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Background: Complications observed during pregnancy affect both mother and fetus, and are more commonly observed among pregnant women from developing countries. The study aims to identify the most common pregnancy and fetal complications during pregnancy, and associated risk factors with these complications. Methods: A longitudinal study was conducted from September 2017 to July 2018 among pregnant women attending and registering in primary health care clinics of the Palestinian Ministry of Health in Nablus city. Data were collected through interviews and by reviewing medical records. Women were followed up during their regular visits to the primary health care clinics. Any complication affecting either the fetus or the mother during the pregnancy period was recorded. Binary logistic regression was used to identify independent risk factors for pregnancy and fetal complications. Results: A total of 380 pregnant women were included in the study. The most common complications seen among women during pregnancy were preterm labor (PTL) (11.3%), followed by an equal number of gestational diabetes (GDM) and pregnancies induce hypertension (PIH), i.e. (7.9%). Large for gestational age (LGA) (11.6 %) and small for gestational age (SGA) (10.5%) were the most commonly observed fetal complications. Pregnant women living in camps (O.R 2.35, 95% [CI] 1.02- 5.45), nulliparity (O.R 14.9, 95% [CI] 1.09-202.5) and low parity women (O.R 16.8, 95% [CI] 1.47- 192.5) were at higher risk of having pregnancy complications. However, lower risk was noticed between women with gravida 4 (O.R 0.11, 95% [CI] 0.03-0.47) compared to women having more than 6 pregnancies. Age younger than 41 years was a protective factor against fetal complications, while parity (≤ 6 parities) especially 4 to 6 parities (OR 36.17; 95% CI 4.88-268) and active smoking mothers (OR 1.25; 95% CI 1.0-3.07) were identified as risk factors that are associated with an increased risk of fetal complications. Conclusions: Fetal and pregnancy-related complications are prevalent among Palestinian pregnant women. Increasing the awareness and improving the understanding of the identified risk factors related to these complications among the public, and specifically, females may help to reduce the prevalence of these conditions and the associated risk of these complications.

Respiratory viral infections are a significant cause of morbidity in asthma [1]. Patients with severe asthma were assumed to be at greater risk from novel coronavirus-2 (COVID-19) infection. In the global response to the COVID-19 pandemic, multiple countries enacted social containment policies. In the UK a countrywide lockdown occurred in March 2020, with stringent self-isolation (“shielding”) advice for high-risk patients, including people with severe asthma.

Introduction Severe asthma patients were assumed to be at greater risk of morbidity from infection with the novel severe acute respiratory syndrome coronavirus (COVID-19), hence, in the UK, were advised to shield. Community data on COVID-19 infection in severe asthmatics is lacking. We assessed the burden of shielding, the impact of COVID-19 and the effect of asthma medication on the UK severe asthma population. Methods Adults previously consented to inclusion in the UK Severe Asthma Registry (UKSAR) across 14 centres were contacted in June 2020 to collect data on potential COVID-19 infection, asthma control and shielding. Electronic records, where available, were reviewed for confirmation. Data was combined with clinical data from the UKSAR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for COVID-19 infection. Results 1365 patients were included. 1268 (93%) were advised to shield, 1131 (89%) patients who received shielding advice followed it. Men (OR 0.4, p=0.045) and those in non-shielding households (OR 0.27, p=0.001) were less likely to follow shielding advice. 544 (47%) of patients advised to shield reported worsening of mental health; females (OR 1.59, p=0.001) and those with history of anxiety or depression (OR 2.12 p=0.001) were at greater risk. 97 (7.1%) patients had suspected/confirmed COVID-19 infection, 19 (1.39%) PCR/serology confirmed infection, 13(0.95%) were hospitalised and 2 patients (0.15%) died (table 1). 918 (67%) were on biologic therapy, 515 (37%) maintenance oral corticosteroid (mOCS). Multivariate analysis showed neither biologic therapy (OR 0.73, p=0.165) nor mOCS (OR 1.18, p=0.427) increased the risk of COVID-19 infection. Patients on biologics were less likely to require an acute course of corticosteroids for asthma symptoms (OR 0.6, p=0.002) while patients on mOCS were more likely (OR 1.96 p≤0.001). Inhaled corticosteroids (ICS) were not associated with COVID-19 infection, including high dose (2000 mcg BDP equivalent) (OR 0.64, p=0.234). Hospitalised patients were on lower median doses of ICS vs non-hospitalised patients (1000 vs 2000 mcg BDP equivalent, p=0.002). Conclusion Hospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.

