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Background Male infertility is a multifactorial syndrome with diverse phenotypic representations. MicroRNAs (miRNAs) are small, non-coding RNAs that are involved in the post-transcriptional regulation of gene expression. Altered abundance levels of ODF2 and UBQLN3 have been reported in patients with different spermatogenic impairments. However, the transcriptional regulation of these two genes by miR-23a/b-3p is still unclear. Objectives To investigate experimentally whether miR-23a/b-3p targets the genes ODF2 and UBQLN3 and whether this targeting impacts abundance levels of ODF2 and UBQLN3 in patients with oligoasthenozoospermia. Materials and methods A total of 92 men attending a fertility clinic were included in the study, including 46 oligoasthenozoospermic men and 46 age-matched normozoospermic volunteers who served as controls. Reverse transcription-quantitative PCR (RT-qPCR), Western blot, and dual-luciferase (Firefly-Renilla) assays were used to validate the miRNAs and their target genes. Results RT-qPCR revealed that miR-23a/b-3p was more abundant and ODF2 and UBQLN3 targets were less abundant in men with impaired spermatogenesis. Besides, Western blot shows that ODF2 and UBQLN3 protein levels were reduced in men with impaired spermatogenesis. In silico prediction and dual-luciferase assays revealed that potential links exist between the higher abundance level of miR-23a/b-3p and the lower abundance level of ODF2 and UBQLN3 targets. Mutations in the miR-23a/b-3p-binding site within the 3'UTRs (3'untranslated regions) of ODF2 and UBQLN3 genes resulted in abrogated responsiveness to miR-23a/b-3p. Correlation analysis showed that sperm count, motility, and morphology were negatively correlated with miR-23a/b-3p and positively correlated with the lower abundance level of UBQLN3, while ODF lower abundance level was positively correlated with sperm motility. Conclusion Findings indicate that the higher abundance level of miR-23a/b-3p and the lower abundance level of ODF2 and UBQLN3 targets are associated with oligoasthenozoospermia and male subfertility.

Amer Mahmoud Sindiani,1 Eman Alshdaifat,2 Basil Obeidat,1 Rawan Obeidat,1 Hasan Rawashdeh,1 Hashem Yaseen3 1Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Obstetrics and Gynecology, Faculty of Medicine, Yarmouk University, Irbid, Jordan; 3Department of Obstetrics and Gynecology, Faculty of Medicine, Muta University, Alkarak, JordanCorrespondence: Amer Mahmoud SindianiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box: (3030), Irbid 22110, JordanTel +962796025538Fax +962-2-7201074Email amsindiani0@just.edu.joObjective: To study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy.Methods: This is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups.Results: The overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (∼ 55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734± 1684 vs 4036± 2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor.Conclusion: The single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.Keywords: ectopic pregnancy, methotrexate, pretreatment β HCG

Amer Mahmoud Sindiani,1 Yousef Khader,2 Zouhair Amarin1 1Department of Obstetrics and Gynecology, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Amer Mahmoud SindianiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box: (630001), Irbid 22110, JordanTel +962796025538Fax +962 2 7095777Email amsindiani0@just.edu.joObjective: To assess a possible association between coffee and tea consumption and preterm delivery.Methods: A case–control design was implemented on a sample of women who were admitted for delivery to a tertiary hospital in the north of Jordan. Three hundred and fourteen cases and 796 controls were evaluated. The study was conducted while women were in the hospital for delivery. They were questioned about coffee and tea consumption and relevant confounding factors. Women were asked to state the average number of coffee and tea cups they drank per day.Results: The mean coffee consumption among women with preterm delivery was 0.75 cups/day ± 1.23 and the mean tea consumption was 1.47 cups/day± 1.76. Multivariable logistic analysis revealed that increased age (OR=1.05; CI=1.02– 1.08), parity (OR=3.82, CI=2.58– 5.64), history of abortions (OR=1.69; CI=1.21– 2.35), family history of preterm deliveries (OR=2.45, CI=1.33– 4.52), having treatment for subfertility (OR=12.14, CI=2.39– 61.62), diabetes mellitus (OR=2.22, CI=1.06– 4.66), worsened emotional status during pregnancy (OR=2.35, CI=1.49– 3.72), short inter-pregnancy interval (OR=1.72, CI=1.10– 2.72), no iron consumption (OR=1.46, CI=1.06– 2.03), using folic acid (OR=2.45, CI=1.33– 4.52), and black colour women (OR=2.87, CI=1.35– 6.10) were predictive for preterm delivery. After controlling for all significant predictors, coffee and tea consumption during pregnancy was not significantly associated with increased odds of preterm delivery.Conclusion: These results do not support an association between coffee and tea consumption and preterm delivery.Keywords: coffee, pregnancy, preterm delivery, tea

