Darwish H. Badran

Behavior of radial forearm skin flaps transplanted into the oral cavity

Radial forearm skin flaps transplanted into the oral cavity in patients undergoing treatment for intra‐oral tumors frequently acquire a gross appearance resembling that of buccal mucosa. This article reports studies of biopsies of the flaps in 53 patients, of which 21 showed changes at some stage in the follow‐up period. The project aims to determine whether 1) the change in the epithelium to a mucosal form is genuine or reactive, 2) a creeping replacement of epidermis results from the surrounding buccal epithelium, 3) alterations in the epidermis could be associated with changes in the dermis, 4) the change is caused by radiotherapy. Examination of the biopsies by resin histology and transmission electron microscopy shows that the changes may be reversible: it suggests that they are reactive in nature, and related to the degree of dermal inflammation, rather than to the effect of radiotherapy. The dermis persists as such and is not replaced by buccal lamina propria. Clin. Anat. 11:379–389, 1998.

Prevalence of Temporomandibular Joint Disorders among Students of the University of Jordan

Background This study aimed to investigate the prevalence of temporomandibular disorder (TMD) among students of the University of Jordan. Methods Information about the symptoms of TMD and the possible risk factors were collected using specifically designed questionnaires. The collected data sets were treated statistically using the SPSS release 14 package. Results The results of the present investigation showed that pain in or about the ears or cheeks was the most prevalent symptom whereas locking of the temporomandibular joint (TMJ) was the least prevalent. Nearly one-third of the investigated sample (31.4%, 346/1103) had no symptoms of TMD whereas 68.6% (757/1103) had at least one symptom. Students of health science studies had significantly the highest risk in developing TMJ clicking compared to students studying pure science or humanitarian studies. Conclusions TMD is of a high prevalence among students of the University of Jordan, particularly among students of health and science studies, which signify the role of stress in the development and/or progression of TMD. The findings of this study are alarming and entailing further investigations to identify risk factors associated with TMD in order to establish measures for prevention and treatment. Keywords TMD; Clicking; Health sciences; Humanitarian studies

Burnout Among the Clinical Dental Students in the Jordanian Universities

Background The study aimed to evaluate the level of burnout among the clinical dental students in two Jordanian universities. Methods A total of 307 students from the two schools were surveyed using Maslach Burnout Inventory survey. Scores for the inventory’s subscales were calculated and the mean values for the students’ groups were computed separately. Kruskal-Wallis and Mann-Whitney tests were carried out and the results were compared at 95% confidence level. Results The results showed that the dental students in both Jordanian universities suffered high levels of emotional exhaustion and depersonalization compared to reported levels for dental students in other countries. The dental students of the University of Jordan demonstrated a significantly higher (p < 0.05) level of emotional exhaustion than their counterparts in the Jordan University of Science and Technology. Conclusions The findings indicated that dental students in the Jordanian universities presented considerable degrees of burnout manifested by high levels of emotional exhaustion and depersonalization. Studies targeting students health and psychology should be carried out to determine the causes of burnout among dental students. The curricula of the dental schools in the two universities should be accordingly improved to minimize burnout among the students. Keywords Burnout; Emotional exhaustion; Depersonalization; Personal accomplishment; Maslach Burnout Inventory

Ultrasonographic assessment of splenic volume and its correlation with body parameters in a Jordanian population

Objectives: To estimate normal linear dimensions and volume of spleen in Jordanians using ultrasonography, and to correlate splenic volume with age and body parameters: height, weight, body surface area (BSA), and body mass index (BMI). Methods: A prospective pilot study was conducted on 205 volunteers (115 males and 90 females) not known to have any conditions likely to be associated with splenomegaly. The study was performed at the Radiology Department, Jordanian University Hospital, Amman, Jordan, between December 2013 and August 2014. All linear dimensions of spleen were measured, and splenic volume (index) was calculated using the standard prolate ellipsoid formula (length × width × depth × 0.523). The splenic volume was then analyzed with age and body parameters using the Pearson’s correlation coefficient. Results: The mean (± SD) splenic dimensions were 10.72±1.37 cm in length, 7.40±1.52 cm in width, 4.40±1.47 cm in depth, and 184.15±79.56 cm3 in volume. Men had larger spleens than women (p<0.0001). Age had no significant effect on spleen volume (r=0.11, p=0.12). There was a significant moderate positive correlation (p<0.0001), using Pearson’s correlation coefficient, between the spleen volume, and other parameters (height, weight, BSA, and BMI), with correlation coefficients exceeding 0.3. Conclusion: A local reference of spleen dimensions was established with a different range of values reported previously.

