Seasonal influenza vaccination among older adults in Jordan: prevalence, knowledge, and attitudes

Objectives: The current study aimed to evaluate the prevalence, level of knowledge and attitudes to seasonal influenza vaccination among older adults in Jordan. Methods: This was a cross-sectional study in which a close-ended questionnaire was administered to older adults (65 years or older) in two major cities in Jordan between May 2018 and July 2018. A p-value of less than 0.05 was considered the cutoff level for statistical significance. Results: Among 500 participants, only 1.2% (n = 6) received a seasonal influenza vaccine during the previous year. In assessing influenza disease and influenza vaccine knowledge, 47.8% had good knowledge. Around 61% of older adults reported influenza vaccine is effective against preventing influenza however, 49.8% reported that influenza could be treated with the influenza vaccine. Moreover, 27% thought the influenza vaccine is important for older adults. In terms of attitudes toward the vaccine, 24.6% had positive attitudes and 40.6% strongly agreed/agreed that influenza is a serious disease in older adults and they should take the influenza vaccine to prevent influenza. Conclusion: The results of this study showed an extremely poor influenza vaccination rate among older adults and a low level of influenza vaccination knowledge and attitudes

A Successful Endovascular Treatment of an Ischemic Stroke following Cardiac Surgery

Ischemic stroke following cardiac surgery is one of the devastating complications that surgeons may encounter, and may lead to serious disabilities for the patient. The clinical course of such a complication may be prolonged if it is not treated properly. Making a quick decision when choosing a revascularization method is very helpful in this matter. Effective treatment options are usually limited. Neurointerventional maneuvers have recently emerged as a possible therapeutic modality in this field. We present the case of a 52-year-old woman who had open heart surgery in Queen Alia Heart Institute, Jordan, to replace a severely stenotic rheumatic mitral valve and repair a leaking tricuspid valve. Her surgery went smoothly with no major event. However, she developed a massive ischemic stroke during her recovery period despite being on adequate anticoagulation therapy. Urgent radiological work-up confirmed the diagnosis of ischemic stroke in the territory of the right middle cerebral artery. We chose a neuro-interventional method for her treatment, and mechanical thrombectomy was performed with a successful outcome and no apparent complications

The Effect of Long-Term Second-Generation Antipsychotics Use on the Metabolic Syndrome Parameters in Jordanian Population

Objectives: The aim of this study was to determine the incidence of metabolic syndrome in patients treated with second-generation antipsychotics (SGAs). Methods: In this retrospective study, we reviewed patients’ electronic medical records (EMRs) of all patients who received one SGA for at least six months, excluding patients who were taking other medications that are associated with significant effect on metabolic syndrome. Relevant clinical information was collected prior to starting the SGA and after six months of continuous use of the same SGA. Results: A total of 91 patients were included in the study. The majority of patients (72%) were diagnosed with schizophrenia. After six months of taking the SGA, 44% of patients experienced elevated systolic pressure, 54.9% had elevated triglyceride, and 31.9% had impaired glucose levels (p value < 0.05). Prior to initiating SGA therapy, 14.3% of patients had metabolic syndrome, while 37.4% had metabolic syndrome after six months of therapy, and it was more prominent in males compared to female patients (p value < 0.05). Conclusion: This study found a strong correlation between SGA use and the appearance of metabolic alterations, such as weight gain, glucose intolerance, and increased triglyceride levels. These findings highlight the importance of assessing metabolic deregulations to minimize SGA associated metabolic abnormalities

Disruption of the Akap12 (gravin) gene and the expression of the gravin in WT and gravin-t/t mice.

