Mahmoud Abu Abeeleh

Effects of experimental acute myocardial infarction on blood cell counts and plasma biochemical values in a nude rat model (Crl:NIH-Fox1RNU)

To determine the clinical pathology parameters in nude rats (Crl:NIH-Fox1RNU) following experimental induction of acute myocardial infarction (AMI), 50 male adult nude rats weighing 250–350 g were used. Complete blood count, total and differential leukocyte counts, plasma total protein, albumin, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase were determined before (time zero, T0), 1, and 5 days following experimental induction of AMI. Lactate dehydrogenase, creatinine kinase (CK), and creatinine kinase MB fraction (CK-MB) were determined at T0, 6, and 24 h following AMI. There were no significant changes in the hematological parameters at any sampling point. Among all plasma biochemical parameters studied, only CK and CK-MB were significantly elevated 6 h following induction of AMI. These data will aid scientists and researchers in the interpretation and better application of their results when using nude rats for AMI studies.

Cardiac myxoma: clinical characteristics, surgical intervention, intra-operative challenges and outcome:

Objective: The objectives of this retrospective study were to characterize the clinical presentation, diagnostic findings, surgical approaches, intra-operative challenges and complications following the surgical treatment of cardiac myxoma in two of the largest referral hospitals in Jordan. Methods: Medical records of all patients presented to the cardiology department during the period between 1984 and 2016 were reviewed. Criteria for inclusion in the study were: (1) patients who were presented for cardiac evaluation due to symptoms suggestive of a primary cardiac problem, (2) completed medical records, including results of echocardiography suggestive of intra-cardiac occupying mass, (3) the surgical operation was undertaken and intra-operative data was available, (4) a histological diagnosis of myxoma was available and (5) the discharge status and follow-up data were available for at least 2 years after initial surgery. Results: A total of 27 patients fulfilled the criteria for inclusion in the study. The average age was 42 years. Thirteen of the patients were females and 14 patients were males. The most common clinical presentations were dyspnea (29.6%) and murmurs (22.2%). Non-specific signs, such as weight loss, fever, fatigue, arthralgia and anemia, were reported in 10 (37%) patients. Signs related to systemic embolization were reported in 9 (33.3%) of the patients, involving the upper and lower extremities (55.6%), brain ischemia and vision loss (54.4%). Tumors in all patients were successfully resected under cardiopulmonary bypass support. The tumor was pedunculated in 17 (62.9%) of the patients and the size of the tumors varied from 1 to 7 centimeters in diameter. The tumor was located in the left atrium in 21 patients (77.7%), in the right atrium in 4 patients (14.8%), in the right ventricular side of the septum in 1 patient (3.7%) and involving the tricuspid valve in 1 patient (3.7%). The left atrial approach was used in 3 patients, a right atrial approach in 4 patients and a bi-atrial approach in 20 patients. The most common concomitant cardiac pathology was coronary artery disease in 3 patients and an atrial septal defect in one patient. The most common intra-operative challenges were inter-atrial communication (2 patients), large defect in the tricuspid valve leaflet (1 patient) and involvement of the inter-ventricular septum (1 patient). In the post-operative period, 1 patient suffered a stroke. In the post-operative period, the most common complications were stroke (1 patient) and recurrence of the tumor (2 patients). Conclusion: The success rate after surgical removal of cardiac myxoma in this study was substantial and complications were rare.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement

Purpose To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Methods Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. Results During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). Conclusion This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Incidence, characteristics, and survival trend of cardiopulmonary resuscitation following in-hospital compared to out-of-hospital cardiac arrest in Northern Jordan

