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Background: Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial. Objectives: This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI). Methods: All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed. Results: Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, ppp=0.042), respectively. Conclusion: This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.

Rasheed K Ibdah,1 Laith N AL-Eitan,2 Nasr N Alrabadi,3 Ayah Y Almasri,2 Adan H Alnaamneh,2 Rame H Khasawneh,4 Mansour A Alghamdi5,6 1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Hematopathology, King Hussein Medical Center (KHMC), Jordan Royal Medical Services (RMS), Amman, Jordan; 5Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia; 6Genomics and Personalized Medicine Unit,College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Laith N AL-EitanDepartment of Biotechnology and Genetic Engineering, Jordan University of Science and Technology. P.O.Box 3030, Irbid 22110, JordanTel +962-2-7201000 Ext. 23464Fax +962-2-7201071Email lneitan@just.eduBackground: The main objective of this study is sought to determine the impacts of PCSK9, WDR12, CDKN2A, and CXCL12 polymorphisms on warfarin sensitivity and responsiveness in Jordanian cardiovascular patients during the initiation and stabilization phases of therapy.Methods: This study took place at the anticoagulation clinic at Queen Alia Heart Institute (QAHI) in Jordan. DNA samples were collected from 212 cardiovascular patients and 213 healthy controls. Genomic SNPs genotyping was conducted using the MassARRAY System at the Australian Genome Research Facility.Results: This study assessed 10 polymorphisms (rs11206510 within the PCSK9 gene, rs6725887 and rs7582720 within the WDR12 gene, rs4977574, rs10757278, and rs1333049 within the CDKN2A gene, rs2862116, rs7906426, rs1746048, and rs268322 within the CXCL12 gene) in 212 Jordanian cardiovascular patients. Carriers of CDKN2A rs1333049, rs10757278, and PCSK9 rs11206510 polymorphisms had an increased risk of resistance during the initiation phase of warfarin therapy compared to those who do not carry it, or those who are carrying one polymorphism only (P < 0.05), while carriers of CXCL12 rs7906426 polymorphism had similar increased risk but during the stabilization phase of warfarin therapy (P < 0.05).Conclusion: Carriers of CXCL12 rs2862116 polymorphism had an increased risk to be warfarin extensive responders compared to those with no or only one polymorphism (P = 0.01). However, the presence of PCSK9 rs11206510 polymorphism affects the warfarin maintenance doses (P ˃ 0.0001).Keywords: warfarin, cardiovascular disease, PCSK9, WDR12, CDKN2A, CXCL1

Introduction Thrombus occlusion of the left main coronary artery (LMCA) is a poorly prognostic condition that is commonly associated with mortality especially when complicated with cardiogenic shock. Presentation of case In this report, we presented a case for 44 years-old male patient who is not known to have ischemic heart disease. He was transferred from a peripheral hospital for emergency percutaneous coronary intervention (PCI) after presenting with anterior ST-elevation myocardial infarction (STEMI) complicated with cardiogenic shock. Discussion The PCI revealed complete occlusion of the LMCA with a thrombus which was stented and the patient regain his cardiovascular stability. The patient survived this complete occlusion that was complicated with cardiogenic shock giving the quick intervention with the PCI and the use of the circulatory support devices. Conclusion The PCI procedure with the intra-aortic balloon pump should be available and offered early for patients with STEMI complicated with cardiogenic shock. This could be very critical in increasing the survival rates for those patients., Highlights • A case of a patient who survived a complete LMCA occlusion. • Total LM occlusion often associated with lifethretining arrhythmia. • A Primary Percutaneous Coronary Intervention with intra-aortic balloon pump should be available and offered early for patients with cardiogenic shock.

Background Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide and in the Middle East. Several studies have shown that women with AF are undertreated despite worse baseline clinical and risk profiles compared with men. It is largely unknown if this also applies to Middle Eastern AF patients. Purpose To evaluate baseline clinical features and utilization of guideline-recommended oral anticoagulant medications (OACs) in Middle Eastern women with AF. Methods The Jordan AF prospective multicenter study enrolled 2160 patients with AF, including 1164 (53.9%) women, in 20 hospital and outpatient clinics (May 2019 through January 2021). Results Nonvalvular AF was present in 1038 (91.0%) of women and 935 (94.6%) of men. Compared with men, women were older (mean age 69.2±11.5 years vs. 66.1±14.9 years, p Conclusions Middle Eastern women with AF have worse baseline clinical and risk score profiles compared with men. In disagreement with other regional studies, the majority of these women received guideline-recommended OACs. Funding Acknowledgement Type of funding sources: None.