<p>(<i>A</i>) The strategy to disrupt the <i>Akap12</i> (gravin) gene (NM_031185) using gene trap technology. The ES cell line (XE450), containing genetically engineered retroviral gene trap, was obtained from BayGenomics. The gene trap vector integrated into the chromosome within the <i>Akap12</i> gene (gene trap vector, En2:β-gal), immediately following exon-2. <i>Akap12</i> gene sequence includes the relative primer set binding site, represented by a bar for the PCR construct (†: exon 1; ‡: exon 2; *: exon 3A; **: exon 3b; ***: exon 3c). Gravin protein sequence includes the relative binding site of the gravin antibody (AKAP250/gravin antibody; Santa Cruz), represented by an arrowed bar marking the antibody’s epitope (<i>Gene and protein sequence diagrams are not drawn to scale</i>). Gravin gene and protein expression levels were determined in hearts of WT and gravin-t/t mice. (<i>B</i>) Amplified PCR products and (<i>C</i>) RT-qPCR analysis of the exons of the gravin gene. (<i>D</i>) Immunohistochemistry (IHC) analysis of gravin protein expression in heart tissue sections from WT and gravin-t/t mice. Heart sections show positively stained cardiomyocytes that expressed gravin from WT (<i>d</i>’ longitudinal tissue section; <i>d</i>’’ cross-sectional tissue) mice (<i>yellow arrows</i>), but not from gravin-t/t (<i>d</i>’’“longitudinal tissue section; <i>d</i>”’<i>’’</i> cross-sectional tissue) mice. This positively gravin-stained expression in WT tissue sections is identified as dark brown oval clusters near the sarcolemma (<i>yellow arrows</i>). (<i>E</i>) Western blot analysis of gravin protein expression levels in LV homogenates from WT and gravin-t/t mice (<i>n</i>=4-6). (<i>F</i>) RT-qPCR analysis of total heart RNA identified the AKAP150 gene using AKAP150 specific primers in WT and gravin-t/t mouse hearts (<i>n</i>=4-7) and (<i>G</i>) Western blot analysis of AKAP150 protein expression levels in LV homogenates from WT and gravin-t/t mice (<i>n</i>=4-6). Experiments were performed in triplicate. The bar graphs show gene expression data collected from 4 to 7 mice per group and Western blot data collected from 4 to 6 mice per group. <i>Yellow </i><i>arrows</i> in panels <i>d</i>’ and <i>d</i>’’ represent a sample of the ubiquitously expressed gravin in WT heart sections. Data are expressed as the mean ± S.E.M.; *, p<0.05 versus respective WT (panels c-d); t/t = gravin-t/t mice.</p

PKA activity and substrate phosphorylation in response to acute ISO stimulation in WT and gravin-t/t mice.

<p>(<i>A</i>) PKA activity in left ventricular cytosolic fractions isolated from WT and gravin-t/t mice following acute vehicle or ISO infusion (10ug/g/min). Western blot analysis of PKA substrate phosphorylation of (<i>B</i>) phospholamban (PLB), (<i>C</i>) cardiac troponin I (TnI) and (<i>D</i>) heat shock protein 20 (Hsp20) in heart homogenates isolated from WT and gravin-t/t mice following acute vehicle or ISO infusion (10µg/g/min). For each substrate, the upper panel shows a Western blot with anti-phospho-protein antibody and the lower panel shows a Western blot with an antibody to total-protein (Lane 1: WT VEH; Lane 2: WT ISO; Lane 3: gravin-t/t VEH; Lane 4: gravin-t/t ISO). The bar graphs show the ratio of phosphorylated to total protein normalized to WT vehicle. Data are expressed as the mean ± S.E.M.; n= 4 to 6 samples; *p<0.05 vs. baseline of same genotype; † p<0.05 either baseline in WT vs. baseline in gravin-t/t mice or ISO in WT vs. ISO in gravin-t/t mice; ‡p<0.05 either baseline in WT vs. ISO in gravin-t/t mice or ISO in WT vs. baseline in gravin-t/t mice.</p

PDE4D3 and PDE4D5 protein expression levels in WT and gravin-t/t mice.