Understanding the various effects that exist among intellectual capital, knowledge sharing, and organizational performance is the main purpose of this study. Data were gathered from 356 employees working in manufacturing companies in Jordan. In order to test the hypotheses of this study, the approach suggested by [1] was undertaken. The results of the analysis revealed that intellectual capital had a positive effect on organizational performance and knowledge sharing. The results also showed that knowledge sharing had a positive effect on organizational performance. Finally, it was found that knowledge sharing had a positive mediating effect on the relationship between intellectual capital and organizational performance. The findings of this study thus provide many benefits for researchers and practitioners despite the presence of some limitations.

Background Childhood obesity is rising in developed and developing countries, while childhood underweight is rising mainly in developing countries. Childhood underweight has been shown to increase a child’s risk of rapid weight gain. Overweight and obese children are more likely to become obese adults, which increases the risk of type-II diabetes and cardiovascular diseases. Studies concerning obesity among Palestinian children are scarce. The prevalence of obesity among Palestinian children has increased from 3 to 6% within 5 years in comparison to the worldwide rise from 1 to 7%, within 41 years. We aim to determine the current prevalence of underweight, overweight and obesity among Palestinian school-age children and to assess the role of dietary and sociodemographic factors. Methodology A cross sectional study was conducted in Palestine in 2017. A total of 1320 school-age children and their 2640 corresponding parents were recruited. A written questionnaire was filled out by the parents. Anthropometric indices were measured and categorized according to the Center for Disease Control and prevention (CDC). Results The mean ± SD age of the children was 9.5 ± 1.5 years and 48.8% were females. The prevalence of underweight, overweight and obesity among the children was approximately 7.3% (95% CI = 5.9–8.8%), 14.5% (95% CI = 12.7–16.6%) and 15.7% (95% CI = 13.8–17.8%) respectively. Multinomial logistic regression analysis demonstrated a significant correlation of waist circumference, age, gender and living place with the body mass indexes of the students. Conclusion Our findings highlighted the accelerated increase in the prevalence of underweight, overweight and obesity (37.5%) among Palestinian children within a very short time in comparison to the globe. Therefore, Interventions aiming to prevent obesity and underweight at an early stage might be vital to avoid obesity later in life and its health-related co-morbidities, e.g. type-II diabetes and cardiovascular diseases.

Background Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cyst (GHC) of the lung is a special clinical entity in children and is related to higher lung tissue elasticity. Aim To compare clinical and imaging features, types of surgical interventions, and postoperative complications in pulmonary GHC and non-giant pulmonary hydatid cysts (NGHC) in children. Methods A retrospective study was undertaken. The data analyzed were taken from medical records of children with pulmonary hydatid cyst (PHC) hospitalized in a pulmonary department in Tunisia between January 2004 and February 2019. Cysts were divided according to their size into GHC ( ≥10 cm) and NGHC ( Results In the study period, 108 PHC were recorded in 84 children. GHC accounted for 21 (19.4%) and NGHC for 87 (80.6%). The median of age of the children was 11 years (IQR 1–9, IQR 3–14) and the mean age was 11.6 years (10.5 in GHC vs. 11.4 years in NGHC). Hemoptysis was found in 25% of the GHC group vs. 48.4% of the NGHC group (P = 0.27). Cysts were multiple in 23.8% of cases and predominated in the right in 64.3% of cases and in the inferior lobes in 71.4% of the cases. GHCs were less frequently complicated (60% vs. 78.1% in NGHC, P ≤ 0.11), although not significantly. Parenchymal resection was realized in 50% of GHC vs. 18.8% of NGHC (P = 0.006). No significant difference was found in postoperative complications between the two groups and there was no recurrence in either group. Conclusion GHC is a special clinical entity in children. It requires major surgery with parenchymal resection, and therefore early diagnostic and therapeutic management is warranted.

