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Diffuse alveolar haemorrhage (DAH) is known to occur from several infectious and non-infectious aetiologies. Among the infectious aetiologies, Haemophilus influenzae, an organism known to cause community-acquired pneumonia, has not been reported in association with DAH prior to this case. On the other hand, vaping, an evolving epidemic concern, has been linked to various types of lung injury, including DAH. However, DAH related to vaping is only limited to several case reports. Our case describes H. influenzae pneumonia with DAH in a patient known to have vaped until the night prior to elective lobectomy for lung cancer and developed DAH within 24 hours of hospitalisation. He subsequently recovered with treatment. DAH requires immediate recognition, and healthcare providers need to be aware that neither haemoptysis nor decrease in haemoglobin level is necessarily associated. Prior to diagnosis, empirical treatment with intravenous steroids and antibiotics can be life-saving.

Although the Pfizer-BioNTech (BNT162b2), Oxford-AstraZeneca (ChAdOx1 nCoV-19), Sinopharm (BBIBP-CorV), and Sputnik V coronavirus disease 2019 (COVID-19) vaccines have been granted emergency approval in many nations, their safety has never been studied and compared in one community-based study. This study aimed to investigate and compare the incidence, nature, severity, and predictors of adverse events following immunization (AEFIs) with COVID-19 vaccines.This was a prospective observational study conducted in Jordan between 1 January and 21 September 2021. A team of pharmacists and nurses (n = 407) collected the local and systemic AEFIs of four COVID-19 vaccines by prospectively contacting participants registered in the national vaccination program platform. A red-flag technology was inserted to classify and track rare and serious AEFIs.This study included 658,428 participants who were vaccinated with 1,032,430 doses; 610,591, 279,606, 140,843, and 1390 participants received the first and second doses of the BNT162b2, BBIBP-CorV, ChAdOx1 nCoV-19, and Sputnik V vaccines, respectively. The overall incidence of AEFIs was 28.8%, and the overall rates of systemic, local, and immediate hypersensitivity AEFIs were 22.2%, 18.8%, and 0.5%, respectively. The highest proportions of immediate hypersensitivity AEFIs and systemic AEFIs were reported after administration of the Sputnik V vaccine and ChAdOx1 nCoV-19 first dose, respectively. The most severe AEFIs were reported after ChAdOx1 nCoV-19 first dose and BNT162b2 second dose. The hospitalization and mortality rates after vaccination were 20 in 10,000 and 1 in 10,000, respectively. Based on red-flag tracking, the top three outcome events were lymphadenopathy (157.9/100,000), anxiety disorders (136.6/100,000), and lower respiratory tract infection (100.9/100,000), with Guillain-Barré syndrome (1.8/100,000), vasculitis (3.0/100,000), and myopericarditis (4.8/100,000) being the least common.The incidence rates of local, systemic, and immediate hypersensitivity AEFIs of four COVID-19 vaccines occur frequently. High incidence rates of rare and serious AEFIs were reported in this study. Younger participants, females, those who had previously had COVID-19, and smokers were more likely to encounter AEFIs.

Purpose Waterpipe (WP) use has become a global trend in young populations. However, there are few well-controlled studies focusing specifically on the chronic effects of exclusive WP use on young adults' respiratory health. We sought to compare in young adults the burden of respiratory symptoms in regular WP smokers (WPS) relative to regular cigarette smokers (CS, positive controls) and non-smokers (negative controls); and to evaluate differences in health-related quality of life between the three groups. Method We implemented a cross-sectional survey in college campuses across four countries (Egypt, Jordan, Morocco and Oman). Purposive sampling was employed to identify habitual (regular) healthy WPS (smoked 3 or more WP per week for 3 or more years); CS (smoked 5 or more cigarettes daily for 3 or more years); and non-smokers. Respiratory symptoms were assessed using the European Community Respiratory Health Survey and the American Thoracic Society and the Division of Lung Diseases Questionnaire. Health-related quality of life was measured using the Short-Form 12. Demographic, environmental and lifestyle factors also were measured. Result The analytic sample included 135 WPS, 303 CS, and 300 non-smokers. Either tobacco group had significantly greater proportions of males than the non-smoker group. A significantly lower proportion of non-smokers (than either tobacco group) was overweight or obese. Average numbers of reported respiratory symptoms were 5.1, 5.8, and 2.9 in WPS, CS, and non-smokers, respectively. In multivariable regressions controlling for environmental exposures, body mass index, and physical activity, WPS and CS exhibited significantly higher rates of respiratory symptoms than non-smokers (1.6 times greater and 1.9 times greater rate of respiratory symptoms than non-smokers, respectively). Non-smokers reported significantly higher scores for general health relative to either WPS or CS. Conclusion Relative to their young non-smoking counterparts, young habitual WPS exhibit a significant burden of respiratory symptoms that is comparable to that observed with CS. Young WPS (and CS), despite their age, may be well on their way to developing respiratory disease.