Aims: This study aimed to utilize a validated sleep questionnaire as a screening tool for symptoms and risk of obstructive sleep apnea in patients undergoing coronary catheterization in Jordan. Materials and methods: A cross-sectional design was used to screen adult patients undergoing coronary catheterization for obstructive sleep apnea (OSA). The Berlin sleep questionnaire was used to record nocturnal and daytime symptoms of OSA and to stratify patients into “low-risk” or “high-risk” for OSA. Coronary artery disease was defined as ≥50% intraluminal stenosis in at least one coronary vessel. Results: A total of 398 patients were studied, mean age was 58.7 years (SD=10.70), ranging from 21–92 years, and 68.6% were males. Based on the Berlin sleep questionnaire’s definition, 176 patients (44.2%) were at high-risk for obstructive sleep apnea. Snoring was reported by 61%; loud in 42.1%, and frequent in 62%. Daytime sleepiness was reported by 36%, and 18.9% had fallen asleep while driving. Witnessed apnea during sleep was less reported (7.8%). Prevalence of symptoms and risk of OSA were not different between patients with and without coronary artery disease, P>0.05. In addition, logistic regression indicated that there was no significant association between risk of OSA and coronary artery disease, adjusted (odds ratio=0.93, 95% Confidence Interval=0.60–1.44, P=0.752). Conclusions: Symptoms and risk of obstructive sleep apnea were common among adult Jordanians undergoing coronary catheterization. There was no association between risk of obstructive sleep apnea and coronary artery disease. Larger studies are needed to assess the role of screening for obstructive sleep apnea in this patient population.

Introduction. Contrast-induced acute kidney injury (CI-AKI) is a worldwide known complication related to the use of contrast media with either imaging or angiography; it carries its own complications and effect on both morbidity and mortality; early identification of patients at risk and addressing modifiable risk factors may help reducing risk for this disease and its complications. Methods. This was a prospective observational study, where all patients admitted for cardiac catheterization between June 2015 and January 2016 were evaluated for CI-AKI. There were two study groups: contrast-induced acute kidney injury (CI-AKI) group, and noncontrast-induced acute kidney injury (non-CI-AKI) group. Results. Patients ( n = 202 ) were included and followed up for 4 years. Death and development of chronic kidney disease (CKD) need for another revascularization were the end points. The incidence of CI-AKI was 14.8%.In univariate analysis, age ( P = 0.016 ) and serum albumin at admission ( P = 0.001 ) were statistically significant predictors of overall death. Age ( P = 0.002 ), HTN ( P = 0.002 ), DM ( P = 0.02 ), and the use of diuretics ( P = 0.001 ) had a statistically significant impact on eGFR. The rate of recatheterization was not statistically significant between the two groups (61 (35.5%) for the non-CI-AKI vs. 12 (40%) for the other group; P = 0.63 ). Some inflammatory markers (NGAL P = 0.06 , IL-19 P = 0.08 ) and serum albumin at admission P = 0.07 had a trend toward a statistically significant impact on recatheterization. Death ( P = 0.66 ) and need for recatheterization ( P = 0.63 ) were not statistically different between the 2 groups, while the rate of eGFR decline in for the CI-AKI was significant ( P = 0.004 ). Conclusion. CI-AKI is a common complication post percutaneous catheterization (PCI), which may increase the risk for CKD, but not death or the need for recatheterization. Preventive measures must be taken early to decrease the morbidity.

Oxidative stress and inflammation are associated with endothelial injury and coronary artery disease. Inflammatory factors that promote oxidative damage include endothelin-1 (ET-1), myeloperoxidase (MPO), and C-reactive protein (CRP). Current guidelines recommend the use of statins in patients with risk of atherosclerotic cardiovascular disease (ASCVD).To assess the impact of atorvastatin on plasma inflammatory and oxidant biomarkers in patients with moderate to very high risk of ASCVD.Two hundred ten patients presented to the cardiology clinic were included and stratified into low, moderate, high, and very high risk of ASCVD. Moderate- (20 mg/d) to high-intensity (40 mg/d) atorvastatin was prescribed. Plasma levels of lipids, ET-1, CRP, MPO, total nitrite, lipid peroxides (thiobarbituric acid reactive substances [TBARS]), and superoxide dismutase (SOD) activities were measured at baseline and 12 weeks after treatment.Relative to low-risk patients, baseline plasma inflammatory markers of CRP, MPO, ET-1, and nitrite were higher in patients with very high risk of ASCVD, whereas plasma SOD was lower (all P.05). Use of high and moderate atorvastatin therapy significantly reduced low-density lipoprotein and total cholesterol levels, as well as plasma levels of CRP, MPO, nitrite, and TBARS, and increased plasma SOD activity in patients with moderate to very high risk of ASCVD, independent of lipid-lowering effects.Key markers of oxidative stress/inflammation such as CRP, ET-1, total nitrite, and MPO are associated with an increased risk of ASCVD. Moderate- and high-intensity atorvastatin use reduces plasma oxidative stress and inflammation regardless of ASCVD risk and independent of its lipid-lowering effect.

The COVID-19 pandemic, caused by the coronavirus SARS-CoV-2, has rapidly spread worldwide starting from China in late 2019. The first case in Jordan was reported on March 2, 2020. The Jordanian government made many transformations to address this crisis. As we are the only referral cardiology center for percutaneous coronary intervention (PCI) in the north of Jordan, we made multiple adjustments to confront COVID-19 challenges. We emphasize that there is an urgent need to update all procedures and therapeutic activities that are performed in the Cath-Lab to minimize the risks for both the patients and the health care providers during the pandemic of COVID-19.