Introduction The elderly, with chronic obstructive pulmonary disease (COPD), are at a higher risk of hospitalisation due to acute exacerbation of COPD (AECOPD). They also often encounter multiple co-morbidities. Objectives This study was aimed to explore the occurrence of anxiety, depression and to identify the factors associated with hospital readmission among older patients after AECOPD discharge. Methods A multicentre prospective study was conducted in Malaysia (from 1st September 2012 till 31st September 2013) among older patients (≥60 years) hospitalised for AECOPD. Anxiety and depression were assessed on discharge using previously validated questionnaires, Generalized Anxiety Disorder-7 (GAD-7 and Geriatric Depression Scale (GDS-15), respectively. Patients were followed up for a period of 3 months after discharge. Results A total of 81 patients with a median age of 72 years (IQR 66.40-78.00) were recruited. Anxiety was observed in 34.57% while 38.27% had depression. Both anxiety and depression were detected in 25.93% of the patients. A history of frequent AECOPD admissions was found to be associated with developing depressive symptoms, while anxiety scores were associated with severe dyspnoea. Severe depression was more commonly identified among patients aged 60-75 and in those with a history of tuberculosis. A high readmission rate (40.74%) during the 3-month period was noticed. History of frequent AECOPD admissions (OR = 2.87; 95% CI 1.05-7.85, P = 0.040) and ischemic heart disease (IHD) (OR = 4.04; 95% CI 1.1-14.6, P = 0.032) were identified as the factors associated with the risk of hospital readmission. Conclusions Anxiety and depression were found to be relatively common among older patients with AECOPD. IHD and history of frequent COPD hospitalisation were associated with short-term readmission among the elderly.

The purpose of this study is to examine the different factors that are expected to influence the intention of hospitals to adopt cloud computing in Jordan. This study is conducted using quatititative methodology. 223 questionnaires were distributed to the IT departments of different hospitals to evaluate their ability and willingness to adopt cloud computing. The data were tested using multiple regression in order to determine whether Technology, Organizational, and Environmental factors (TOE) played a role in hospitals’ decision to consider cloud computing as a beneficial investment. The findings of this study showed that all the factors had a significant positive impact on the intention of hospitals to adopt cloud computing, with the Technological factor having the most impact on the decision made.

Existing research tackling the influence of pharmaceutical trade-name types upon physician prescription behavior is rather minimal. The aim of this study was to investigate physicians’ perception of pharmaceutical trade (brand) names in Jordan’s private sector using two approaches—a real-world setting approach, and another simulated approach. For the real-world setting approach, 13 trade-name types were used to test physician perception versus their prescription predictors (clarified benefits, conveyed efficacy, enhanced memorability, and reduced confusion), then linked to physician perception in terms of prescription behavior, as measured by increased prescription preference for each of the trade-name types. Regarding the simulated approach, a sample of 100 pharmaceutical product trade names was utilized to demonstrate the relationship between their unit-wise sales and the type of trade name to which they belong. Results for the real-world setting approach revealed that physicians had a favorable perception of names that are derived from the site of action, those that are experiential, and functional names. A neutral perception was demonstrated for name types with a hint of competitive advantage, as well as short names. An unfavorable perception was observed for evocative names, geographical location-derived names, fricative names, manufacturer-derived names, and poetic and plosive names. As for the simulated approach, unit-wise sales were highest for functional as well as evocative trade-name types. The pharmaceutical trade-name types that are most favorable are those that reflect the drug’s site of action, experiences delivered, and function. It was recommended that pharmaceutical companies choose more appropriate trade names for their products based on physicians’ preference.