Purpose Few studies evaluated ICU readmission in cancer patients. This study aimed to describe the incidence and risk factors for ICU readmission in cancer patients and the association with mortality. Materials and methods A retrospective cohort study at a comprehensive cancer center, which included cancer patients who were discharged after their initial ICU admission over a 5-year period. The characteristics and outcomes of patients who required ICU readmission within 30 days of discharge were compared to those who did not require readmission during the study period. Multivariate analyses were performed to identify factors associated with readmission and to evaluate the association between readmission and mortality. Results Among 1582 patients discharged from the ICU, 313(19.8%) were readmitted after a median of 6 days. The most common readmission diagnoses were respiratory failure and sepsis. Mechanical ventilation (OR 5.80; 95% CI 4.29–7.84) and thrombocytopenia (OR 1.66; 95% CI 1.16–2.38), on the first ICU admission were associated with readmission. Readmission was associated with a higher risk of 28-day and 90-day mortality, (OR 3.02; CI 2.3–4.00) and (OR 3.47; 95% CI 2.69–4.49), respectively. Conclusions ICU readmission was associated with increased mortality. Mechanical ventilation and thrombocytopenia at the first admission were associated with ICU readmission.

Despite inconclusive evidence, chloroquine (CQ) and hydroxychloroquine (HCQ)are commonly used for the treatment of Corona virus Disease 2019(COVID-19) in critically ill patients.It was hypothesized that HCQ as an aerosol application can reach the antiviral concentration of ~1–5 μM in the alveolar cells which has been proven effective in vitro. A physiologically-based pharmacokinetic (PBPK) model of nebulized HCQ for pulmonary delivery to COVID-19 patients using the Nasal-Pulmonary Module in GastroPlus® V9.7 simulator, in order to calculate the necessary inhalation dose regimen of HCQ, was developed. The physiological, drug disposition, and pharmacokinetic parameters were obtained from the literature and used during model building after optimization using Optimization Module, while oral data was used for validation. The 25 mg BID inhalation dosing was predicted to lead to alveolar HCQ levels of 7 µM (above EC50 of ~1–5 µM), and small plasma levels of 0.18 µM (as compared to plasma levels of 3.22 µM after 200 mg BID oral dosing). However, average contact time (>1 µM) is around 0.5 h in lung parts, suggesting indirect exposure response effect of HCQ.The developed PBPK model herein predicted HCQ levels in plasma and different lung parts of adults after multiple inhalation dosing regimens for 5 days. This in-silico work needs to be tested in vivo on healthy subjects and COVID-19 patients using 12.5 mg BID and 25 mg BID inhalation doses.

Background Staging of non-small-cell lung cancer (NSCLC) is a multidisciplinary process involving imaging, endoscopic and surgical techniques. This study aims at investigating the diagnostic accuracy of 18F-FDG PET/CT, CT scan, and endobronchial ultrasound/transbronchial needle aspirate (EBUS/TBNA) in preoperative mediastinal lymph nodes (MLNs) staging of NSCLC. Methods We identified all patients who were diagnosed with NSCLC at the King Hussein Cancer Center in Amman, Jordan, between July 2011 and December 2017. We collected their relevant clinical, radiological, and histopathological findings. The per-patient analysis was performed on all patients (N = 101) and then on those with histopathological confirmation (N = 57), followed by a per-lymph-node-station basis overall, and then according to distinct N-stage categories. Results 18F-FDG PET/CT, in comparison to CT, had a better sensitivity (90.5% vs. 75%, p = 0.04) overall and in patients with histopathological confirmation (83.3% vs. 54.6%), and better specificity (60.5% vs. 43.6%, p = 0.01) overall and in patients with histopathological confirmation in MLN staging (60.6% vs. 38.2%). Negative predictive value of mediastinoscopy, EBUS/TBNA, and 18F-FDG PET/CT were (87.1%), (90.91%), and (83.33%) respectively. The overall accuracy was highest for mediastinoscopy (88.6%) and EBUS/TBNA (88.2%), followed by 18F-FDG PET/CT (70.2%). Dividing patients into N1 disease vs. those with N2/N3 disease yielded similar findings. Comparison between 18F-FDG PET/CT and EBUS/TBNA in patients with histopathological confirmation shows 28 correlated true positive and true negative findings with final N-staging. In four patients, 18F-FDG PET/CT detected metastatic MLNs that would have otherwise remained undiscovered by EBUS/TBNA alone. Lymph nodes with a maximal standardized uptake value (SUVmax) more than 3 were significantly more likely to be true-positive. Conclusion Multimodality staging of the MLNs in NSCLC is essential to provide accurate staging and the appropriate treatment. 18F-FDG PET/CT has better overall diagnostic utility when compared to the CT scan. The NPV of 18F-FDG PET/CT in MLNs is reliable and comparable to the NPV of EBUS/TBNA. SUVmax of MLNs can help in predicting metastases, but nevertheless, a positive 18F-FDG PET/CT MLNs particularly if such a result would change the treatment plan, should be verified histopathologically. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00580-w.