Patient: Female, 27 Final Diagnosis: Right atrial thrombus compressing the sinoatrial node Symptoms: Dyspnea • cough and hemoptysis with supine bradycardia reaching 36/min and dizziness Medication: — Clinical Procedure: Cardiac surgical intervention removing the mechanical cause if conservative management failed can be done safely Specialty: Surgery Objective: Rare disease Background: Behçet’s disease (BD) is a chronic multi-systemic disease of unknown cause. Intra-cardiac thrombus (ICT) complicating BD is extremely rare. In general, cardiac manifestations in BD are associated with poor prognosis. Chest computed tomography (CT) scan and echocardiogram are excellent modalities for diagnosis and patient assessment. Cardiac surgical intervention can be done safely using an on-pump technique when medical management has failed. Case Report: We report on a case of a 27-year-old Jordanian woman diagnosed with BD who presented with dyspnea, cough, and hemoptysis, with supine bradycardia reaching 36 beats/minute and dizziness which disappear on sitting or standing position, and with heart rate reaching 76 beats/minute. Right atrial thrombus was identified using transthoracic echocardiogram and chest CT scan. After medical management failed, cardiac surgical intervention became an option and targeted extraction of the right atrial thrombus compressing the sinoatrial node (SA node). Conclusions: In BD, right atrial thrombus compressing the SA node is rare. If conservative management has failed, cardiac surgical intervention removing the mechanical cause can be done safely, either using on-pump with cross clamp or on-pump with beating heart technique.

Here, we describe a rare echocardiographic finding of a floating right heart thrombus in an elderly woman who presented with an unexplained syncope. Our case demonstrates the pivotal role of echocardiography in the workup of patients admitted with syncope.

Basheer Y Khassawneh,1 Shaher M Samrah,1 Mohamad I Jarrah,1 Rasheed K Ibdah,1 Ali M Ibnian,1 Abdelhameed W Almistarehi,1 Aseel A Zghayer,1 Saddam I Abuqudairi,1 Yousef S Khader2 1Department of Internal Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan Purpose: COPD and coronary artery disease (CAD) are common chronic diseases with shared risk factors. COPD continues to be largely underdiagnosed and undertreated. We aimed to describe the prevalence and predictors of undiagnosed COPD in Jordanian men with CAD. Patients and methods: In a cross-sectional study conducted at a referral center in Jordan, male patients who underwent coronary angiography for suspected CAD and reported ≥10 pack-year of cigarette smoking were recruited. Pre- and post-bronchodilator spirometry was undertaken for all participants, and COPD was defined as post-bronchodilator FEV1/FVC

Peritoneal adhesion index (PAI) is a score based on appearance and distribution of peritoneal adhesions. The study aims to assess the validity of PAI in order to standardize the definition of peritoneal adhesions. The study includes an expert survey to assess the feasibility of the score and a prospective observational and multicenter trial to assess its validity. 96% of surgeons of the survey consider PAI a useful tool. From January 2013 to March 2015, 205 patients were enrolled to undergo a surgical intervention for bowel obstruction caused by peritoneal adhesions in 21 centers. PAI was significantly higher in the population with previous surgery (P=0.043) and in patients who underwent two previous surgical interventions, if compared to those with only one previous intervention (P=0.012). Length of surgery was significantly longer in patients with higher PAI (P

Objectives To determine the pattern of presentation, prevalent age, hospital incidence, and outcome of management of prostate cancer in our environment. Method Patients with histopathology evidence of prostate cancer managed between January 1991 and December 2007 were studied. Information entered into a pro-forma sheet and analyzed included the age of patients, clinical features, investigations, histopathology diagnosis, outcome of management, and duration of follow-up. Results During the period, 189 patients aged 46-99 years (mean, 68.0; 9.8 SD) confirmed and managed for prostate cancer were studied. The average hospital incidence (2002-2004) was 182.5 per 10 5 male admissions with 15.1-month mean duration of symptoms. Most 178 (94.2%) patients presented with advanced diseases, with 1 or multiple complications in 172 (91.0%), obstructive lower urinary tract symptoms 156 (82.5%), distant metastasis 97 (51.3%), lower back pain 95 (50.3%), weight loss 95 (50.3%), hematuria 86 (45.5%), anemia 77 (40.7%), renal failure 74 (39.2%), and inability to walk 42 (22.2%). Eighty-nine (47.0%) patients were farmers, 111 (58.7%) indulged in alcohol, and 46 (24.3%) smoked cigarettes. Mean prostate-specific antigen results available in 53 patients was 106.0 ng/mL (187.2SD) and digital rectal examination was valuable in diagnosis. Adenocarcinoma (186 [98.4%]) was the main histopathology type and most patients 136 (71.9%) had bilateral orchidectomy with or without antiandrogens. Mean duration of follow-up was 83.7 weeks. Conclusions The burden of prostate cancer in our developing community is worrisome. It is prevalent between 46 and 99 years in our community. Presentation is late, often with urinary retention and other complications. In our setting, treatment is still essentially palliative with orchidectomy, which we found to be beneficial, acceptable, and the most affordable to our patients.