Basheer Khassawneh

Utility of Fiberoptic Bronchoscopy for Retrieval of Aspirated Headscarf Pins

Background: Headscarf pin aspiration is a common and unique form of foreign body aspiration among young Moslem women. Rigid bronchoscopy (RB) is considered the standard procedure for retrieval. There are little data on the role of flexible fiberoptic bronchoscopy (FOB) in the retrieval of aspirated headscarf pins. Objectives: The aim of this study is to prospectively evaluate the utility of FOB for the retrieval of aspirated headscarf pins. Methods: Patients with the diagnosis of headscarf pin aspiration admitted to King Abdullah University Hospital from December 2002 to December 2005 were included in the study. Standard FOB procedure under local anesthesia and conscious sedation was performed as the primary tool for retrieval. Results: A total of 16 cases was admitted during the study period. The mean age was 19 years. The aspirated pin was successfully retrieved in 9/16 cases (56%) during the first attempt of FOB. In another 3 cases, although the pin was successfully retrieved from the bronchial tree, it was lost in the throat and swallowed, and then recovered by esophagogastroduodenoscopy. However, FOB was not successful in 4/16 cases. In 3 cases, the aspirated pins were successfully retrieved by RB under general anesthesia and the fourth case required thoracotomy. Conclusions: Headscarf pin aspiration is a relatively common form of foreign body aspiration among young Moslem Jordanian women. FOB under local anesthesia can be a useful first-step tool in retrieval, provided facilities for esophagogastroduodenoscopy and RB are readily available.

Anti-TNF therapy in Jordan: a focus on severe infections and tuberculosis.

Background A high rate of infection has been reported in patients receiving treatment with anti-tumor necrosis factor (anti-TNF). This study describes the rate of and risk factors for serious infections in patients receiving anti-TNF agents in Jordan. Methods This retrospective observational study was conducted at a large tertiary referral center in the north of Jordan. Between January 2006 and January 2012, 199 patients who received an anti-TNF agent (infliximab, adalimumab, or etanercept) were included. Patients received the anti-TNF treatment for rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, or other conditions. A serious infection was defined as any bacterial, viral, or fungal infection that required hospitalization, administration of appropriate intravenous antimicrobial therapy, and temporary withholding of anti-TNF treatment. Results The mean duration of anti-TNF treatment was 26.2 months. Steroids were used in 29.1% of patients, while 54.8% were given additional immunosuppressant therapy (methotrexate or azathioprine). Only one anti-TNF agent was given in 70.4% of patients, while 29.6% received different anti-TNF agents for the duration of treatment. Serious infections were documented in 39 patients (19.6%), including respiratory tract infections (41%), urinary tract infections (30.8%), and skin infections (20.5%), and extrapulmonary tuberculosis in three patients (7.7%). Exposure to more than one anti-TNF agent was the only factor associated with a significant increase in the rate of infection (relative risk 1.9, 95% confidence interval 1.06–4.0, P=0.03). Conclusion Serious infections, including tuberculosis, were a common problem in patients receiving anti-TNF agents, and exposure to more than one anti-TNF agent increased the risk of serious infection.

Association between vitamin B12 level and anti-parietal cells and anti-intrinsic factor antibodies among adult Jordanian patients with Helicobacter pylori infection

OBJECTIVE Evaluate the association of Helicobacter pylori infection with anti-parietal cell antibodies (APCA) and anti-intrinsic factor antibodies (AIFA) and their impact on vitamin B12 serum level. PATIENTS AND METHODS One hundred patients (M/F: 43/57; age 46.5±17.5 years) who underwent upper gastrointestinal endoscopy at King Abdullah University Hospital, Irbid, Jordan were enrolled in the study. The patients were grouped as H. pylori-infected (n=81) or H. pylori negative (n=19) by histopathological examination. Fasting serum vitamin B12 levels, anti-parietal cell antibodies and anti-intrinsic factor antibodies for patients and controls were determined. RESULTS Anti-parietal cell antibodies and anti-intrinsic factor antibodies were positive in 9.9% and 18.5% of H. pylori-positive patients respectively. None of the H. pylori negative subjects had anti-parietal cell antibodies or anti-intrinsic factor antibodies. Serum vitamin B12 level was lower in the H. pylori-infected patients (275±70.4pg/mL) than in controls (322.9±60.7pg/mL; p<0.05). H. pylori was positive in 94% of the low-vitamin B12 group compared with 64.6% of the normal-vitamin B12 group (p<0.5). CONCLUSION Patients with H. pylori infection are more likely to have anti-parietal cell antibodies and anti-intrinsic factor antibodies. There was an association between H. pylori infection and lower vitamin B12 levels. H. pylori infection might be a significant factor in the pathogenesis of autoimmune gastritis.