Introduction In the spot of the new emerging COVID-19 pandemic and its major impact worldwide on day-to-day activities many rules had to be changed in order to fight this pandemic. Lockdown started in Jordan and around the globe affecting several aspects of life including economy, education, entertainment, and government policies. Regarding education, the priority was to ensure the safety and progress of the educational process. Thus, new methods of teaching had to be applied using the online learning at Jordan University of Science and Technology (JUST), Faculty of Medicine. This study was done to assess (1) Class Experience (2) Students and Lecturers' Interaction (3) Online Learning Advantages & Disadvantages (4) Students’ Preference. Methods A cross sectional study was conducted Convenience sampling technique was used to collect the data from the participants using a survey composed of 18 questions on Google Forms platform. A link was sent to the undergraduate medical students at the Jordan University of Science & Technology via their e-learning accounts (n = 3700). The form was available from May 22nd, 2020 to May 30th, 2020 for 8 days long. Data analysis was done using SPSS V 23. Results 2212 out of 3700 students responded, (55.8%) of them were in the basic years and (44.2%) of them were in the clinical years. (55.8%) of students started to take online lectures after 3 weeks. (45.7%) used the hybrid teaching method (asynchronous and synchronous), (31.4%) used live classes, and 22.8% recorded classes. Zoom was the most used platform. (48.7%) and (57%) of clinical students and basic students express their interaction as bad, while the others had good and excellent interaction. Maintaining social distance was the most advantage of online teaching, while poor technical setup and no direct contact were the most disadvantage, furthermore inability to have real clinical access was a significant problem for clinical students (p, Highlights • The traditional teaching is preferred more than the online one among the students. • 43.9% of clinical group students believe that inability to have clinical access is a major obstacle when using the online learning. • Students who had underwent online learning before the pandemic are more pleased with their online experience. • Online learning helps maintaining social distance among students.

Objective To study the clinical, pathological and surgical features of primary epithelial ovarian cancer treated at our institution. Methods fifty-nine patients with primary epithelial ovarian cancer were included. Clinical data collected included patient's age, presenting symptoms, laboratory and tumor markers results as well as preoperative imaging reports. Pathological and surgical findings included were: spread of the disease, histologic type, stage of the disease, type of surgical procedure and amount of residual disease. Results Mean age of the patients was 54.5 years. Lower abdominal pain was the most common presenting symptom, followed by abdominal distension. The commonest histopathological type was high grade serous carcinoma (72.9%). In our study, majority of patients were diagnosed with stage III disease, accounting for 69.5% of the total number of patients. Complete cytoreduction with no gross residual disease was achieved in 77.3% of patients with stage 3–4 disease. Conclusion clinical and pathological features of primary epithelial ovarian carcinoma in our populations are similar to what is reported worldwide. We have also documented that our surgical approach to the management of ovarian cancer is comparable to the international consensus., Highlights • The commonest histopathological type of ovarian cancer in our institute is high grade serous carcinoma (72.9%). • In our study, majority of patients were diagnosed with stage III disease, accounting for 69.5% of the total number of patients. • Complete cytoreduction with no gross residual disease was achieved in 77.3% of patients with stage 3–4 disease. • We have reported a high complete cytoreduction rate (77.3%).

Purpose To review the indications and clinical profile of neonatal admissions at King Abdullah University Hospital in Jordan. Materials and Methods We conducted a cross-sectional review of all neonates admitted to the neonatal intensive care unit between September 2016 and September 2018. Collected data include demographic characteristics, indications for admission, morbidities and mortality, and discharge outcomes. Findings were reported among term and preterm infants. Results A total of 1444 infants were admitted during the study period of whom 1332 (92.2%) were inborn and 612 (42.4%) were term neonates. Of the 832 preterm infants, 545 were late preterm (34-36 6/7 gestation) and 125 had very low birth weight (˂ 1500 grams); 925 (64%) were born by cesarean section. Respiratory failure of the newborn (41.2%) and prematurity (33.3%) were the main indications for admission among the whole cohort. Maternal prolonged premature rupture of membranes (PROM) was observed in nearly half the admissions of term infants. Hypoxic ischemic encephalopathy (3.2% vs 0.7%, p 0.01) and congenital anomalies (5% vs 1.2%, p 0.03) were more common in term infants. The rate of bronchopulmonary dysplasia was 39% among