Objective Though research is well established in the developed world, it lags behind in developing countries. We describe a multi-disciplinary, structured, mentor-based program that aimed to improve research skills and increase research productivity among critical care practitioners in the Middle East region. Results The program was conducted between October 2016 and September 2017, and enrolled 11 critical care practitioners (5 pharmacists and 6 physicians) with minimal research experience from 5 countries (Jordan, Saudi Arabia, Oman, Egypt, and Sudan).The program addressed three major factors that contribute to low research productivity in developing countries which include: lack of research knowledge and skills, lack of mentorship, and poor preparation of manuscripts. It started with a research proposal workshop and ended with a manuscript writing workshop, with monthly webinars throughout the year about research-related topics. The faculty consisted of 10 clinical instructors, among whom 7 also served as mentors, a biostatistician, and a medical editor. By the end of the program, 7 research projects and 5 manuscripts were completed. According to the program evaluation, participants agreed that the program improved their research skills and the quality of their research.

ObjectivesTo characterize psychological distress and factors associated with distress in healthcare practitioners working during a stringent lockdown in a country (Jordan) with one of the lowest incidence rates of Covid-19 globally.MethodsA cross-sectional online survey sent to physicians, nurses and technicians, and pharmacists working in various hospitals and community pharmacies. Demographic, professional and psychological characteristics (distress using Kessler-6 questionnaire, anxiety, depression, burnout, sleep issues, exhaustion) were measured as were potential sources of fear. Descriptive and multivariable statistics were performed using level of distress as the key outcome.ResultsWe surveyed 1,006 practitioners (55.3% females). Approximately 63%, 13%, 17% and 7% were nurses/technicians, physicians, pharmacists, and other nonmedical personnel (respectively). 32% suffered from high distress while 20% suffered from severe distress. Exhaustion, anxiety, depression, and sleep disturbances were reported (in past seven days) by approximately 34%, 34%, 19%, and 29% of subjects (respectively). Being older or male, perception of effective protective institutional measures, and being satisfied at work, were significantly associated with lower distress. Conversely, suffering burnout; reporting sleep-related functional problems; exhaustion; being a pharmacist (relative to a physician) and working in a cancer center; harboring fear about virus spreading; fear that the virus threatened life; fear of alienation from family/friends; and fear of workload increases, were significantly associated with higher distress.ConclusionDespite low caseloads, Jordanian practitioners still experienced high levels of distress. Identified demographic, professional and psychological factors influencing distress should inform interventions to improve medical professionals’ resilience and distress likelihood, regardless of the variable Covid-19 situation.

Ropień płuca spowodowany przez Serratia marcescens występuje niezwykle rzadko i tylko u osób mających obniżoną odporność. Przedstawiono przypadek uprzednio zdrowej kobiety z ropniem płuca wywołanym przez Serratia, położonym blisko dodatkowego oskrzela sercowego (cardiac bronchus). Pacjentka była leczona odpowiednimi antybiotykami, co doprowadziło do całkowitego wyleczenia zmiany. Opisany przypadek pokazuje, że u osób chorych na schorzenia współistniejące mogą występować nietypowe zakażenia płuc wywołane przez Serratia, związane z odchyleniami anatomicznymi.

The incidence of lung abscess caused by Serratia marcescens is extremely low and is only reported in the immunocompromised population. We present a previously healthy woman with Serratia lung abscess in close proximity with an accessory cardiac bronchus. The patient was treated with appropriate antibiotics which led to complete resolution of the lesion. Our case highlights that individuals without medical co-morbidities may develop atypical lung infections like Serratia when associated with anatomic anomalies.