Background: Cardiac arrest remains a leading cause of mortality worldwide. Early cardiopulmonary resuscitation (CPR) is the cornerstone intervention to optimize the survival rates. Objectives: The main aim of this study was to determine and compare the incidence, characteristics, risk factors, and outcomes of CPR in a referral university hospital following in-hospital cardiac arrests (IHCAs) and out-of-hospital cardiac arrest (OHCA) in Northern Jordan. Patients and Methods: Retrospective observational study of adults referred to King Abdulla University Hospital who received CPR between January 2014 and January 2015. Data were obtained from the medical recorded of included patients. The primary outcome was survival to hospital discharge. Chi-square and logistic regression analyses were performed to identify risk factors associated with survival to discharge. Results: A total of 79 OHCA and 257 IHCA were included in the study. The overall survival rate for OHCA was 2.97%. The survival rate increased to 4.3% if CPR performed before arriving the hospital. Only 22% of the OHCA cases had CPR performed mainly due to lack of knowledge and skills of bystanders. The survival rate for IHCA was 14.88%. In this study, patient survival was not associated with age, smoking habit, diabetes mellitus, cancer status, hypertension, or heart failure. Conclusion: This is the first study to describe the incidence and outcome of adult IHCA and OHCA in Jordan. The findings will serve as a benchmark to evaluate future impact of changes in service delivery, organization, and treatment for OHCA and IHCA. Furthermore, findings will urge the regulatory bodies to establish well-structured Emergency Medical Service system. Educational programs at the national level to improve public awareness of CPR intervention are crucial to improve survival rates.

Lack of strong association of Chlamydia pneumoniae and atherosclerosis in a Jordanian population

INTRODUCTION The correlation of Chlamydia pneumoniae to coronary artery disease (CAD) in Jordan was investigated in this study. METHODOLOGY Totals of 361 atherosclerotic patients and 392 apparently healthy controls of both sexes were enrolled. C. pneumoniae-specific IgG antibodies were measured by the microimmunofluorescence assay (MIF). The presence of the bacterial DNA in the blood by polymerase chain reaction (PCR) was also tested. RESULTS The overall IgG seroprevalence, estimated at a titer of 1/16, was insignificantly higher in patients (75.9%) than in controls (71.7%). About 59.3% of patients demonstrated seropositivity at titers ≤ 1/256, which are suggestive of chronic or presumed past infection, whereas 54.1% of controls were seropositive at these titers (p > 0.05). Analysis of gender-specific seroprevalences revealed no obvious relation between C. pneumoniae and atherosclerosis in males (78.9% and 77.9% in atherosclerotic and control males, respectively; p > 0.05). However, a significantly elevated seropositivity was detected in atherosclerotic females (71.7%) compared with control females (64.2%). On the other hand, the PCR-based detection of C. pneumoniae DNA failed to correlate the bacterium to atherosclerosis. CONCLUSIONS We were unable to show a strong association between C. pneumoniae and CAD, potentially because of the presence of high seroprevalence of C. pneumoniae antibodies and the unreliability of the whole blood-based nested PCR technique used.

Effects of Sidr honey on second-intention healing of contaminated full-thickness skin wounds in healthy dogs

Abstract The therapeutic effects of Sidr honey on second-intention healing of contaminated full-thickness skin wounds in dogs were investigated. Povidone-iodine was used as a standard treatment and served as a control. Healthy adult (two-to-four-year-old) mongrels, comprising six dogs and two bitches, were divided into four equal groups in order to obtain multi-aged wounds at the end of the study. Four 2cm × 2cm full-thickness skin wounds were created on both sides of the back area of each dog under general anaesthesia adhering to aseptic technique. Contaminated wounds were then divided into two treatment groups: Group 1, Sidr honey treated (right side wounds) and group 2, povidone-iodine treated (left side wounds). All wounds were evaluated grossly daily at the time of treatment application and digitally photographed once every week. Images were analysed using ImageJ software. The parameters of unhealed wound area and length of advancing epithelium were obtained. The epithelialisation areas, percentage of wound area, and wound contraction rate were then calculated. No significant differences were found between the two treatment groups in any of the parameters studied. Overall, both honey treated and iodine treated wounds healed well within the time period of the study (28 d). However, the study showed a beneficial effect of Sidr honey on second-intention healing of full thickness contaminated wounds in healthy dogs and the effect was comparable to that of Povidone iodine.