Effect of Oral Diseases on Mothers Giving Birth to Preterm Infants

Objectives: To determine the association between preterm birth (PTB) and maternal oral diseases during pregnancy. Subjects and Methods: This prospective study was performed by the neonatal and dental departments at Jordan University Hospital. The study included 100 women who gave birth to preterm singleton infants (born less than 37 complete weeks from last menstrual period) between January and July 2009. The control group included an equal number of women who delivered singleton, full-term infants on the same day or the day after the women in the study. The mothers’ demographic data were collected using a questionnaire, and an oral examination was conducted for each participant. Statistical analysis was performed using SPSS for Windows release 16.0 (SPSS Inc., Chicago, Ill., USA). Factors related to PTB were studied in univariate and multivariate logistic regression analyses. Results: Significantly higher DMFT (decayed, missing, filled teeth) index scores, Silness and Loe plaque index scores and Mühlemann tooth mobility index scores were associated with PTB. Mothers who did not have prepregnancy dental checkups had a significantly higher incidence of PTB. Fewer mothers in the PTB group visited dentists during their last pregnancy compared with controls. Conclusions: Oral health, especially healthy periodontium, is one reliable indicator for predicting a safe pregnancy outcome.

The Cricothyroid Space: a Guide for Successful Thyroidectomy

OBJECTIVE The frequent complications of thyroid surgery are mostly related to the anatomy of the region. This stimulated us to look for a starting point that makes exploration of the region easier and consequently reduces complications. We aimed to explore and define the anatomy of the cricothyroid [CT] region from cadaveric dissection and to present the outcome of 73 consecutive thyroidectomies starting from a space in the CT region. METHODS Dissection in the thyroid gland region and creating a space in the CT region was performed on five cadavers [10 spaces], followed by 73 consecutive thyroidectomies through a standard approach beginning from the CT space. RESULTS In all cadavers, a space was easily created in the CT region. Vessels, nerves and the parathyroid glands were identified. Standard thyroidectomy starting from the CT space was performed on 73 patients. The external laryngeal nerve was seen in 40% of the cases. The recurrent laryngeal nerve was identified and preserved in all patients. Six patients had temporary hypocalcaemia and eight had a temporary voice change. None of the patients had permanent hypoparathyroidism or recurrent laryngeal nerve palsy. CONCLUSION The CT space is an avascular space medial to the thyroid lobe and is a good starting point for thyroidectomy that allows easy and safe exploration of the region.

Normative Values of Peripapillary Retinal Nerve Fiber Layer Thickness in a Middle Eastern Population

Purpose Peripapillary retinal nerve fiber layer (pRNFL) thickness is subject to high variability. Normative values of pRNFL thickness remain undocumented in the Middle East. The aim of our study is to assess the normative values of pRNFL thickness in a Middle Eastern population. Methods A retrospective chart review of 74 patients was conducted. Outpatients who had presented to the ophthalmology clinic at the Jordan University Hospital between January 2016 and July 2018 were consecutively sampled. Measurements had been recorded using Fourier-domain optical coherence tomography. Multivariable regression models were developed to generate predicted normative values with adjustments to candidate confounders. Results The mean global pRNFL thickness was 99 ± 11 μm. The mean quadrantic pRNFL thickness increased from the nasal quadrant (75 ± 16 μm) to the temporal (82 ± 20 μm), superior (114 ± 20 μm), and inferior (125 ± 20 μm) quadrants. Gender and eye sidedness did not contribute to the variability in pRNFL thickness. The relationship between aging and pRNFL thinning is independent of diabetes mellitus type 2 and systemic hypertension. Both systemic conditions significantly predicted pRNFL changes despite negative fundoscopic findings. Conclusions Our set of predicted normative data may be used to interpret measurements of pRNFL thickness in Middle Eastern patients. Our findings suggest that systemic conditions with potential ocular manifestations may require consideration in predictive models of pRNFL thickness, even in the absence of gross fundoscopic findings. Normative data from additional Middle Eastern populations are required to appraise our models, which adjust for common clinical confounders.

