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Majid Bani-Ata,1 Abdelwahab Aleshawi,2 Maulla Alali,1 Yazan Kanaan,1 Wala Al-Momani,1 Nadia Kanaan,2 Khalid Abdalla,3 Ala’’a Alhowary4 1Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Intern, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan; 3Radiology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 4Anesthesia Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, JordanCorrespondence: Majid Bani-AtaDepartment of Special Surgery, Jordan University of Science and Technology, P.O. Box: 3030, Irbid 22110, JordanEmail majidbaniata@yahoo.comBackground: Tonsillectomy is one of the most commonly performed procedures among children and it is the gold standard management to reduce episodes of tonsillitis and obstructive symptoms. Many studies showed a significantly higher incidence of previous tonsillectomy in the parents and siblings. This study investigated the influence of familial and environmental trends in tonsillectomy.Methods: Retrospectively, we identified those patients who underwent tonsillectomy (the case group). Also, a control group of participants attending the hospital as visitors who had not undergone tonsillectomy was collected. Both groups are compared using the proper statistical tests.Results: This study included 1,232 participants; 615 underwent tonsillectomy (cases) and 617 did not (controls). It was found that paternal and maternal history of tonsillectomy, childhood asthma, and daycare attendance are independent factors influencing tonsillectomy in the offspring. Of about 85.4% of fathers who underwent tonsillectomy their children will also have tonsillectomy. Also, regarding the maternal history, 72.5% of offspring will have tonsillectomy if the mothers underwent the procedure.Conclusion: This study reveals that genetic predisposition factors may have a role for tonsillectomy and its underlying causative indications. Also, it highlights the importance of asthma control in children. Moreover, the role of ethnicity may be minimal due to the similar trend of this study with other studies. Further studies and prospective research are recommended.Keywords: tonsillectomy, tonsillitis, family history, asthma

Background: Serum vitamin B12 plays a crucial role in cellular growth, DNA synthesis, and maintaining a healthy nervous system. Its deficiency can lead to various health issues, including cardiovascular problems. The reference range for vitamin B12 varies between populations due to cultural, genetic, and dietary differences. Methods: A cross-sectional study was conducted on 127 healthy An-Najah National University students aged between 18 and 25. Blood samples were collected, and a questionnaire assessed factors affecting vitamin B12 levels. Serum vitamin B12 levels were measured using ACCUBIND ELIZA microwells. Results: The study found a reference range for serum vitamin B12 of 136–640 pg/mL (5th to 95th percentile) among the studied population, which differed from the manufacturer’s claimed range of 200–835 pg/mL. Gender did not significantly affect the reference intervals. Conclusion: The study highlights the importance of establishing local reference values for laboratory tests like vitamin B12 due to variations in demographics. Further research in different Palestinian regions and age groups with larger sample sizes is recommended to refine these reference values.

ISSR marker system was quite informative for assessing the extent of genetic diversity as well as pattern of genetic relationships within the selected plants of Jojoba clones. The second main cluster was divided into two sub-clusters; one sub-cluster contains 10 Jojoba clones (4, 6, 8, 12, 9, 14, male, 13, 1 and 11), while the other sub-cluster contain three Jojoba clones (2, 7 and 3). ISSR polymorphism among different Jojoba clones Jojoba is a potential oilseed crop; however, it still needs to be developed commercially and agronomically. [Extracted from the article]

Background: Atrioventricular conduction abnormalities after transcatheter aortic valve implantation (TAVI) are common. The value of electrophysiological study (EPS) for risk stratification of high-grade atrioventricular block (HG-AVB) and guidance of permanent pacemaker (PPM) implantation is poorly defined. Objective: The purpose of this study was to identify EPS parameters associated with HG-AVB and determine the value of EPS-guided PPM implantation after TAVI. Methods: We performed a systematic review and meta-analysis of studies investigating the value of EPS parameters for risk stratification of TAVI-related HG-AVB and for guidance of PPM implantation among patients with equivocal PPM indications after TAVI. Results: Eighteen studies (1230 patients) were eligible. In 7 studies, EPS was performed only after TAVI, whereas in 11 studies EPS was performed both before and after TAVI. Overall PPM implantation rate for HG-AVB was 16%. AV conduction intervals prolonged after TAVI, with the AH and HV intervals showing the largest magnitude of changes. Pre-TAVI HV >70 ms and the absolute value of the post-TAVI HV interval were associated with subsequent HG-AVB and PPM implantation with odds ratios of 2.53 (95% confidence interval [CI] 1.11–5.81; P = .04) and 1.10 (95% CI 1.03–1.17; P = .02; per 1-ms increase), respectively. In 10 studies, PPM was also implanted due to abnormal EPS findings in patients with equivocal PPM indications post-TAVI (typically new left bundle branch block or transient HG-AVB). Among them, the rate of long-term PPM dependency was 57%. Conclusion: Selective EPS testing may assist in the risk stratification of post-TAVI HG-AVB and in the guidance of PPM implantation, especially in patients with equivocal PPM indications post-TAVI.

