Musa A. Alshehabat

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.

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.

Review of animal models used to study effects of bee products on wound healing: findings and applications

Abstract Non-healing wounds are associated with high morbidity and might greatly impact a patient’s well-being and economic status. For many years, scientific research has focused on developing and testing several natural and synthetic materials that enhance the rate of wound healing or eliminate healing complications. Honey has been used for thousands of years as a traditional remedy for many ailments. Recently, honey has reemerged as a promising wound care product especially for infected wounds and for wounds in diabetic patients. In addition to its proposed potent broad-spectrum antibacterial properties, honey has been claimed to promote wound healing by reducing wound hyperaemia, oedema, and exudate, and by stimulating angiogenesis, granulation tissue formation and epithelialisation. Several animal models, including large animals, dogs and cats, and different species of laboratory animals have been used to investigate the efficacy and safety of various natural and synthetic agents for wound healing enhancement. Interpreting the results obtained by these studies is, however, rather difficult and usually hampered by many limiting factors including great variation in types and origins of honey, the type of animal species used as models, the type of wounds, the number of animals, the number and type of controls, and variation in treatment protocols. In this article, we provide a comprehensive review of the most recent findings and applications of published experimental and clinical trials using honey as an agent for wound healing enhancement in different animal models.

Zoonotic Anaplasma phagocytophilum, Ehrlichia canis, Dirofilaria immitis, Borrelia burgdorferi, and spotted fever group rickettsiae (SFGR) in different types of dogs

Dogs can carry and share zoonotic pathogens with humans. This problem is understudied in different parts of the world, including Jordan. This study determined the prevalence of Anaplasma phagocytophilum, Ehrlichia canis, Dirofilaria immitis, and Borrelia burgdorferi using the SNAP 4Dx Plus test and spotted fever group rickettsiae (SFGR) using enzyme immunoassay IgG test in different types of dogs (farm/breeding, police, and stray) in Jordan. The results showed a very high seroprevalence (87%) of SFGR in dogs all over Jordan. Specifically, the seroprevalence was 97.0, 90.5 and 71.2% in farm, stray, and police dogs, respectively. Overall, 9.9% of dogs were seropositive for A. phagocytophilum. Specifically, 14.9% of farm, 14.3% of stray, and 0% of police dogs were seropositive. None of the studied dogs had D. immitis, E. canis, or B. burgdorferi. It can be concluded that SFGR and A. phagocytophilum are endemic in Jordan. This study suggests that controlling stray dogs and monitoring dog breeding farms should be considered as control measures to limit the transmission of SFGR and A. phagocytophilum and to limit their public health impact in Jordan. Moreover, further follow-up studies are needed to study these pathogens in the human population in Jordan.

Selected metabolic biochemical and enzyme activities associated with Besnoitia besnoiti infection in dairy cattle

The main aim of the study was to explore, compare, and identify whether there is an association between Besnoitia besnoiti seropositivity in apparently healthy dairy cows with some biochemical parameters, enzyme activities, and beta-hydroxybutyrate (BHBA). A total of 98 dairy cows were included in the study, of which there was 50 seropositive and 48 seronegative cows. Analysis of serum antibodies against B. besnoiti antibodies was performed using an indirect enzyme-linked immunosorbent assay kit. Student’s independent t test showed that there was a significant difference in BHBA, albumin, and lactate dehydrogenase (LDH) between the seropositive and seronegative groups. Univariable regression analysis showed no significant association between seropositivity status with any of the evaluated parameters except BHBA level, mastitis, and abomasum displacement. Multivariable logistic regression analysis showed that there was a strong association between seropositivity with BHBA level. The significant association between BHBA and B. besnoiti seropositivity represents preliminary finding that needs further exploration.