Association between occupational lead exposure and plasma levels of selected oxidative stress related parameters in Jordanian automobile workers

OBJECTIVES To study any possible correlation between blood lead levels and some oxidative stress parameters of selected groups of lead-exposed automobile occupational Jordanian workers. MATERIAL AND METHODS Blood lead levels were determined for a total of 90 male automobile workers aged within the range of 25-45 years old along with the group of 20 agematched healthy males control. To get an idea about the antioxidant status of controls and lead-exposed workers, and to estimate the oxidative stress caused by exposure to lead, we measured the hydrogen peroxide (H2O2) concentration, superoxide dismutase (SOD) activity, lipid peroxidation as malondialdehyde (MDA) and total antioxidant capacity of controls and workers. RESULTS The study showed that lead levels in the case of workers were approximately 4-5 times as high as in controls 14.5-21 μg×dl-1 vs. 4.3 μg×dl-1, respectively. There was a significant decrease (16-25%) in the level of plasma reduced glutathione and 21-33% decrease in total antioxidant capacity (TAOC) in all worker groups, as compared to controls. The results showed that the concentration of malondialdehyde (MDA) in plasma was higher (120-333%) in the case of workers than controls being the highest in automobile electronics and the lowest - in mechanics. Furthermore, there was 149-221% increase in hydrogen peroxide (H2O2) concentration, and 26-38% increase in SOD activity in the case of workers compared to the control group. CONCLUSIONS There is a strong evidence for the associations between occupational lead exposure and various markers of oxidative stress in Jordanian automobile occupational workers. Thus, there is an urgent need to raise awareness and to initiate suitable protection guidelines for workers. Int J Occup Med Environ Health 2018;31(4):517-525.

THE EFFECT OF SMOKING MODELS ON THE SERUM LIVER ENZYMES

Introduction: Smoking has been associated with adverse health effects including cardiovascular system and other body organs. Study objectives:The main objective of the present study is to evaluate the effects of smoking models on the level of liver enzymes. Methods: This experimental study was carried out on 30 male albino rats. Male albino rats (Rattusratas) weighted 50-180 g (6-8 weeks old) were used. Rats were randomly assigned to one of 3 groups (n= 10 per group), group 1 was negative control exposed only to fresh air, groups 2 exposed to the most commonly used cigarette brands in the Jordanian market (red LM cigarettes) as 1 cigarette/rat/day for 30 consecutive days. Rats in groups 3 were exposed to flavored water-pipe coming from the complete burning of 20 g from one of moassal for a period of 30 days one session a day for whole body. A digital smoking machine was used. Liver enzymes, LDH, AST, and ALT were evaluated in study groups. Data obtained were analyzed using SPSS version 20. Results:Liver enzymes were significantly increased as a result of exposure to both smoking models: cigarette smoking and water-pipe smoking. It was interestingly found that smoking cessation restore liver enzymes close to control group. Conclusion: Smoking models can induce liver injury as reflected by increased levels of liver enzymes and this injury is reversible if smoking is quitted.

Incidence and anatomical variations of accessory navicular bone in patients with foot pain: A retrospective radiographic analysis

The accessory navicular (AN) is an accessory ossicle anatomically located on the medial side of the foot, proximal to the navicular and continuous with the tibialis posterior tendon. It is occasionally a source of pain and local tenderness. Knowledge of the AN and its morphological variations can help identify the source of a patients symptoms and prevent misinterpreting them as fractures. Foot radiographs from 1,240 patients who presented in two centers with chronic foot pain, or persistent pain developed after trauma, were retrospectively reviewed to determine the incidence and variations of the AN in relation to gender. The AN was found in 20.9% (259/1240). Among 259 feet with AN, Type 1 was identified in 25.4% (66/259), Type 2 in 42.4% (110/259) (20.0% (52/259) Type 2 A and 22.4% (58/259) Type 2B), and Type 3 in 32.0% (83/259). After 13 patients with incomplete medical records had been excluded, the remaining records showed that foot pain was associated with an AN in 10.6% of patients (26/246). In 1.2% of cases, two additional ossicles were found proximal to the navicular, possibly the result of multiple ossification centers that did not unite at the time of development. Patient symptomatology was related to the presence of an AN in 2% of patients with chronic foot pain. The AN could vary morphologically. Our data can enhance our diagnostic skills in detecting these ossicles. Clin. Anat. 30:436–444, 2017.