Background: Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cysts (GHC) of the lung are a special clinical entity in children and are related to higher lung tissue elasticity. Aim: To compare the characteristics on presentation, location of the cyst, type of the intervention, postoperative complications and long-term results in GHC and non-giant pulmonary hydatid cysts (NGHC) in children. Methods: A retrospective study was undertaken. The data analyzed were taken from medical records of pulmonary hydatid cyst (PHC) children hospitalized in a Pulmonary Department between 2004 and 2016. Cysts were divided according to their size into GHC (>10cm) and NGHC (≤10cm). Results: In the period of study, 94 PHC were recorded in 74 children. GHC accounted for 13 (13.8%) and NGHC for 81 (86.2%). Mean age of children was 11.21 years (9.5 in GHC vs 11.5 years in NGHC). Hemoptysis was founded in 25% of children with GHC vs 45.2% in those with NGHC (p=0.19). Cysts were unique in 61.7% of cases and predominated at right in 59.1% and in inferior lobes in 70% of cases. GHC were significantly less frequently complicated (46.2% vs 76.6% in NGHC, p≤0.05). Parenchymal resection was realized in 61.5% of GHC vs 14.8% of NGHC. No significant difference in post-operative complications was found between the two groups. Sequels were found in 58.3% of GHC vs 45.2% of NGHC (p>0.05). Any child had recurrent cyst. Conclusions: GHC is a frequent clinical entity in children because of lower frequency of complications (hemoptysis and rupture) and thus delayed diagnosis. They are associated with more frequent sequels, require major surgery with parenchymal resection and therefore require early diagnostic and therapeutic management.

Background: One of the most common medications, that their ordering is associated with many medication errors, is PRN medications. In order to explore the types of medication errors that are associated with ordering PRN medications, and to test the correlation between these medication errors with many factors, we conducted this study. Methods: A comparative cross-sectional study design was used, all medical records for critically ill patients were screened for PRN medications orders. All medication errors that occurred in the ordering stage of the medication process were documented. The study was conducted in March 2015. Results: 114 patients were found on PRN medication order. Among those patients, 130 PRN orders were detected; 116 orders had medication errors and 14 orders did not. The number of medication errors was 216. The percentage of PRN ordering errors at the different intensive care units was: 14.8% in the Medical ICU, 13.9% in the Surgical ICU, 21.3% in the Trauma ICU, 9.3% in the ICU for chronic patients, 39.8% in the Cardiac ICU and 0.9% in Maternity ICU. There was significant difference in the percentage of PRN ordering medication errors between different ICU sections (Cardiac ICU, Medical, Surgical, Trauma, and Chronic), P value was 0.03. We also found statistical significant difference when we compared the percentage of PRN ordering medication errors in all ICUs (total percentage) except Cardiac ICU and percentage of PRN ordering medication errors in Cardiac ICU (p value was 0.03) The most common PRN ordering error was not writing the indication; 106 errors of total 216 errors (49%). The most common PRN medication was acetaminophen; 39.2% of PRN orders (51 of 130 orders).

Background: Health-care professionals across the globe are obligated to report adverse drug reactions (ADRs). The knowledge of ADRs and attitude of health-care professionals toward ADRs reporting is vital for patient safety. This study intends to investigate the knowledge of ADRs and attitude of health-care professionals toward ADRs reporting. Materials and Methods: A cross-sectional study using an anonymous questionnaire was conducted over a period of 3 months (September 2016 to November 2016) at King Saud Medical City, Riyadh, Saudi Arabia. This study included 399 questionnaires submitted by health-care professionals. Results: A total of 399 questionnaires were submitted by health-care professionals, of which only 14.8% knew the term “ADR” and 55.1% of the respondents reported ADRs during their practice. A total of 93.8% of the respondents agreed that ADR reporting should be made mandatory for health-care professionals, and 94.5% agreed that it improves the patient safety. Conclusion: The findings generally indicate that health-care professionals in a tertiary care setting have low awareness regarding the term “ADR.” Lack of pharmacovigilance training, amount of workload, and legal liabilities are the main causes of underreporting. More than half of the respondents agreed that ADR reporting eventually improves patient safety.