Introduction: Secondary lesions in the breast from extramammary malignancies are rarely encountered in medical practice. Medical imaging of the breast (mammography and ultrasonography) may not differentiate between a primary breast mass and a secondary tumor from an extramammary malignancy.Case description: A 90-year-old woman with a history of thyroid cancer, skin metastasis, thyroidectomy, and radiotherapy 12 years prior presented with pain in the left breast and no palpable masses in either breast or axilla. Mammography and ultrasonography of the breast confirmed a suspicious lesion in the upper outer quadrant of the left breast. Histopathology of the core biopsy, including immune histochemistry staining of the lesion, confirmed secondary follicular carcinoma of the thyroid.Conclusion: Thyroid cancer is a rare extramammary malignancy that may metastasize to the breast; however, it may rarely occur a few years after thyroidectomy and radiotherapy.

Hypomagnesemia is one of the electrolyte disturbances that can cause seizures. It is common in the hospitalized patients and can be induced by long-term usage of many medications. A 68-year-old male known to have hypertension and gastroesophageal reflux presented to the Emergency Department with an unprovoked first seizure at home followed by a temporary right-sided hemiparesis, dysphasia, and facial asymmetry. The hemiparesis, dysphasia, and facial asymmetry resolved within less than an hour after the seizure. His serum potassium was low with prolonged QT interval in the electrocardiogram (serum magnesium was not checked in the Emergency Department). He received intravenous IV potassium chloride infusion, and his serum potassium level was corrected, but he had a recurrent seizure after 10 h. At that time, his serum magnesium was found to be very low, he received IV magnesium sulfate infusion, and his indapamide, omeprazole, and metformin medications were stopped. He had no further seizures, the rest of his blood tests were normal, and his CT brain was unremarkable. He was treated for aspiration pneumonia, and his outpatient MRI brain and EEG came to be normal too.

Khalid M Abdalla,1 Mostafa A Abdelrahman,2 Abdelwahab J Aleshawi,3 Alaha S Al Taweel,1 Majid Bani-Ata,4 Khaled Obeidat5 1Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan; 3Department of Special Surgery, Ophthalmology Division, Jordan University of Science and Technology, Irbid 22110, Jordan; 4Department of Special Surgery, Otolaryngology Division, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 5Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, JordanCorrespondence: Khalid M AbdallaDepartment of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid 22110, JordanTel +962 799273019Fax +962 2 7201064Email khalidmohabdalla@yahoo.comObjective: Developmental dysplasia of the hip (DDH) is an abnormal relationship between the acetabulum and the head of the femur. Plain x-ray of both hips at the age of 3 months is still in use in some countries. On plain films, classic lines and angles are evaluated to meet current guidelines for positive DDH. Among these is the acetabular angle (AA), which most did not exceed 30° in normal pelvis regardless of gender. A flat promontory gives the impression of a high AA angle, whereas a sharp promontory gives the impression of a low AA angle.Materials and Methods: All anteroposterior (AP) pelvic digital x-ray studies performed to rule out DDH were collected from the PACS systems. A novel angle was measured between a line parallel to the lateral aspect of the region of the inferior iliac spines and a line that extends along the acetabular roof to quantify the roundness of the iliac promontory. We called the former line the Miral line and the formed angle the iliac promontory angle.Results: We show that the promontory shape is significantly different between genders, and therefore it is mistaken to generalize an upper AA limit for males and females. In addition, we show that the current guideline of the upper limit of AA did not predict the incidence of DDH.Conclusion: We suggest that the current practice is introducing a high rate of false positive, especially among females, and the current guidelines on AA should be reviewed and assigned separately for males and females. This is more important for countries that did not utilize the ultrasonographic assessment for DDH.Keywords: acetabular angle, DDH, plain x-ray, head of the femur