Vitamin D deficiency and level of asthma control in women from North of Jordan: a case–control study

Abstract Introduction: Reduced vitamin-D levels in patients with asthma have been associated with impaired lung function, increased airway hyper-responsiveness, and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. Objective: A case–control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. Methods: Sixty-eight asthmatics, age range between 14 and 65 years and 77 healthy women, age range between 19 and 51 years, were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. Results: The prevalence of VDD (<15 ng/ml) was higher but not statistically significant for women with asthma compared with controls (95.6% vs. 87.0%; p = 0.070). The severity of VDD correlated with the number of asthma medications (p = 0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p = 0.012) and GINA classification (p = 0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p = 0.214) and none had vitamin-A deficiency (<200 µg/dl). Conclusions: VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and a need for more medications to control asthma. There was no association between vitamin-A and asthma.

Rheumatoid arthritis in Jordan: a cross sectional study of disease severity and associated comorbidities

Treating rheumatoid arthritis (RA) to target is advocated using disease activity measures. The impact of RA on the general health status of affected patients in Jordan is not well described. This study reported the severity of RA in Jordan and its association with consequent disabilities and comorbidities. A cross-sectional, observational study was conducted at King Abdullah University Hospital in the north of Jordan. All patients who were diagnosed with RA were included. Patients’ demographics, comorbidities, disease activity score (DAS 28), and clinical disease activity index (CDAI) were collected. Both DAS 28 and CDAI were utilized to categorize RA disease activity. A total of 465 patients with RA were included: 82% were females; mean age ± standard deviation (SD) was 47.62±14.6 years; and mean disease duration ± SD was 6±4.45 years. The mean ± SD for the DAS 28 and CDAI was 5.1±1.5 and 23±14.2, respectively. According to the DAS 28, 51% of the patients were in the high disease activity category and only 5% were in remission. On the other hand, according to the CDAI, 44% were in the high disease activity category and only 1% were in remission. In Jordan, patients with RA have a high severe disease rate and a low remission rate. The disease is often progressive and associated with comorbidities that need to be managed.

Awareness of patients who undergo cesarean section about venous thromboembolism prophylaxis

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially life-threatening condition and the most well-known cause of postpartum maternal death, especially in patients undergoing cesarean section (CS). The aim of this study was to evaluate the level of awareness of VTE among patients who undergo CS. This study was cross-sectional, involving 230 patients who underwent CS at a major university hospital. A validated standardized questionnaire was used to determine the awareness of VTE among CS patients. Approximately 46% of the patients were aware of DVT, and 18.7% were aware of PE. Most patients recognized obesity or immobility as risk factors of DVT, and 22.6% of them recognized CS as a risk factor for DVT. Only 25.4% recognized pregnancy as a risk factor for DVT. The level of patient knowledge about both DVT and PE were not affected by parity. The study showed that most patients who underwent CS were not aware of VTE as a complication of CS and the factors that may increase its risk, which could reflect inadequate patient counseling/education on the part of healthcare professionals.

Prevalence of chronic obstructive pulmonary disease among adult male cigarettes smokers: a community-based study in Jordan

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence of COPD among cigarette smokers in the Middle East is not well studied. A prospective descriptive study was performed in the north of Jordan. Male cigarette smokers (≥10 pack-year) aged 35 years and older were recruited from the community. They completed a questionnaire and a postbronchodilator spirometry. Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (postbronchodilator forced expiratory volume in 1 second <70%) was used to define COPD. A total of 512 subjects completed the study protocol. According to the GOLD criteria, 42 subjects (8.2%) had COPD. Of those, 27 subjects (64.3%) had symptomatic COPD. Using the GOLD criteria, eight subjects (19%) with COPD had mild disease, 24 (57.1%) had moderate disease, eight (19%) had severe disease, and two (4.8%) had very severe disease. Only 10.6% were aware of COPD as a smoking-related respiratory illness, and 6.4% had received counseling about risk for COPD by a physician. Chronic bronchitis (cough for 3 months in 2 consecutive years) was reported by 15% of the subjects, wheezes by 44.1%, and dyspnea by 65.2%. Subjects with COPD reported having more chronic bronchitis 18/42 (42.9%) and wheezing 28/42 (66.7%) than subjects without COPD. The prevalence of COPD increased with increased number of pack-years smoked. In conclusion, COPD prevalence among cigarette-smoking men in Jordan is lower than in the developed world. COPD was largely underdiagnosed, despite the majority of participants being symptomatic and having moderate to severe disease.