<p>(<i>A</i>) Western blot analysis of PDE4D5 in heart homogenates isolated from WT and gravin-t/t mice following acute vehicle or ISO infusion (10µg/g/min; Lane 1: WT VEH; Lane 2: WT ISO; Lane 3: gravin-t/t VEH; Lane 4: gravin-t/t ISO). The <i>upper </i><i>panel</i> shows a Western blot with anti-PDE4D5 antibody and the <i>lower </i><i>panel</i> shows a Western blot with an antibody to GAPDH. (<i>B</i>) Western blot analysis of PDE4D3 in heart homogenates isolated from WT and gravin-t/t mice following acute vehicle or ISO infusion (10µg/g/min); (Lane 1: WT VEH; Lane 2: WT ISO; Lane 3: gravin-t/t VEH; Lane 4: gravin-t/t ISO). The <i>upper </i><i>panel</i> shows a Western blot with anti-PDE4D3 antibody and the <i>lower </i><i>panel</i> shows a Western blot with an antibody to GAPDH. The <i>bar </i><i>graphs</i> show the ratio of PDE4D isoform to GAPDH normalized to WT vehicle. Data are expressed as the mean ± S.E.M.; n= 6-8 samples.</p

Phosphorylation of cardiac Myosin Binding Protein C in response to acute ISO stimulation in WT and gravin-t/t mice.

<p>(<i>A</i>) Representative western blots of the three phosphorylation sites of cardiac myosin binding protein C (cMyBPC) as well as total cMyBPC in heart homogenates isolated from WT and gravin-t/t mice following acute vehicle or ISO infusion (10µg/g/min); (Lane 1: WT VEH; Lane 2: WT ISO; Lane 3: gravin-t/t VEH; Lane 4: gravin-t/t ISO). (<i>B</i>-<i>D</i>) The bar graphs show the ratio of phosphorylated to total protein for p273, p282 and p302 respectively normalized to WT vehicle. Data are expressed as the mean ± S.E.M.; n= 4 to 6 samples; *p<0.05 vs. baseline of same genotype; † p<0.05 either baseline in WT vs. baseline in gravin-t/t mice or ISO in WT vs. ISO in gravin-t/t mice; ‡p<0.05 either baseline in WT vs. ISO in gravin-t/t mice or ISO in WT vs. baseline in gravin-t/t mice.</p

Calcium transients, sarcomere length shortening and cell length shortening in response to ISO stimulation in WT and gravin-t/t cardiomyocytes.

<p>(<i>A</i>) Representative cardiomyocyte Ca²⁺ transients and (<i>B</i>) corresponding bar graph of the 340/380 ratio in WT (n=18) and gravin-t/t (n=30) myocytes perfused with control buffer and WT (n=14) and gravin-t/t (n=29) myocytes perfused with ISO. (<i>C</i>) Representative cardiomyocyte sarcomere length fractional shortening transients of WT (n=9) and gravin-t/t (n=13) myocytes perfused with control buffer and WT (n=8) and gravin-t/t (n=8) myocytes perfused with ISO. (<i>D</i>) Representative cell length fractional shortening transients of WT (n=12) and gravin-t/t (n=12) myocytes perfused with control buffer and WT (n=13) and gravin-t/t (n=10) myocytes perfused with ISO. (<i>E</i>) Shows the corresponding bar graph of the percent shortening in sarcomere length and cell length of the represented traces in <i>Panel</i>’s <i>C</i> and <i>D</i>. The bar graphs show the Ca²⁺ transient 340/380 ratio (Panel <i>B</i>) and percent shortening (Panel <i>E</i>) from cardiomyocytes collected from 4 to 6 mice per group. Data are expressed as the mean ± S.E.M.; *, p<0.05 versus respective WT (Panel <i>B</i>); *, p<0.01 versus respective WT (Panel <i>E</i>); t/t = gravin-t/t mice; †, p<0.05 either baseline in WT vs. baseline in gravin-t/t mice or ISO in WT vs. ISO in gravin-t/t mice.</p