Background During the last decades, the rate of caesarean section is increasing and this can increase the mortality and morbidity. Up to one third of the caesarean sections are attributed to the elective repeat caesarean section (ERCS). This study aims to evaluate attitudes and factors affecting the choice of pregnant women with one previous caesarean section regarding their mode of delivery in their second pregnancy. By assessing these attitudes, this study can help the efforts in developing strategies to increase the rates of vaginal delivery. Material and methods A cross-sectional design was conducted by a structured questionnaire on 166 pregnant women who had delivered once by caesarean section for their first pregnancy and were in the third trimester of their second pregnancy. Any women with an absolute indication for caesarean section was excluded. The study comprises women who attend the clinic at our center in Northern of Jordan. Proper statistical tests were performed to assess the association between the choice of delivery and selected demographic and clinical factors. Results About 55.4% responded that they would choose ERCS (n = 92) and the remaining participants chose trial of labour after caesarean section (TOLAC) (n = 74). Fear of pain was the most common reason for choosing caesarean section, accounting for 55.4%. Interestingly, our study did not show a significant association between the mode of delivery and demographic factors, such as age, educational level and occupation. The single independent significant factor influencing patients’ choice that our study revealed was “being informed about the complications of TOLAC”. The choice of TOLAC was almost four times higher for those participants who had been informed about the complications, compared to those who had not been informed. Conclusion Proper counselling is a main factor that affected the patients’ choice toward the mode of delivery. Proper pain management may encourage patients to choose TOLAC because fear of pain was a main reason that patients requested ERCS instead of TOLAC., Highlights • Pregnants with a previous caesarean section has the right to choose TOLAC or ERCS. • Pregnants should be aware about the risks and benefits for each mode of delivery. • Proper counselling pain management are the main factors affect their choice. • Knowledgeable pregnant women tend to choose TOLAC over ERCS.

Heba H Hijazi,1,2 Mohammad S Alyahya,2 Rabah M Al Abdi,3 Main N Alolayyan,2 Amer M Sindiani,4 Liqaa A Raffee,5 Wegdan A Baniissa,6 Amina M Al Marzouqi1 1Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; 2Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Biomedical Engineering, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 5Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 6Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab EmiratesCorrespondence: Heba H HijaziDepartment of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab EmiratesEmail hhijazi@sharjah.ac.aeObjective: This study aimed to evaluate the association between perceived social support during pregnancy and levels of anxiety among postpartum women using an anxiety-specific screening instrument.Methods: Using a prospective cohort design, a two-stage methodology was conducted to collect data from women seeking maternal care at the King Abdullah University Hospital in northern Jordan. In the first stage, perceived social support was assessed among pregnant women using the Medical Outcomes Study Social Support Survey. During the first six months after childbirth, postpartum women were contacted to complete the second stage, wherein their perceptions of infant-focused anxieties were assessed using the Postpartum Specific Anxiety Scale. In our study, two types of infant-focused anxieties were investigated among a final sample of 419 mothers: infant safety and welfare anxieties and practical infant care anxieties.Results: The results of multivariate linear regression analysis indicated that providing pregnant women with high levels of emotional support from close social networks (β= − 0.08, p= 0.01) and perceiving informational support from health care providers (β= − 0.71, p< 0.01) were protective factors for reducing the levels of postpartum anxiety concerning infant safety and welfare. Our findings also demonstrated that pregnant mothers who perceived high informational support from health care providers had a lower level of postpartum anxiety about practical infant care (β= − 0.20, p< 0.01). In contrast, mothers who reported receiving high tangible support from close social networks during pregnancy had a significantly higher level of perceived anxiety concerning practical infant care after delivery (β= 0.13, p= 0.02).Conclusion: Our study suggests that postpartum anxiety would be reduced if effective informational support were readily available for pregnant women. There is a clear need for building bridges between women, their families, and providers to distinguish the specific type and amount of support that should be provided to mothers during pregnancy.Keywords: postpartum anxiety, infant care, social support, pregnancy, childbirth, postnatal care, infant-focused anxieties

Since the discovery of diabetes, it is about insulin production, or function. In this study, we may introduce a controversial concept. Insulin as a predictor of diabetes, in other words, insulin can cause diabetes type 2. We think that this could serve as a new medical hypothesis. To examine this hypothesis, we analyzed dataset posted in Kaggle from India. The dataset included 763 female patients of whom 497 had no diabetes, and 266 with type 2 diabetes. We used routine statistical analysis and neural network analysis. The results showed that insulin level increases as the diabetes is progressed, and its relative contribution to diabetes was estimated as 28.4%. Taken together, insulin measurement is recommended to be considered in the management of diabetes.