Pulmonary hydatid disease is a significant health problem in children in endemic areas such as Tunisia. Pulmonary hydatid disease is more frequent than hepatic hydatid disease in children. The aim of this study was to evaluate the characteristics of pulmonary hydatid disease in children in our province which is endemic for echinococcosis. It9s a retrospective study conducted between 2002 and 2013 by reviewing the medical records of patients (≤18 years) who were diagnosed with pulmonary hydatid disease. A total of 70 patients with the diagnosis of pulmonary hydatid disease were enrolled in this study. The mean age was 11.36 (4 to 18) years. Symptoms were present in 57.7% of patients and dyspnea was the major complaint. Hydatoptosis was noticed in 15.7% of cases. An important diagnosis delay was found and estimated to 131.78 days. Misdiagnosis as benign bronchitis was the major cause of diagnosis delay. Hydatid cyst rupture was found at diagnosis in 61% of cases. Hepatopulmonary hydatidosis was found in 31.42% of cases. Diagnosis was easy in 58.6% of cases and made on clinical, Chest X ray and ultrasonography data and CT scan was necessary in 41.4% of cases because of atypic presentation. Surgical treatment was performed in all cases except one case of multiple hydatidosis and lobectomy was necessary in 13 cases (18.5%) . Although it9s a frequent disease in our country, diagnosis delay of pulmonary hydatid cyst remains important leading to complicated forms and a high rate of lobectomies.

It9s now admitted that vitamin D deficiency is associated with allergic diseases and asthma. Recently, IL33, an IL1 family cytokine was described as an “alarmin” that promotes TH2-type cytokines and airway inflammation in asthma. Recent data showed a possible interaction between IL33 and vitamin D levels when vitamin D supplementation increased sST2 levels a soluble IL33 receptor and inhibitor in situ of IL33. The aim of our study was to investigate the link between serum levels of IL33 and vitamin D (by ELISA) according to disease severity and control in winter and summer in 38 asthmatic children (17 mild asthmatics and 21 moderate asthmatics) compared to 30 healthy controls (HC). Our results showed that vitamin D levels were lower in asthmatics compared to HC in summer (p=0.004). These levels were lower in winter and in more severe asthma (p These results suggest that vitamin D deficiency may increase IL33 levels and thus induce TH2 inflammation. Vitamin D supplementation may reduce inflammation through sST2 production.

This study aims to investigate the impact of intellectual capital on innovation in telecommunication companies in Jordan, through the presence of knowledge management as a mediator. Data were collected using a self-administrated questionnaire from 498 employees working in three telecommunication companies in Jordan. Structural equation modelling approach based on AMOS 22.0 was used to examine the causal relationships and to test the hypotheses between the observed and latent constructs in the proposed research model. The results led to the confirmation of a mediation model as intellectual capital did not have a direct impact on innovation. The results revealed that intellectual capital did have a significant impact on knowledge management and the latter on innovation. In light of these findings, implications to both theory and practice are discussed.

Posterior epidural migration of a lumbar disc herniation is rare. Clinical symptoms frequently indicate severe radicular compression. Cauda equina syndrome is very unusual. Three cases of cauda equina syndrome from posterior epidural migration of a lumbar disc herniation along with a review of the literature are presented to illustrate the Imaging features of this entity and related diagnostic difficulties. Finaly, early surgical management is the treatment of choice for optimal symptomatic recovery.

This study aims to examine the associated relationships between transformational leadership, corporate social responsibility, and organizational performance. A total of 217 questionnaires were gathered from employees operating the various pharmaceutical companies in Jordan and then were analysed using structural equation modelling (SEM). The results of the data were threefold. First, transformational leadership did not have a positive influence on organizational performance. Second, transformational leadership did have a positive influence on corporate social responsibility. Third, corporate social responsibility did have a positive influence on organizational performance. These findings may aid future researchers in their quest in understanding the inherent relationships that lie between the variables in question and may provide a platform for managers in their efforts to improve organizational performance.

Sana’ MH Al Aqqad, Li Li Chen, Asrul Akmal Shafie, Mohamed Azmi Hassali, Balamurugan Tangiisuran Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia Background: Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents. Methods: A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. Results: The median age of the 211 participants was 77 years (interquartile range 72–82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences. Conclusion: PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents. Further studies with a bigger sample size and longer follow up period are required to establish this association. Keywords: elderly, health related quality of life, patient safety