Asthma control in adults in the Middle East and North Africa: Results from the ESMAA study

BACKGROUND Low levels of asthma control are reported in many countries worldwide. Improved knowledge of asthma control in the Middle East and Africa and predictive factors is needed to address this major public healthcare burden. OBJECTIVE To assess the level of asthma control in patients attending a routine consultation for asthma in the Middle East and North Africa, and the relationship between level of control and patient and disease characteristics, adherence, and quality of life (QoL). METHODS A large-scale cross-sectional epidemiological study (ESMAA: Assessment of Asthma Control in Adult Asthma Population in the Middle East and North Africa) was performed in adults suffering from asthma for at least 1 year and without an acute asthma episode within 4 weeks. Asthma control was assessed per the 2012 GINA guidelines and the ACT questionnaire. QoL and adherence were assessed with the SF-8 and Morisky questionnaires respectively. Predictive factors of asthma control were analysed with univariate and multivariate logistic regressions analyses. RESULTS Overall 7236 eligible patients were included in 577 sites between June 2014 and December 2015 (median 10 patients/site). Mean age was 45 years (±14), 57% were female, mean BMI was 28.5 kg/m2 (±6.0), and 11% were active smokers. Reliever medication was prescribed in 96% of patients with 65% having fixed-dose combined inhaled corticosteroid plus long-acting beta agonists. Good medication adherence was reported in 24% of patients. Among 7179 patients evaluable for GINA, asthma was controlled in 29.4% (95% CI, 28.4%-30.5%), partly controlled in 29.1% (95% CI, 28.1%-30.2%), and uncontrolled in 41.5% (95% CI, 40.3% to 42.6). The mean global ACT score was 17.8 (±5.0), with 16% of patients considering their asthma as controlled. Poor medication adherence, active smoking, absence of medical insurance, lower level of education, or diagnosis at least 5 years earlier were significantly associated with uncontrolled asthma in multivariate analyses (p < 0.001). CONCLUSIONS Asthma control in the Middle East and North Africa is unsatisfactory with less than one-third of asthma patients having controlled disease, highlighting the need to improve treatment access and medication adherence, along with better follow-up and education among healthcare providers and patients.

Association Between Obstructive Sleep Apnea and Periodontitis Among Male Adults Attending a Primary Healthcare Facility in Jordan.

PURPOSE To determine the association between periodontitis and a high risk for obstructive sleep apnea (HR-OSA). MATERIALS AND METHODS A sample of 296 males with a mean (±SD) age 40 (8.5) years was selected. Subjects who scored positive in two or more categories of the Berlin questionnaire were considered as having HR-OSA. RESULTS Based on the self-reported symptoms of obstructive sleep apnea, 15% of patients were considered as HROSA. Patients with HR-OSA showed higher probing pocket depth (PPD) and clinical attachment level (CAL) compared with those with low risk for obstructive sleep apnea (LR-OSA)-2.35±0.69 vs 1.97±0.34 (p=0.000) and 2.95±0.82 vs 2.12±0.55 (p=0.000), respectively. Patients with HR-OSA were more likely to have periodontitis (OR=2.3; 95% CI: 1.03/5.10) compared to patients with LR-OSA. The prevalence of periodontitis varied significantly only among patients according to their response to category 1 (37% responded positively and 20% responded negatively, p=0.003). When the OSA variable was replaced by the individual categories (1, 2 and 3), patients with a positive category 1 (OR=2.27; 95% CI: 11.14/4.45) were more likely to have periodontitis than were patients with a negative response. CONCLUSION The risk of finding periodontitis in HR-OSA patients was approximately double that of LR-OSA patients. Habitual snoring was also associated with increased risk for periodontitis.

Adult Primary and Secondary Immune Thrombocytopenic Purpura: A Comparative Analysis of Characteristics and Clinical Course

This study was conducted to compare the platelet count and the presence of bleeding manifestations at initial diagnosis of immune thrombocytopenic purpura (ITP) between patients with primary and secondary ITP. Medical records for 67 consecutive adult patients with ITP were reviewed retrospectively and the relevant data were abstracted. Thirty-eight (56.7%) patients were diagnosed as having primary ITP and 29 (43.3%) were considered to have secondary ITP. At the time of diagnosis, the median initial platelet count (median: 60 × 109/L) for patients with secondary ITP was significantly (P < .005) higher than that for patients with primary ITP (median: 3.5 × 109/L). Ecchymosis and/or purpura was observed in 4 (13.8%) patients with secondary ITP and in 33 (86.6%) patients with primary ITP (P value <.005). In conclusion, patients with secondary ITP had higher platelet count at diagnosis and were less likely to present with bleeding manifestations than those with primary ITP.