News media play a critical role in tobacco control. To strengthen this role in Jordan, four newspapers were searched and 1 145 articles between 2011 and 2015 were coded for mention of MPOWER topics and for tone of coverage (neutral, pro-, or anti-tobacco control). Monthly counts, mention of tobacco control topics and the tones were examined. The monthly count of tobacco control-related news items showed an upward trend with an average monthly growth of 16%. Peaks in coverage were observed in synchrony with national tobacco control developments. 'Warn' was the topic most frequently mentioned (46%). 'Protect' was the only topic that showed a statistically significant upward trend over time. A pro-tobacco control tone was more prevalent than an antitobacco control or neutral tone. Thus, efforts are needed to enhance the newsworthiness of certain topics, boost influence on decision-makers and pre-empt industry interference.تغطية مكافحة التبغ في الصحافة الاردنية: استنتاجات لتعزيز دور وسائل الاعلام الاخبارية.رشا بدر، عائشة شتيوي، روان شهاب، نور عبيدات، فراس الهواري.تؤدي وسائل الاعام دورا بالغ الأهمية في مكافحة التبغ. ولتعزيز هذا الدور في الاردن، تم رصد 1145 مقالة بن عامي 2011 و 2015 في أربع صحف أردنية وتصنيفها من حيث اشارتها لموضوعات مكافحة التبغ ونرة التغطية (محايدة، مؤيدة، أو مناهضة لمكافحة التبغ). وتمت دراسة عدد المقالات الشهرية وتكرار ذكرها للموضوعات ونبرتها. وأظهرت النتائج اتجاها صعوديا لعدد الأخبار الصحفية ذات العلاقة بمكافحة التبغ حيث بلغ متوسط النمو الشهري 16 %. كا لوحظ وصول التغطية الى مستويات الذروة بالتزامن مع الاحداث ذات العلاقة بمكافحة التبغ عى المستوى الوطني. وجاء "التحذير" أكثر الموضوعات شيوعا (46 %) في حن كانت "الحماية" هي الموضوع الوحيد الذي أظهر اتجاها صعوديا ذا دلالة احصائية بمرور الوقت. وتبن أن النرة المؤيدة لمكافحة التبغ كانت أكثر انتشارا من النرة المناهضة أو النرة المحايدة. ويلزم بذل الجهود لرفع الأهمية الخبرية لبعض الموضوعات وزيادة التأثر عى صانعي القرار واستباق تدخل شركات التبغ.Couverture de la lutte antitabac dans les journaux jordaniens : implications pour le renforcement du rôle des médias d’information.Les médias d’information jouent un rôle crucial dans la lutte antitabac. Afin de renforcer ce rôle en Jordanie, quatre journaux ont été étudiés et 1145 articles publiés entre 2011 et 2015 ont été codés lorsqu’ils comportaient la mention du programme MPOWER et pour le ton de la couverture (neutre, pour ou contre la lutte antitabac). Les décomptes mensuels, les mentions de sujets relatifs à la lutte antitabac et les tons ont été passés en revue. Le nombre mensuel d’articles traitant de la lutte antitabac a montré une tendance à la hausse, avec une croissance mensuelle moyenne de 16 %. Des pics dans la couverture ont été observés de façon synchrone avec les nouveautés liées à la lutte antitabac au plan national. Les mises en garde étaient le sujet mentionné le plus fréquemment (46 %). La protection était le seul sujet qui affichait une tendance à la hausse significative au cours du temps. Un ton en faveur de la lutte antitabac était plus prévalent qu’un ton défavorable à la lutte antitabac ou un ton neutre. Des efforts sont donc requis pour renforcer la crédibilité de certains sujets, accroître l’influence sur les décideurs politiques, et anticiper l’ingérence de l’industrie du tabac.

AimTo measure the knowledge, perceptions, and practices of Jordanian primary healthcare practitioners (PHCPs) (physicians, nurses, midwives, and nurse aids) employed in Jordanian Ministry of Health (MoH) primary health clinics with respect to counseling on cancer (cancer screening, the signs and symptoms of cancer, and referral for specialized care).BackgroundIntegration of oncology services within primary care is a means of enhancing cancer early detection, and requires involvement of skilled. In the Middle East, little is known about PHCPs’ potential to be providers of such services.MethodsA questionnaire measuring PHCP perceptions and practices related to counseling on cancer screening and diagnosis was distributed to PHCPs across MoH clinics covering the main regions of Jordan.FindingsA total of 322 practitioners responded (75.1% response). Across most activities involving cancer detection, no more than 30% reported performing activities. Roughly half of PHCPs expressed discomfort at providing cancer-related counseling and at least 43% of non-physicians expressed limited confidence in cancer-related counseling. Confidence was a consistent predictor of provision of counseling and confidence in turn was associated with having greater knowledge, having positive a valuation of counseling, and being a physician. Results reveal points where educational efforts can strengthen PHCPs’ provision of cancer control-related services.