Spontaneous left atrial intramural hematoma associated with large hemorrhagic pericardial effusion

Atrial intramural hematoma is a rare entity. It was reported to occur spontaneously especially in patients with recent history of cardiac surgery or cardiac trauma. In this report, a case of spontaneous intramural hematoma associated with large bloody stained pericardial effusion presented with progressive shortness of breath as the primary clinical manifestation is described. The diagnosis was tentatively achieved by transesophageal echocardiography and cardiac computed tomography scan and was later confirmed during surgery. The patient recovered uneventfully following surgery and follow-up echocardiography demonstrated complete resolution of pre-existing hematoma. <Learning objective: We present a case of spontaneous intramural atrial hematoma and cardiac tamponade in a 61-year-old patient with a history of progressive shortness of breath. The proper diagnosis and surgical intervention are described. This case description will help increase the awareness regarding the diagnosis of this rare cardiac condition.>.

Aortopulmonary ectopic parathyroid gland and concurrent thymolipoma

Ectopic parathyroid adenomas are considered the main cause of primary hyperparathyroidism. However, concurrent parathyroid and thymic pathologies are rarely diagnosed in the same patient. A 47-year-old man with history of diabetes mellitus, hypertension, and myasthenia gravis presented with persistent hypercalcemia. Laboratory investigations, computed tomography, and technetium-99 m sestamibi scintigraphy revealed ectopic parathyroid glands, a mediastinal mass, and an enlarged thymus. The patient underwent thymectomy and mass excision via a median sternotomy. Histopathology was consistent with ectopic parathyroid adenoma and thymolipoma. The serum calcium and parathormone concentrations normalized within 48 hours after surgery.

FREQUENCY OF BLOOD GROUPS AMONGA SAMPLE OF PATIENTSWITH RENAL FAILURE AT ROYAL MEDICAL SERVICES

Introduction: Renal failure underlies various etiologies among which are infectious and autoimmune origins which may link directly or indirectly with blood groups. Objectives: To determine the frequency of blood groups among a sample of patients with renal failure at Royal medical services, and to investigate the association of renal function tests with blood groups. Methodology: A retrospective study design was followed to collect data from files of patients with renal failure. Files of renal patients was included if blood groups were written and kidney function tests were provided. A data sheet was made for each patient that included relevant information about renal patients. A total of 197 files were reviewed. Data were entered into excel sheet to make raw data for all patients. Data analysis was conducted using SPSS V20. Data were presented as frequencies and percentages. The relationships between blood groups and renal function tests were investigated using T-independent test. Significance was considered at alpha level 0.05), except for potassium level which was observed in its maximal level among patients with blood group A, and its minimal levels were observed among patients with blood group AB (p=0.032). Conclusions: The present study showed that renal failure patients exhibited more frequency with blood groups A and O and agreed with other studies in which blood group AB is the least associated blood group with renal failure. The level of potassium was highest in patients with blood group A and lowest in patients with blood group AB and this was statistically significant (p=0.032).

Anesthetic Management of Simultaneous Coronary Artery bypass Grafting with Cardiopulmonary bypass and Extended Thymectomy in a Patient with Myasthenia Gravis

A 61-yr-old male having myasthenia gravis MG (Osserman IIB), Hypertension HTN, hyperlipidemia, type II diabetes mellitus DM II, a single pelvic kidney, chronic obstructive pulmonary disease COPD with a positive history of smoking and coronary artery disease, was admitted for uncontrolled myasthenic symptoms, cardiology team was consulted, cardiac catheterization was performed and revealed a three vessel coronary artery disease. All the findings dictated the management, a combined coronary artery bypass graft CABG and an extended thymectomy was performed. Optimization of the patient was achieved preoperatively. Total intravenous anesthesia using propofol and remifentanyl was applied to this patient. Continuous monitoring of the neuromuscular transmission NMT was maintained throughout the perioperative period. Although neither muscle relaxants nor inhalational agents were used in the anesthetic management of this patient; the patient developed postoperative atelectasis and lung collapse; which was managed successfully, and extubation of the trachea was done after ensuring adequate recovery of the NMT and respiratory function. Myasthenic therapy was continued throughout the perioperative period.