Objectives This study aimed to determine leptin levels in term newborns who were born in the north of Jordan. We also aimed to investigate the relationships of leptin levels with fetal growth parameters, and to assess the difference in leptin levels according to sex and gestational age. Methods A cross-sectional descriptive study that involved 170 term newborns was conducted. A working sheet for data collection was created for each newborn and included sex, weight, length, head circumference, gestational age, and Apgar score. Blood samples were obtained from the umbilical cord vein of newborns after delivery to measure serum leptin levels. Data are shown as frequency, percentages, means, and standard deviations. Results We found that the mean leptin level was 1.17 ± 0.48 ng/mL. The independent t-test showed that the mean leptin level in boys (0.93 ± 0. 34 ng/mL) was significantly lower than that in girls (1.38 ± 0.47 ng/mL). Pearson’s correlations showed that leptin levels of newborns were positively and significantly correlated with weight, length, and head circumference. Conclusion In Jordanian healthy term newborns, leptin levels correlate with sex and intrauterine growth parameters.

Objective To evaluate the impact of previous lower segment cesarean section on maternal and fetal outcomes of patients with non-adherent placenta previa Methods This is a retrospective study of all patients who delivered at a tertiary referral university hospital by lower uterine cesarean section with non-adherent placenta previa, over a 10-year period. Data were obtained through hospital registry and medical records. The differences in demographic, obstetric characteristics, peripartum complications, and fetal outcome between patients with no previous cesarean and those with previous cesarean section were analyzed. Results Ninety patients with non-adherent placenta previa were included, 54 patients with no previous cesarean and 36 patients with previous cesarean section. Patients with previous cesarean section were significantly more likely to incur inadvertent organ injury, transfusion of 4 or more units of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy. Conclusion There is a significant increase in the incidence of inadvertent neighboring viscus injury, transfusion of 4 units or more of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy in patients with non-adherent placenta previa and previous cesarean section, compared to those with non-adherent placenta previa and no previous history of cesarean section, with no difference in perinatal outcome.

BackgroundResidency programs have been impacted by the Coronavirus disease 2019 (COVID-19) pandemic. In this study we aim to investigate and evaluate the impact of the pandemic on residents as well as residency training programs.MethodsThis was a cross-sectional study including a survey of 43 questions prepared on Google forms and electronically distributed among a convenience sample of residents training at a tertiary center in North Jordan during the COVID-19 pandemic. Data were collected in the period between October 30th and November 8th of 2020. The survey included questions that addressed the impact of the pandemic on residents’ health as well as training programs. The study participants included residents in training at KAUH in 2020 and were stratified according to the type of residency program (surgical residents (SRs) and non-surgical residents (NSRs)). Statistical methods included descriptive analysis, Chi-square or Fisher’s exact test, Mann Whitney U test, and Cramer’s V and r statistics as measures of effect sizes.ResultsOf all 430 residents, 255 (59%) responded to the survey. A total of 17 (7%) of residents reported being infected with COVID-19 and a significant difference was reported between SRs and NSRs (10% vs 4%, V = .124 “small effect” (95% CI; .017–.229),p = 0.048). Approximately, 106 (42%) reported a decrease in the number of staff working at the clinic and 164 (64%) reported limited access to personal protective equipment during the pandemic. On a 4-point Likert scale for the feeling of anxiety, the median was 2 (2–3 IQR) in the NSRs group, vs 2 (1–2 IQR) in the SRs groups, with the NSRs being more likely to feel anxious (r = 0.13 “small effect” (95% CI; 0.007–0.249),p = .044). Similarly, the proportion of residents who reported feeling anxious about an inadequacy of protective equipment in the work area was significantly greater in the NSRs group (90.3% vs 75.2%; V = .201 “small effect” (95% CI; .078–.313),p = .001), as well as the proportion of residents who reported feeling increased stress and anxiety between colleagues being also significantly higher in the NSRs group (88.1% vs 76%; V = .158 “small effect” (95% CI; .032–.279),p = .012).ConclusionThe burden of the ongoing pandemic on the mental health status of residents is very alarming and so providing residents with psychological counseling and support is needed. Also, critical implications on the flow of residency training programs have been noticed. This necessitates adapting and adopting smart educational techniques to compensate for such limitations.