Background Smoking cessation is a key step towards improving cancer care and outcomes. However, smoking cessation interventions are underprovided in oncology settings. Within Jordan’s only comprehensive oncology center, we sought to evaluate receipt of care at a smoking cessation clinic and the effect of assisted abstinence through the smoking cessation clinic on short-term (two-year) survival after a cancer diagnosis. Methods We employed a retrospective cohort study design. Cancer registry and smoking cessation clinic data for adult Jordanian cancer patients diagnosed between 2009 and 2016, who also were cigarette smokers, and who received full treatment at King Hussein Cancer Center, were analyzed. Specifically, descriptive statistics of patients who visited the smoking cessation clinic were generated, and short-term (two-year) hazard of death of patients based on whether or not smoking cessation clinic-assisted abstinence occurred, were evaluated. Results There were 3403 patients who met our inclusion criteria. Approximately 21% of cancer patients were seen at the smoking cessation clinic, and significant demographic and clinical disparities in who was being seen [at the smoking cessation clinic] existed. In 2387 patients with available survival data, smokers who never went to the smoking cessation clinic (or were seen only once, or seen a year or more from diagnosis) had a hazard of death 2.8 times higher than smokers who had visited the smoking cessation clinic and who also confirmed they had not smoked on atleast two of their 3-, 6- or 12-month follow-up visits (95% confidence interval [CI] = 1.7–4.6). Non-abstainers at the smoking cessation clinic exhibited a similar disadvantage (HR 2.7, 95% CI 1.4–5.0). Conclusions Although evidence-based smoking cessation interventions increase the likelihood of abstinence and can lower the short-term hazard of death during cancer treatment, there is a deprioritization of smoking cessation interventions during cancer care, as indicated by low proportions of patients seen at the smoking cessation clinic. Our findings emphasize the importance of promoting interventions to avail smoking cessation interventions in oncology settings within the cancer treatment phase.

Diffuse alveolar haemorrhage (DAH) is known to occur from several infectious and non-infectious aetiologies. Among the infectious aetiologies, Haemophilus influenzae, an organism known to cause community-acquired pneumonia, has not been reported in association with DAH prior to this case. On the other hand, vaping, an evolving epidemic concern, has been linked to various types of lung injury, including DAH. However, DAH related to vaping is only limited to several case reports. Our case describes H. influenzae pneumonia with DAH in a patient known to have vaped until the night prior to elective lobectomy for lung cancer and developed DAH within 24 hours of hospitalisation. He subsequently recovered with treatment. DAH requires immediate recognition, and healthcare providers need to be aware that neither haemoptysis nor decrease in haemoglobin level is necessarily associated. Prior to diagnosis, empirical treatment with intravenous steroids and antibiotics can be life-saving.

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting, two-thirds had been providing tobacco treatment for 1 year or less, and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

Background Evidence regarding the health effects of habitual waterpipe smoking is limited, particularly in young smokers. Respiratory health and cardiopulmonary exercise tests were compared in young male habitual waterpipe smokers (WPS) versus non-smokers. Methods 69 WPS (≥3 times/week for three years) and 69 non-smokers were studied. Respiratory health was assessed through the American Thoracic Society and the Division of Lung Diseases (ATS-DLD-78) adult questionnaire. Pulmonary function and cardiopulmonary exercise tests were performed. Self-reported respiratory symptoms, forced expiratory volume in first second (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC ratio, forced expiratory flow between 25 and 75% of FVC (FEF 25–75% ), peak expiratory flow (PEF), exercise time, peak end-tidal CO 2 tension (PetCO 2 ), subject-reported leg fatigue and dyspnea; peak O 2 uptake (VO 2 max), and end-expiratory lung volume (EELV) change from baseline (at peak exercise) were measured. Results WPS were more likely than non-smokers to report respiratory symptoms. WPS also demonstrated: shorter exercise time; lower peak VO 2 ; higher perceived dyspnea at mid-exercise; lower values of the following: FEV 1 , FVC, PEF, and EELV change. Conclusion Habitual waterpipe tobacco smoking in young seemingly healthy individuals is associated with a greater burden of respiratory symptoms and impaired exercise capacity.

Little is known with regard to perceptions and information needs of oncology practitioners in the Middle East as they pertain to smoking cessation (SC) support for cancer patients. We sought to assess these in a regional cancer center. A survey was distributed to oncology practitioners (physicians, nurses, pharmacists, and physio- and respiratory therapists) at King Hussein Cancer Center (Amman, Jordan) for self-completion. The survey included SC-related measures of perceptions, knowledge, and practices. Descriptive statistics and cross tabulations were performed to identify misperceptions and knowledge gaps that could be corrected through continuing education. Findings revealed, among 254 practitioners surveyed, low referral rates to the SC clinic. Negative perceptions about cancer patients who smoke existed (e.g., patients needing smoking to control anxiety; patients' willpower sufficient for quitting; patients not wanting to quit and not needing more information). Substantial knowledge gaps were prevalent with regard to the detrimental outcomes associated with continued tobacco use after a cancer diagnosis and with regard to approved SC medication choices. Our results are useful in identifying topics that need to be highlighted during training and educational efforts in the region and also reinforce the need to avail such efforts in order to improve SC-related knowledge and perceptions.