Patients with COVID-19 infection may present to the Emergency Department (ED) with gastrointestinal complaints and no respiratory symptoms. We are presenting 3 patients who came to the ED with abdominal pain; and the computed tomography [CT] of the abdomen showed findings suggestive of COVID-19 pneumonia.A 65-year-old male patient presented with symptoms of urinary tract infection and left renal angle tenderness. A 42-year-old male patient presented with right flank pain postextracorporeal shock wave lithotripsy. A 71-year-old male known to have type 2 diabetes mellitus and who had had whipple surgery for a neoplasm of the head of the pancreas presented with a painful epigasteric swelling. The 3 patients had positive COVID-19 polymerase chain reaction (PCR) tests and mild-to-moderate illness, and were discharged home after 2 weeks with a good recovery. The first patient had a false negative early PCR test, which turned positive on 2 repetitions of the test.A systematic review of CT abdomen, including inspection of the lung bases using the lung window in all CT abdomen, is essential to detect findings suggestive of COVID-19 pneumonia in patients requiring a CT abdomen study. As proven in the literature, CT findings of COVID-19 pneumonia have a higher sensitivity than the PCR test.

Abstract Background The established role miRNA-mRNA regulation of gene expression has in oncogenesis highlights the importance of integrating miRNA with downstream mRNA targets. These findings call for investigations aimed at identifying disease-associated miRNA-mRNA pairs. Hierarchical integrative models (HIM) offer the opportunity to uncover the relationships between disease and the levels of different molecules measured in multiple omic studies. Methods The HIM model we formulated for analysis of mRNA-seq and miRNA-seq data can be specified with two levels: (1) a mechanistic submodel relating mRNAs to miRNAs, and (2) a clinical submodel relating disease status to mRNA and miRNA, while accounting for the mechanistic relationships in the first level. Results mRNA-seq and miRNA-seq data were acquired by analysis of tumor and normal liver tissues from 30 patients with hepatocellular carcinoma (HCC). We analyzed the data using HIM and identified 157 significant miRNA-mRNA pairs in HCC. The majority of these molecules have already been independently identified as being either diagnostic, prognostic, or therapeutic biomarker candidates for HCC. These pairs appear to be involved in processes contributing to the pathogenesis of HCC involving inflammation, regulation of cell cycle, apoptosis, and metabolism. For further evaluation of our method, we analyzed miRNA-seq and mRNA-seq data from TCGA network. While some of the miRNA-mRNA pairs we identified by analyzing both our and TCGA data are previously reported in the literature and overlap in regulation and function, new pairs have been identified that may contribute to the discovery of novel targets. Conclusion The results strongly support the hypothesis that miRNAs are important regulators of mRNAs in HCC. Furthermore, these results emphasize the biological relevance of studying miRNA-mRNA pairs.

The management of agroecosystems plays a crucial role in the global carbon cycle with soil tillage leading to known organic carbon redistributions within soils and changes in soil CO2 emissions. Yet, discrepancies exist on the impact of tillage on soil CO2 emissions and on the main soil and environmental controls. A meta-analysis was conducted using 46 peer-reviewed publications totaling 174 paired observations comparing CO2 emissions over entire seasons or years from tilled and untilled soils across different climates, crop types and soil conditions with the objective of quantifying tillage impact on CO2 emissions and assessing the main controls. On average, tilled soils emitted 21% more CO2 than untilled soils, which corresponded to a significant difference at P < 0.05. The difference increased to 29% in sandy soils from arid climates with low soil organic carbon content (SOCC < 1%) and low soil moisture, but tillage had no impact on CO2 fluxes in clayey soils with high background SOCC (> 3%). Finally, nitrogen fertilization and crop residue management had little effect on the CO2 responses of soils to no-tillage. These results suggest no-tillage is an effective mitigation measure of carbon dioxide losses from dry land soils. They emphasize the importance of including information on soil factors such as texture, aggregate stability and organic carbon content in global models of the carbon cycle. [ABSTRACT FROM AUTHOR]

This study aims at detecting the degree to which the science and life textbook for fifth grade in Palestine included the next generation of science standards (NGSS) and Bloom’s taxonomy levels. The study used a content analysis card designed according to NGSS. The tool's reliability and validity were confirmed. The study adopted a descriptive analytical method. The results showed that the field of disciplinary core ideas came first, with a remarkably high percentage of (68.4%), while the field of crosscutting concepts came next, with a low percentage of (16.7%). The field of science and engineering practices ranked third, with a low percentage of (14.9%). They also demonstrated that there is a marked disparity when applying the levels of Bloom’s taxonomy through which the next generation of science standards (NGSS) appeared. More accurately, the lower level of cognitive skills (remembering and understanding) hit a high percentage of (90.3%), compared to the higher-level cognitive skills (applying, analyzing, creating, and evaluating) which came low with a percentage of (9.7%).