Amer Mahmoud Sindiani,1 Faheem Zayed,2 Eman Hussein Alshdaifat,3 Hasan M Rawashdeh,1 Wesam Al-Woshah,4 Nada Zayed5 1Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Obstetrics and Gynecology, Irbid Speciality Hospital, Irbid, Jordan; 3Department of Obstetrics and Gynecology, Yarmouk University, Irbid, Jordan; 4Department of Obstetrics and Gynecology, IBN Al-Nafis Hospital, Irbid, Jordan; 5Department of Dermatology, Albalqa Applied University, Salt, JordanCorrespondence: Amer Mahmoud SindianiDepartment of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, PO Box: 3030, Irbid, 22110, JordanTel +962796025538Email amsindiani0@just.edu.joPurpose: To find out whether couples with predominant female offspring have more chances to produce more female embryos during non-medical pre-implantation genetic diagnosis (PGD) for male sex selection.Methods: A total of 125 couples who had three or more female offspring and underwent non-medical PGD for male sex selection between 2015 and 2019 were included. Nuclear DNA was analyzed by fluorescent in situ hybridization (FISH). Two-chromosome (X, Y), 3-chromosome (21, X, Y), and 5-chromosome (13, 18, 21, X, Y) probes were used for FISH. The standard protocol was followed for sperm processing and embryo culture for IVF and PGD.Results: In 83.2% of the couples, the ratio of female embryos was higher than male embryos. Independent sample t-test showed that there is no significant difference between equal and unequal embryonic groups in patients’ age, husbands’ age, sperm count, sperm motility, total male embryos, total female embryos, normal male embryos, and normal female embryos. For patients with positive pregnancy outcome, 84.6% had unequal embryonic ratio while 15.4% had equal embryonic ratio. Similarly, patients who were treated by short protocol had 85% of unequal embryonic ratio and 15% had equal ratio.Conclusion: A greater variability in the female to male embryonic ratio is produced in couples having predominantly female offspring and seeking non-medical PGD for male sex selection.Keywords: embryos, infertility, IVF, PGD

Background: About one in five women suffer from postpartum depression, placing it the leading complication during childbirth. Oxytocin has been suggested to play a key role in modulating maternal behaviour and stress-related disorders. However, there is little evidence to support its role in predicting postpartum depression. Our aim is to investigate the relationship between serum oxytocin level in the third trimester and early-onset postpartum depression symptoms and whether oxytocin is capable of predicting postpartum depression symptoms.Methods: A total of 172 healthy pregnant women participated in this cross-sectional descriptive study. The serum oxytocin level was measured between 34 and 37 weeks. A validated Edinburgh Postnatal Depression Scale (EPDS) was used to assess symptoms of depression four to six weeks postpartum. Participants with EPDS scores of 13 or more were considered having depressive symptoms. SPSS version 23 was used for data analysis. Descriptive statistics were provided. Independent sample t-test and Pearson r were used to examine differences in depression scores between selected demographic, psychosocial, and clinical variables. The level of significance for all analyses was set at α=0.05.Results: 8% of participants have scored 13 or above at the EPDS. Pearson r indicated that there was no correlation between EPDS scores and oxytocin level r(170)=0.10, p=0.23. Furthermore, there was no correlation between EPDS scores and oxytocin level among women with a lifetime history of depression, r(43)= - 0.13, p=0.37. Independent t-test has shown that participants with low education, low income, previous history of depression, positive family history of depression, positive family issues and absent emotional family support have scored significantly higher on EPDS scores than their counterparts. The association with a previous lifetime history of depression was noticeable t(170)= - 4.40, pConclusions: There was no relation between late antenatal third trimester serum oxytocin level and early onset postpartum depression symptoms. Third trimester serum oxytocin level alone was not capable of predicting early onset postpartum depression.

Purpose: In this study, the Pre-implantation embryonic sex ratio in 125 couples who had three or more female children and underwent pre-implantation genetic diagnosis (PGD) for non-medical reason was included. Besides, we have aimed to find out whether these couples had more chances of getting a girl child once again. Methods: 125 couples who had three or more female offspring and those who underwent PGD for non-medical sex selection (XY) between 2015 and 2019 were included. Nuclear DNA was analyzed by Fluorescent in situ Hybridization (FISH). 2-chromosome (X, Y), 3-chromosome (21, X, Y), 5-chromosome (13, 18, 21, X, Y) probes were used for FISH. The standard protocol was followed for sperm processing and embryo culture for IVF and PGD. Result: Independent sample t-test showed that there is no significant difference between equal and unequal embryonic groups in patients’ age, husbands’ age, sperm count, sperm motility, total male embryos, total female embryos, normal male embryos, and normal female embryos. For patients with positive pregnancy outcome, 84.6% had unequal embryonic ratio while 15.4% had equal embryonic ratio. Similarly, patients those who were treated by short protocol had 85% of unequal embryonic ratio and 15% had equal ratio. Conclusion: Greater variability in the female to male embryos was found in these couples, confirms the fact that couples previously having girl offspring may predominantly not produce embryo of the same sex every time.