Research productivity in the Eastern Mediterranean Region is relatively low in all fields, including critical care. We describe a capacity-building research program that was piloted with 11 clinicians from the Eastern Mediterranean Region, who had minimal research experience. The program was conducted over 1 year, with a structure that specifically addressed factors that contribute to low research productivity. We describe the structure of the program, the faculty involved, the feasibility, and challenges faced, as well as the impact of the program on research output. At a small scale, the program was generally feasible and demonstrated promising results. Evaluating the feasibility of conducting such a program over a longer period of time and with a larger group of participants is necessary since research capacity-building programs require multiple years to demonstrate a significant impact on research output.

Background: During the last decade, the prevalence of carbapenem-resistant infection associated with multidrug resistant (MDR) Acinetobacter baumanniiin patients has been continuously increasing. This prospective study aimed to determine the occurrence and molecular characterization of metallo-β-lactamases (MBLs) and carbapenem hydrolyzing oxacillinases among A. baumannii isolates from cancer patients over a period of 6-month. Methods:Antimicrobial susceptibility profile of 70 randomly collected A. baumannii isolates was first determined using disc diffusion test, and second, the MICs of 45 representative multidrug resistant (MDR) isolates were tested to useful drugs in treatment of their infections using E-test. PCR assays were used to detect the common four types of class D carbapenem hydrolyzing oxacillinases, two types of class A carbapenemases, four types of class B metallo-β –lactamases, and prevalence of Class 1 Integron among MDR isolates. Results: All 70 isolates were MDR, including 100% resistance to meropenom, aztreonem, piperacillin/tazobactum and 99% to carbapenem. All isolates carried blaOXA-23 and blaOXA-51, but none carried a blaOXA-24 like or blaOXA-58. The isolates also were positive for NDM-1, NDM, VIM, GES, KPC and SPM at the rates of 29%, 20%, 29%,19%,7% and 2%, respectively. Class 1 Integron was positive in 82% of A. baumanniiisolates. The clonal relationship of 42 MDR A. baumanniiisolates using ERIC-PCR and constructed dendrogram showed 3 major genotype clusters of genetically related isolates. These include 4 genotype groups, each composed of 2 isolates with 100 % similarity of DNA bands. Conclusion:This study demonstrates that A. baumannii colonize frequently cancer patients in association with antibiotic treatment. The organism is mostly carrying wide spectrum of antibiotic resistance genetic factors, especially many types of ESBLs and MBLs and Class 1 Integron. This fact should be considered when therapy is selected for treatment of patients infected with MDR A. baumannii. Key words. Acinetobacter baumannii, ESBLs, MBLs, Class 1 Integron, Jordanian cancer patients.

Purpose: Limited studies evaluated the predictive value of serum lactate (LA) in critically ill patients with cancer. The main objective of this study was to evaluate the predictive validity of LA single measurements as well as LA clearance in predicting mortality in patients with cancer having septic shock. The study also aimed to determine the LA measurement over the first 24 hours with the highest predictability for hospital mortality. Materials and Methods: A retrospective cohort study of adult patients with cancer having septic shock and LA measurements during the first 24 hours. Three receiver–operating characteristic (ROC) curves were constructed to evaluate the predictive validity for hospital mortality of LA at baseline, at 6 hours and at 24 hours after identifying septic shock. The ROC with the largest area under the curve was analyzed to determine LA level with the highest predictability for hospital mortality. In addition, the ability of LA normalization (LA 10% and >20% at 24 hours) to predict hospital mortality were evaluated by determining the predictive values for each clearance end point. Results: The study included 401 patients. LA >2.5 mmol/L at 24 hours showed the largest area under the ROC curve to predict hospital mortality (ROC area: 0.648; 95% confidence interval: 0.585-0.711) with a sensitivity of 58.4% and specificity of 62.8%. The LA normalization, LA clearance >10%, and LA clearance >20% were also predictors of hospital mortality, with the highest sensitivity for LA normalization at 6 hours (74%) and LA normalization at 24 hours (73.4%). Conclusion: In patients with cancer having septic shock, LA >2.5 mmol/L at 24 hours of septic shock had the highest predictability for hospital mortality. The LA normalization and clearance were also predictors of hospital mortality. However, all LA end points were not strong predictors.