This study aims at revealing the impact of teaching according to Posner’s strategy in modifying of some concepts in chemistry for 10th grade female students. The quasi-experimental design was chosen to achieve the purposes of the study. The sample consisted of (30) female students as an experimental group which was taught using Posner's strategy, and (30) female students as a control group which was taught using traditional method. The test was consisted of (20) items of Two-Tier Multiple Choice questions, and it was applied before and after to both groups. After data collection, SPSS for statistical analysis was used. The results showed that the students had misconceptions in chemistry. Also the results revealed the presence of statistically significant differences between the mean scores of the two groups, in favor of the experimental group which was taught using to Posner’s strategy. This confirms the effectiveness of Posner’s strategy in modifying chemistry misconceptions. In light of the results, it was recommended to use Posner’s strategy in teaching, and training teachers on it.

Introduction: Co-infection with COVID-19 and other viral or bacterial infections has been described in many studies. Most cases of dengue fever in Saudi Arabia have been reported in Jeddah city and mainly during the summer season. Method and results: We describe four patients who presented to the emergency department with febrile illness accompanied by symptoms and blood tests suggestive of dengue fever. They also had radiological findings suggestive of COVID-19 chest infection and positive PCR tests. Three of the patients required hospital admission, and all had a good outcome. Conclusion: In areas with a high rate of dengue fever, serological screening for dengue fever should be considered as part of COVID-19 investigation, especially if symptoms or a full blood count are suggestive.

Emphysematous Pyelonephritis is a rare necrotizing infection with gas production and a high overall mortality rate.An elderly diabetic male patient presented to our Emergency Department with septic shock and was found to have left perinephric emphysematous pyelonephritis with a large collection. He was managed with the proper antibiotic therapy, and two trials of percutaneous drainage of the collection with no significant reduction in the size of the abscess. After operative drainage and debridement of multiple pockets, he improved and was discharged home. Extender spectrum beta-lactamase producing organism was an additional challenge in our patient's management.

Introduction: Missing a leaking abdominal aortic aneurysm (AAA) is common in medical practice because few at-risk patients have a history of AAA and many have an unusual presentation. Background: AAA is less common among Asians than white Caucasians of the same age. Our patient had no significant risk factors apart from age and sex and had an unusual presentation. Patient and Methods: A 67-year-old Asian man presented to the emergency room (ER) with a 1-day history of nausea, vomiting, diarrhoea, fever and abdominal pain. He was febrile, dehydrated. and had marked tenderness at the right iliac fossa. Laboratory findings suggested bacterial gastroenteritis but this did not explain the localized tenderness at the right iliac fossa. Result and Discussion: A CT scan of the abdomen revealed an AAA arising above the origins of the renal arteries, an intramural thrombus, a retroperitoneal haematoma and a leak extending to the right iliac fossa. The patient was transferred to another hospital and underwent exploratory laparotomy, surgical repair of the aneurysm, and aortobi-iliac grafting with removal of the thrombus. The patient was discharged in good shape 3 weeks after surgery. Without the CT scan of the abdomen, the AAA could have been missed and the patient treated for severe gastroenteritis.

Postoperative septic complications of hemorrhoids surgical interventions are rare, but very serious with high mortality rate. Early diagnosis and prompt therapy are essential to save patient’s life. There are a good number of articles and case reports about these septic complications. We are presenting a case report of a prostatic abscess caused by extended spectrum beta lactamase (ESBL) producing Klebsiella pneumoniae after hemorrhoidopexy. Our patient was a healthy middle aged Saudi male who has no significant medical history apart from morbid obesity and recurrent urinary tract infections. ESBL producing K. pneumoniae could be detected only after aspiration of the prostatic abscess, but proper antibiotic was introduced intravenously on admission before culture of aspirate of the abscess was available. Antibiotic was continued for 30 days and abscess resolved completely. In our electronic search, we could not find any case report of prostatic abscess after stapled hemorrhoidopexy caused by ESBL producing organism. This is an additional challenge for treating physicians as these organisms are sensitive only to one group of antibiotics (carbapenem group).