Background Emergence of coronavirus disease 2019 (COVID-19) forced the worldwide higher educational institutes to adopt distance learning mode. Further, remote electronic exams (E−exams) were considered as mode of assessment. Objectives: This cross-sectional study evaluated the students' experience of remote E-exams during the COVID-19 pandemic among Medical Sciences students in Jordan. Materials and Methods: A survey of 29 questions was prepared on Google forms and distributed among students at Faculties of Medical Sciences (Medicine, Dentistry, Pharmacy, Nursing and Applied Medical Sciences) at Jordan University of Science and Technology. The questions include students' demographics, stress experience, and factors contributing to stress as well as behavioral changes related to remote E-exams. Responses were analyzed using descriptive, cross tabulation and Chi-square tests. Results: Among 1019 respondents, 32% reported more stress with remote E-exams. This was associated with academic major and gender. Among students with more stress during remote E-exams, the exam duration, mode of questions navigation and technical problems (exam platform and internet connectivity) appeared as the main factors related to stress in 78%, 76% and >60%, respectively. Other factors include concern regarding the teaching methods, exam environment and students' dishonesty. Remote E-exams had negative impact on students' dietary habits (increase consumption of caffeine and high energy drinks, high sugar food, fast food), sleep (reduction in sleeping hours, more consumption of insomnia medications), physical activity (less exercises) and smoking habits (increase). Conclusion: Results suggested a negative impact of E-exams on students within Medical Faculties. Robust exam platform and remote mock E-exams are recommended to reduce students' potential stress. A stress-free environment is very essential to encourage students to adopt remote E-exams, particularly if the pandemic will take longer. Various awareness programs about students' habits related to dietary, sleep quality, physical activity and smoking are highly valuable for students’ health benefits. This is of particular importance since the current students at Faculties of Medical Sciences are the future health care providers., Highlights • Remote E-exams are more stressful in one third of students from faculties of medical sciences. • Exam duration, mode of questions navigation and technical problems are major causes for students stress with remote E-exams. • Remote E-exam experience has negative impact on students' habits related to diet, sleep, physical activity and smoking.

Background and Objectives: The goal of this study was to evaluate the clinical sonographic evaluation of postmenopausal bleeding (PMB) followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy in Jordanian hospitals. Materials and Methods: A retrospective multi-centric study was performed in hospitals in Al-Karak and Amman from 2014&ndash, 2016. The study recruited 189 cases to evaluate the aetiology of postmenopausal bleeding. Atrophic endometrium was observed as a major cause of postmenopausal bleeding according to histopathology. The cases were also distributed according to parity in which nulliparous patients were observed. Results: Hysteroscopy was observed to be effective for the diagnosis of postmenopausal bleeding. Conclusion: There is a need to assess more approaches for the diagnosis of postmenopausal bleeding among women.

Patient: Female, 33-year-old Final Diagnosis: Twins molar pregnancy Symptoms: Vaginal bleeding Medication:— Clinical Procedure: Evacuation Specialty: Obstetrics and Gynecology Objective: Rare co-existance of disease or pathology Background: A complete mole with a living fetus in a form of twin pregnancy that is a rare obstetric event. The development of metastatic gestational trophoblastic disease is the most important and serious complication. It is debatable whether to terminate the pregnancy or to continue. Another point is the validity of the conservative treatment of this type of neoplasm, especially in developing countries. Case report: In this study, we report the first case of a twin pregnancy with complete mole and a living fetus in Jordan, which is a developing country. A 33-year-old woman presented with vaginal bleeding which was revealed to be due to a complete mole in the form of a twin pregnancy. A hystrostomy was performed with subsequent drop of β-hCG level. However, the β-hCG started to rise and the CT scan revealed multiple metastatic sites. Accordingly, she received 3 cycles of methotrexate, with a subsequent reduction in β-hCG level. Conclusions: This is the first case report of a complete mole in twin pregnancy in Jordan. To overcome the development of metastasis, close follow-up and immediate treatment are crucial when the conservative approach is being considered. This report highlights the importance of considering the diagnosis of complete mole for women with twin and vaginal bleeding.

Introduction: Cervical cancer ranks the fourth prevalent cancer in women at the global level, and the second in poor countries. The main objectives of the present study were to investigate the risk factors associated with cervical cancer and to study their possible association with the decision to take a cervical biopsy. Aim: The main objectives of this study were to investigate the risk factors associated with cervical cancer and to study their possible association with the decision to take a cervical biopsy. Methods: It was cross-sectional study and we analyzed an online data posted on Kaggle. This Dataset is obtained from UCI Repository. A list of risk factors for cervical cancer leading to biopsy examination was included, such as age, number of sexual partners, first sexual intercourse, number of pregnancies, smoking variables, hormonal contraceptives, IUD, and sexually transmitted disease variables, Hinselmann, Schiller, Cytology, and Biopsy. The dataset was prepared for appropriateness through filtering invalid cases with missing data. Results: The results of the study showed that the following variables were significantly associated with cytological examination: STD-Condylomotosis (p=0.035), STD-Pericondylomotosis (p=0.029), STD_HIV (p=0.006), Hinselmann (p

