Indications and outcomes of pediatric penetrating keratoplasty: A retrospective observational study

Background: Pediatric corneal transplantation can be indicated in congenital and acquired conditions. Challenges include preoperative evaluation, multiple intraoperative obstacles, and postoperative problems in follow-up and management. This study was aimed at identifying the indications and clinical outcomes of pediatric penetrating keratoplasty (PKP) in Jordan. Methods: This retrospective cohort study was conducted in Amman, Jordan. Using the hospital’s electronic database, all medical records of patients aged < 18 years who underwent PKP between January 2004 and October 2019 were reviewed. Preoperative evaluations included best-corrected distance visual acuity (BCDVA) and anterior and posterior segment examinations. Postoperative complications, BCDVA, and graft survival were examined 1 year postoperatively. Results: A total of 149 cases of pediatric PKP were performed on 141 eyes of 118 patients with an age mean ± standard deviation (SD) of 11.44 ± 4.97 years at the time of surgery. Acquired non-traumatic corneal pathologies accounted for 65.8% of indications for PKP. The most frequent indication was advanced keratoconus (55.7%). Preoperative and 1-year postoperative BCDVAs significantly differed (P < 0.001), with 111 (74.5%) patients showing improved BCDVA, 12 (8.05%) patients showing worsened BCDVA, and 26 (17.45%) patients showing no change in BCDVA. The overall 1-year graft survival rate was 80.54%. Conclusions: This was the largest study in Jordan involving pediatric patients who underwent PKP for various indications, showing a significant improvement in BCDVA, with a high survival rate at 1 year. Future studies with longer follow-up periods could provide stronger evidence for surgical outcomes and graft survival. Further, the option of lamellar keratoplasty in the pediatric age group should be assessed

Assessment of Psychometric Properties of the Postpartum Bonding Questionnaire (PBQ) in Jordanian Mothers

Background: Mother to infant bonding is the most important process in the puerperium, where many instruments have been designed to screen for mother-infant bonding issues. In this study, we will translate and validate the Postpartum Bonding Questionnaire (PBQ) to the Arabic and to measure the mother-infant bonding in a sample of Jordanian mothers.Materials and methods: This sample is a representative sample taken from multiple centers in Amman, Jordan. Post-partum lady who give a birth to a live healthy baby, regardless the mood of the delivery, who have been discharged with their babies home. Women with multiple pregnancies were also included. We calculated reliability indices and relevant statistics using SPSS.Results: A total of 120 participants included in this study. The mean age for the included sample was 28.1 (±6.3) years. Scale internal consistency measured via Cronbach’s alpha is 0.720. Average intraclass correlation coefficient for single measure is 0.067 (CI 0.045 to 0.097). Mean score for the 4 factors of the questionnaire were: Factor 1: 17.43 (±3.95), factor 2: 4.10 (±3.98), factor 3: 7.99 (±2.39), factor 4: 0.37 (±0.94).Conclusion: We translated and validated an Arabic version of the Postpartum Bonding Questionnaire (PBQ), an easy and widely used instrument to measure mother-infant bonding disorders. We observed a high frequency of bonding disorder among a Jordanian sample

The Frequency of Asymptomatic Sacroiliitis in Jordanian Patients with Crohn’s Disease. Assessment by Magnetic Resonance Enterography

Background: our aim was to assess frequency of asymptomatic sacroiliitis (SI) in patients with Crohns disease referred for magnetic resonant enterography (MRE) as a part of small bowel evaluation. Methods: this was a retrospective study of all patients with Crohns disease who were referred for MRE between January of 2016 to October of 2017 to Jordan University Hospital. All MRE were reviewed by an experienced radiologist and SI was diagnosed and graded based on predefined MRI criteria. All patients were contacted and assessed for symptomatic SI based on Assessment of SpondyloArthritis international Society (ASAS) criteria of 2009 for axial spondyloarthropathy. All patients were included in the final analysis.Results: a total of 60 patients were included, overall 18 (30%) showed evidence of SI, two patients were symptomatic and another two were diagnosed with ankylosing spondylitis as assessed by ASAS criteria. Those were excluded. Fourteen (23%) patients were included in the final analysis, with an average age of 36.7 years, 71% males. The average disease duration was 7.25 years. The percentage of ASA used by patients was 50%, Azathioprine 71%, Biologic agents in 36% in combination and single drug was used in 36% of patients.Conclusion: The prevalence of asymptomatic SI based on predefined MRI criteria was 23%, the importance of this finding and future course progression needs further studies

Impact of plastic surgery medical training on medical students' knowledge, attitudes, preferences, and perceived benefits: Comparative study

Introduction: Misconceptions surrounding the discipline of plastic surgery are widespread among not only the public, but medical students and professionals, as well. The purpose of this study was to explore how the inclusion of plastic surgery rotation into the medical curriculum affects medical students’ knowledge, attitudes and preferences regarding plastic surgery specialization and referral.  Design and Methods: A descriptive-correlational design was utilized to collect data from 200 medical students in the final two years of education from two separate six-year medical programs in Jordan. Data was collected using self-reported questionnaires regarding knowledge of surgical procedures allocation, attitude towards plastic surgery, preference of specialization, and benefits of plastic surgery to physicians and patients.Results: Analysis showed that medical students of plastic surgery integrate rotation (program A) had a higher average score of correct procedure-allocation (M = 12.57, SD = 3.14), compared to non-integrated plastic survey rotation program (program B) (M = 8.29, SD = 3.05) 8.29. About 83% of students in program A had their knowledge on plastic surgery from direct exposure to a plastic surgeon, compared to 43% of program B, and 24% of students in program A reported that their perception of plastic surgery influenced by media compared to 62% of those in program B.Conclusions: medical students who have been exposed to plastic surgery education are more confident about procedures of plastic surgery specialty and had more reliable sources of knowledge about plastic surgery than those who were not exposed to plastic surgery rotation