To describe the characteristics and outcomes of Acinetobacter baumannii (AB) infections in critically ill cancer patients and to evaluate the impact of AB on mortality and length of stay (LOS).In a 4-year case-control study of critically ill cancer patients, we identified 161 patients with AB infections and 232 matched patients who were treated in the intensive care unit (ICU) during the same time period, but had no AB cultures. The case and control groups were matched for APACHE II, age, gender, type of malignancy, and mechanical ventilation. Most AB isolates were carbapenem-resistant (n=142, 88.2%). The majority of positive cultures were collected from the respiratory tract (58%) and blood (21.8%). The median ICU LOS and mortality rate for patients with AB infections were higher than those for the control group (12 days [IQR 6-23] vs. 3 days [IQR 1-7], p0.0001 and 73.3% vs. 61.5%, p=0.015, respectively). AB infection was independently associated with ICU LOS and mortality: OR 1.108 (95% CI, 1.077-1.139), OR 1.658 (95% CI, 1.017-2.703), respectively.AB infections in critically ill cancer patients were independently associated with increased mortality and increased ICU LOS. Measures to improve the outcomes of critically ill cancer patients infected with AB are necessary.

Several Eastern Mediterranean (EM) countries, including Jordan, suffer from high smoking prevalence but weak implementation of smoking bans (SB). Public support (PS) influences successful implementation of SB, but little is known about PS for SB in EM countries with weak SB implementation. We conducted a cross-sectional survey measuring knowledge and perceptions of a large purposive sample of the Jordanian public regarding tobacco harms and anti-tobacco laws. Among 1169 respondents, 46% of whom used tobacco, PS for SB varied from 98% to 39% based on venue, being highest for health facilities and lowest for coffee shops. In venues with relatively lower PS (restaurants, coffee shops), lower educational groups, older age groups, nonsmokers, and those who had more knowledge regarding tobacco and secondhand smoke harms were significantly more likely to support SB than the highest educational group, the youngest age group, smokers, and those who had less knowledge (respectively). Our results suggest that aggressive promotion of SB is needed in countries like Jordan (where smoking is increasing), tailored to venue and specific sociodemographic characteristics of the public accessing these venues, particularly restaurants and coffee shops. Multifaceted health messages that enhance public knowledge can be of benefit in improving PS for SB.

Recent studies suggested that high doses of colistin are necessary in the treatment of serious infections. However, few studies have evaluated such treatment. The objective of this study was to evaluate the effectiveness and nephrotoxicity of high-dose colistin in critically ill patients with respiratory infections associated with carbapenem-resistant Acinetobacter baumannii (CRAB).This was a retrospective cohort study of critically ill cancer patients who received high-dose intravenous colistin for treatment of CRAB-related respiratory infections. Patients received colistimethate sodium 9 million IU/day or an equivalent dose, adjusted for renal function. Treatment effectiveness was evaluated by determining the microbiological clearance, recurrent and new CRAB-related infections, and mortality in the intensive care unit (ICU). Nephrotoxicity was defined according to the RIFLE (risk, injury, failure, loss, and end-stage kidney disease) criteria.A total of 89 patients met the inclusion criteria. Microbiological clearance was observed in 51 (66.2%) subjects who had at least 2 follow-up cultures (n = 77). In patients who achieved microbiological clearance, recurrent and new CRAB-related infections occurred in 3 (5.9%) and 9 (17.6%) subjects, respectively. Fifty-seven patients (64%) died in the ICU. Thirty-five (39.3%) subjects developed nephrotoxicity according to the RIFLE criteria, which was classified as risk in 4 (11.4%) subjects, injury in 8 (22.8%) subjects, and failure in 21 (60%) subjects.In critically ill cancer patients, high-dose colistin was associated with microbiological clearance in about two-thirds of the subjects with CRAB-related respiratory infections but mortality was high. A significant portion of patients developed nephrotoxicity while receiving colistin therapy.

Introduction Primary healthcare practitioners (PHCPs) can contribute to the control of cancer by promoting healthy lifestyles to patients. Given the scarcity of data in the Middle East on this subject, we sought to determine, through a cross-sectional survey, the status of healthy lifestyle promotion by PHCPs (physicians, nurses, midwives, nurse aids) in Jordan. Methods Building on published studies, an Arabic questionnaire was developed to measure knowledge, perceptions and practices of Jordanian PHCPs with regard to healthy lifestyle counselling. A purposive sample of 20 clinics covering the main regions of Jordan was selected and all PHCPs were asked to complete the questionnaire. Results 322 practitioners (32.3% physicians) responded (a 75.1% response rate). 24.4% of PHCPs were current cigarette smokers (physicians 44.2%). Roughly 58% of physicians and 50% of non-physicians reported advising the majority of patients to quit tobacco, but proportions were lower for providing other services (eg, asking about frequency of tobacco use, inquiring about diet and exercise, providing evidence-based guidance on quitting tobacco or improving diet and activity). Only 8% of the sample reported collectively asking the majority of patients about smoking status, exercise and diet; and providing evidence-based tips to improve these. Among physicians and non-physicians, 14.2% and 40.4% were able to identify the lifestyle-related risk factors associated with breast, colorectal and lung cancer. In multivariable analyses, confidence was the only significant variable associated with provision of counselling on healthy lifestyles. Conclusions Among Jordanian PHCPs, primary prevention services are underprovided, and data suggest ample room to improve PHCPs9 skills and practices.