Background One of the major reproductive health challenges among disadvantaged populations is to provide pregnant women with the necessary antenatal care (ANC). In this study, we suggest applying an integrated conceptual framework aimed at ascertaining the extent to which attendance at ANC clinics may be attributed to individual determinants or to the quality of the care received. Methods Using a cross-sectional design, data were collected from a sample of 831 women residing in nine sub-districts in three northern governorates of Jordan and designated according to national categorization as persistent poverty pockets. All of the sampled women were recruited from public maternal and child health centers and interviewed using a structured pre-tested survey. This tool covered certain predictors, ranging from the user’s attributes, including predisposing, enabling, and need factors, to the essential components of the experience of care. These components assessed the quality of ANC in terms of five elements: woman–provider relations, technical management, information exchange, continuity of care, and appropriate constellation of services. Adequate ANC content was assessed in relation to the frequency of antenatal visits and the time of each visit. Results The results of multivariate logistic regression analyses show that the use of ANC facilities is affected by various factors related to the quality of service delivery. These include receiving information and education on ANC during clinic visits (OR = 9.1; 95% CI = 4.9–16.9), providing pregnant women with opportunities for dialogue and health talks (OR = 7.2; 95% CI = 4.1–12.8), having scheduled follow-up appointments (OR = 6.5; 95% CI = 3.5–12.0), and offering dignified and respectful care (OR = 5.7; 95% CI = 2.5–13.1). At the individual level, our findings have identified a woman’s education level (OR = 1.2; 95% CI = 1.1–1.3), desire for the pregnancy (OR = 1.7; 95% CI = 1.1–2.7), and living in a district served by an ANC clinic (OR = 4.3; 95% CI = 2.3–8.1) as determinants affecting ANC utilization. Conclusion Taking women’s experiences of ANC as a key metric for reporting the quality of the care is more likely to lead to increased utilization of ANC services by women in highly disadvantaged communities. Our findings suggest that the degree to which women feel that they are respected, informed, and engaged in their care has potential favorable implications for ANC.

Objective The purpose of the present study was to compare the physiological and perceived exertion responses of two different interval-training protocols – decreasing- and increasing-distance, matched for total distance, throughout a six-week training period. Methods Forty male physical education students (23 ± 1.3 years) were randomly assigned to either the increasing- or decreasing-distance interval-training group (ITG and DTG). The ITG performed increasing-distance interval training (100–200–300–400–500 m) and the DTG performed decreasing-distance interval training (500–400–300–200–100 m), twice a week for each. Heart rate (HR) and rate of perceived exertion (RPE) responses were monitored in each of the six-week training program sessions. Results Mean HR values were significantly higher (p = .00) in the DTG (181 ± 2.8 bpm) compared with the ITG (163 ± 10.4 bpm). Mean RPE values were significantly higher (p = .00) in the ITG (7.5 ± 0.3 a.u.) compared with the DTG (5.8 ± 0. 6 a.u.). The percent change in RPE responses throughout the six-week training program was significantly greater (p = .00) in the DTG (50% ± 0.7) compared with the ITG (25% ± 0.7). Conclusions The findings demonstrated that physiological responses may not necessarily match the participant's perceived exertion, and that in addition to training physical load, a sensation of relief from the achievement is probably a significant factor to be considered during training.

The aim of the present study was to compare the effect of an increasing-distance interval-training program with a decreasing-distance interval-training program, matched for total distance and recovery times, on blood free radicals and total anti-oxidative capacity (TAC) at rest and following intense exercise. Forty physical education students were randomly assigned to either the increasing- or decreasing-distance interval-training group (ITG and DTG), and completed two similar relevant sets of tests before and after a six-week twicea- week training program. One training program consisted of increasing-distance interval training (100-200- 300-400-500 m) and the other decreasing-distance interval training (500-400-300-200-100 m). Following training, free radical resting levels were significantly higher in the ITG compared to the DTG (7.94 ± 4.76 vs. 3.84 ± 1.49 μmole, respectively, p

Made available in DSpace on 2018-12-11T16:45:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-02 This study aimed to investigate the effect of contact (C-SSG) and no-contact (NC-SSG) handball small-sided games (SSGs) on motion patterns and physiological responses of elite handball players. Twelve male handball players performed 10 C-SSG and 10 NC-SSG while being monitored through the heart rate (HR) and rate of perceived exertion (RPE) as physiological responses and time-motion activities profile using video-match analysis. Both game conditions resulted in similar HR responses (P > 0.05), but the NC-SSG led to a higher RPE scores. The time-motion activity analysis featured NC-SSG with a greater amount of walking (855.6 ± 25.1 vs. 690.6 ± 35.2 m) and backward movements (187.5 ± 12.3 vs. 142.5 ± 8.7 m) combined with fast running (232.3 ± 8.5 vs. 159.7 ± 5.7 m) and sprinting (79.5 ± 4.7 vs. 39.7 ± 3.7 m) activities (P