The impact of the open-access status on journal indices: a review of medical journals [version 1; peer review: 3 approved, 1 approved with reservations]

Background: Over the past few decades, there has been an increase in the number of open access (OA) journals in almost all disciplines. This increase in OA journals was accompanied an increase in funding to support such movements. Medical fields are among the highest funded fields, which further promoted its journals to move toward OA publishing. Here, we aim to compare OA and non-OA journals in terms of citation metrics and other indices. Methods: We collected data on the included journals from Scopus Source List on 1st November 2018.  We filtered the list for medical journals only. For each journal, we extracted data regarding citation metrics, scholarly output, and wither the journal is OA or non-OA. Results: On the 2017 Scopus list of journals, there was 5835 medical journals. Upon analyzing the difference between medical OA and non-OA journals, we found that OA journals had a significantly higher CiteScore (p< 0.001), percent cited (p< 0.001), and source normalized impact per paper (SNIP) (p< 0.001), whereas non-OA journals had higher scholarly output (p< 0.001). Among the five largest journal publishers, Springer Nature published the highest frequency of OA articles (31.5%), while Wiley-Blackwell had the lowest frequency among its medical journals (4.4%). Conclusion: Among medical journals, although non-OA journals still have higher output in terms of articles per year, OA journals have higher citation metrics

Pre-operative Over-investigation of Routine Tests Prior to Elective Surgeries

Background: Previous studies stressed on the burden raised by routine pre-operative test ordering, which should be based on the assessment of patient physical status. In a tertiary hospital in Jordan, we aim to study the compliance with guidelines regarding pre-operative routine testing prior to an elective surgery, cholecystectomy, and calculate the estimated cost from non-compliance with the guidelines.Methods: We included laparoscopic cholecystectomy (through ICD-9 code) to represent an elective surgery. For each surgery done from the period 1/1/2016 to 31/12/2016, data regarding preoperative investigations, admission history note, operative and discharge note were obtained. Tests that are considered routine investigations are Complete blood count (CBC), kidney function tests (KFT), electrolytes, chest X-ray, electrocardiogram, coagulation studies, and urine-analysis. We classified patients who underwent cholecystectomy according to the latest version of the American Society of Anesthesiologists (ASA) physical status system to assess the need for routine tests, then we calculated the number and cost of excess tests.Results: A total 382 routine, non-emergent laparoscopic cholecystectomy surgeries were performed. 319 (83.5%) of patients were classified as ASA-1, 60 (15.7%) were classified as ASA-2, and only 3 (0.8%) were classified as ASA-3. Age was a significant determinant in obtaining chest X-ray ordering and findings (p< 0.001) and electrolytes ordering and findings (p= 0.001). Total routine tests cost for elective cholecystectomy during 2016 was 16,021$. Regarding operative compilations, only 14 (3.7%) complication occurred, all of which were bleeding related.Conclusion: Oversighting routine preoperative test ordering before elective cholecystectomy will significantly reduce the cost without increasing post-operative complications

Outcome of Penetrating Keratoplasty (PKP) and Redo PKP among Jordanian Population

Background: The success of penetrating keratoplasty (PKP) is determined by the duration of graft survival, which is the time to graft failure. Our study aims to identify various indications of corneal graft among our Jordanian population, their success rate as well as spotting the light on cases of re-grafting. Methods: In this study, we analyzed data for patients who had PKP as well as re-do PKP in the period from January 2014 to June 2017. For each study eye, we identified pre-operative visual acuity as well as visual acuity at six months and one year. We also focused on the specific indication for PKP, the surgical procedure and graft clarity at one year post-op. On SPSS statistical analysis software, we used repeated measure ANOVA, Pearson correlations, and Fischer’s exact test to analyze our study’s variables.Results: We included a total of 230 patients in this study with a mean age of 34.22 (±19.32). They were 112 (48.7%) males and 118 (±51.3%) females. We found a significant difference in mean age and outcome (p< 0.001), as the mean age for patients with successful PKP was 31.55 (±16.55) compared to 44.1 (±25.1) for patients with failed PKP. the success rate for patients with KC as an indication was 96.7% compared to only 58.3% for other indications. We found that failure rate in redo surgeries was significantly higher than first time surgeries.Conclusion: Among the Jordanian population, we found that Keratoconus was the main indication for PKP in our population, where we also found that it was associated with the best prognosis

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

Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000–2021: a systematic analysis from the Global Burden of Disease Study 2021

Background Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. Methods We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures—borrowing strength from predictive covariates and across age, time, and geography—and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). Findings Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13·7% (95% uncertainty interval 11·1–16·5), to 515 000 (425 000–614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41·4% (38·3–44·9), from 5·46 million (4·62–6·45) in 2000 to 7·74 million (6·51–9·2) in 2021. We estimated 34 400 (25 000–45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000–467 000). In children younger than 5 years, there were 81 100 (58 800–108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. Interpretation Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease.publishedVersio

Ophthalmology randomized controlled trials

On 15th of May 2019, we performed a PubMed search for randomized controlled trials published in the field of ophthalmology using the following search filters: • Ophthalmology studies: eye diseases[MeSH Terms] • RCT: Randomized Controlled Trial[Publication Type