient treatment strategies in the future. The study aims to discover antimicrobial resistance trends exhibited by E.coli strains isolated from women urine cultures over the past 10 years. Methods: A total of 1874 affected urine samples over the years 2009 to 2018 were collectively reviewed and classified according to the response they showed to 24 different antimicrobial disks in the laboratory. Relations between time and resistance evolutionary profiles were calculated. Results: Gentamicin (p value =0.039), Augmentin (p value =0.017), Cefoxitin (p value =0.001), Cefixime (p value =0.026) fulfilled satisfactory figures in terms of average resistance, regression of resistance, speed of resistance evolution, steadiness of performance, side effects, spectrum range and cost with high significance. Conclusion: Drugs that showed satisfactory figures are recommended for future treatment protocols in Jordan. &nbsp

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030