The aim of the present study was to compare the effect of an increasing-distance, interval-training programme and a decreasing-distance, interval-training programme, matched for total distance, on aerobic and anaerobic physiological indices. Forty physical education students were randomly assigned to either the increasing- or decreasing-distance, interval-training group (ITG and DTG), and completed two similar relevant sets of tests before and after six weeks of training. One training programme consisted of increasing-distance interval-training (100–200–300–400–500 m) and the other decreasing-distance interval training (500–400–300–200–100 m). While both training programmes led to a significant improvement in VO2 max (ES = 0.83–1.25), the improvement in the DTG was significantly greater than in the ITG (14.5 ± 3.6 vs. 7.8 ± 3.2%, p

The aim of the study was to compare the effect of an increasing-distance interval-training program and a decreasing-distance interval-training program, matched for total distance, on aerobic and anaerobic performance capabilities. Forty physical education students were randomly assigned to either increasing- or decreasing-distance interval-training group (ITG and DTG), and completed two similar sets of tests before and after six weeks of training. One training program consisted of 100 – 200 – 300 – 400 – 500m running intervals, and the other 500 – 400 – 300 – 200 - 100m. While both training programs led to a significant improvement in 2000m run (ES = 0.02-0.68), the improvement in the DTG was significantly greater than in the ITG (18.3 ± 3.6 vs. 12.2 ± 3.2 %, p< 0.05). In addition, while both training programs led to a significant improvement in 300m run (ES = 0.25-0.73), the improvement in the DTG was significantly greater than in the ITG (21.1 ± 1.8 vs. 15.4 ± 1.1 %, p< 0.05). The findings indicate that beyond the significant positive effects of both training programs, the DTG showed significant superiority over the ITG in improving aerobic and anaerobic performance capabilities. Athletes should acknowledge that, in spite of identical total work, interval-training program might induce different physiological impacts if order of intervals is different.

Background: Newborn ovary homeobox (NOBOX) gene plays a critical role in the transcriptional regulation of oocyte-specific genes. Previous studies have demonstrated a pathogenic effect of NOBOX variants on premature ovarian insufficiency (POI) patients. Poor ovarian response (POR) is a risk factor for POI. Therefore, genetic variants in the NOBOX gene may also be studied as risk factors for POR development. Aims: The aim of the study is to investigate the association between seven known NOBOX single-nucleotide polymorphisms (SNPs) and POR in Jordanian females. Settings and Design: This was a case–control study of 60 females with POR for controlled ovarian hyperstimulation and 59 healthy females with no history of reproductive problems. Blood samples were collected from the participants and seven SNPs of NOBOX gene were screened. Subjects and Methods: DNA was extracted from blood samples. Polymerase chain reaction with primers specific for seven known SNPs in NOBOX gene was used to amplify the specified region within the gene followed by Sanger sequencing. Results: The seven SNPs investigated in this study, namely, rs77587352 (c.271G>T, p. Gly91Trp), rs7800847 (c.349C>T, p. Arg117Trp), rs193303102 (c.907C>T, p. Arg303X), rs193303103 (c.1025G>C, p. Ser342Thr), rs193303104 (c.1048G>T, p. Val350Leu), rs201947677 (c.1064G>A, p. Arg355His), and rs146227301 (c.1856C>T, p. Pro619Leu), only represent the wild-type allele in both females with POR and healthy participants. Conclusions: The results show that only monomorphic genotype of the NOBOX variants was found in Jordanian females studied.

Repeated anaerobic conditions during athletic performance may cause general and local fatigue that result in postural balance deficit. Evidence suggests that improved postural balance during athletic training may decrease the risk for fallings and traumatic injuries among athletes. Twenty athletes (12 girls, 8 boys) and 20 controls (12 girls, 8 boys) ages 10–15 years participated in the current study. All athletes were active in an 8-month physical activity program, 3 times per week for 90 min., specific to basketball, soccer, or athletic training. The control children participated in physical education at school only, with no involvement in organized extracurricular sports. All participants were evaluated for postural balance in three assessments over one year (at 4-mo intervals); the Interactive Balance System machine (Tetrax device) was used to assess balance at three test times (pre-, post-, and 10 min) after a session of a repeated sprint anaerobic test, consisting of 12 × 20 m run starting every 20 sec. The athletes had better postural balance than controls. There were different group patterns of change over the sessions; a significant interaction of session and group indicated that postural balance of the groups differed. The contribution of low sway frequencies (F1) and high sway frequencies (F6) differed between the controls and the athletes group. Results suggested that although athletes had better postural balance, improvement should be encouraged during training over the sessions and seasons, with special awareness of the balance deficit that occurs immediately after anaerobic stress and at the end of the season, to decrease the risk of injuries.