Waterpipe tobacco smoking (WTS) has gained popularity, but its physiologic effects have not been extensively studied: rather, studies have focused on WTS's chronic effects or have evaluated limited respiratory/cardiac parameters.We sought to characterize in a more detailed manner the acute effects of WTS on lung function and exercise capacity.We recruited 24 healthy WTS males. We used a pilot single-group pre-test (abstained from WTS for ≥48 h) post-test (within 0.5 h of a 45-min WTS session) design. We performed spirometry, diffusing lung capacity and time-limited CPE testing (CPET; cycloergometer; 2-min 20-Watt warm-up and 25-Watt increase every 2-min for 10 min).Mean age was 20.4 years; Post-WTS, the following significant changes were observed: CO level increased from 3.7 ppm to 24.4; oxygen consumption decreased (from 1.86 L/min to 1.7); baseline respiratory rate increased (from 17.7 breath/min to 19.7); forced expiratory flow over the middle half of the forced vital capacity decreased (from 5.51 L to 5.29); and perceived exertion (measured by Borg scale) at mid and peak exercise increased. Baseline resting systolic blood pressure, pulse pressure, and pulse pressure product increased post-WTS (from 118.9 mmHg to 129.2; from 45.3 mmHg to 55.6; and from 9.9 mmHg/min to 11.1 post-WTS, respectively). During exercise, a decrease in oxygen pulse was observed post-WTS (from 10.89 ml/beat to 9.97), while the heart rate-oxygen consumption relationship increased post-WTS (from 3.52 beats/ml/kg to 3.91).Acute WTS appears to induce impairment in lung function and exercise capacity. Larger studies are warranted to further characterize the nature and extent of such impairment.

BackgroundIn Jordan, four non-graphic pictorial health warning labels (PHWLs) concerning a limited selection of tobacco-caused harms have been used since 2011; however, research suggests that they may be ineffective.ObjectivesTo explore Jordanian smokers’ reactions to novel PHWLs featuring various health themes and/or graphic and symbolic imagery and to discuss existing PHWLs in light of the novel PHWLs.MethodsWe conducted 14 focus groups (FGs) with smokers who assessed 12 novel PHWLs and commented on four existing PHWLs. Data were analysed using an inductive approach.ResultsSix themes emerged from the FG discussions: understanding the overall meaning of PHWLs, the impact of graphic images, magnitude and controllability of harm, personal or vicarious experiences, the futility of quitting and fatalism. PHWLs depicting graphic respiratory and oral tobacco-caused harms resonated with most smokers. Smokers also sought direct, harm-specific taglines when trying to understand the overall PHWL. Some smokers viewed the PHWLs as exaggerated, and while the majority acknowledged that smoking was harmful, they felt that PHWLs would not accomplish their goal of inducing quitting.ConclusionsOur findings support the use of graphic imagery to communicate tobacco-caused harms (particularly respiratory ones) and the use of specific taglines explaining the mechanism of harm depicted.

This study examined smoking cessation support (SCS) by oncologists in a Jordanian cancer center and found it to be deficient. Recommendations to improve SCS include improving patient-provider communication and building providers’ self-efficacy through continuing education.

BACKGROUND In Jordan, a developing country with a high tobacco burden and where roughly 40% of cancers are tobacco-related, limited knowledge exists on public awareness regarding tobacco. This is a hindrance for experts seeking to strengthen anti-tobacco health promotion and counter growing tobacco use. We sought to evaluate public awareness regarding tobacco; to gauge exposure to anti-tobacco public messages; and to draw attention to the lay public's informational needs. MATERIALS AND METHODS A cross-sectional survey of lay public in the capital, Amman, capturing knowledge regarding tobacco harms and anti-tobacco laws, perceptions regarding tobacco use and control, and exposure to and recall of anti-tobacco messages, was conducted. Statistics on perceptions were generated and analyzed by smoking status and sociodemographic factors. Multivariate regression was performed to estimate independent associations of smoking and sociodemographic factors with knowledge. RESULTS Of 1,169 respondents, 17.8% could recall specific anti-tobacco messages. With regard to knowledge, despite high proportions of respondents exhibiting knowledge for individual statements regarding tobacco health harms, variables capturing breadth of knowledge showed that much lower proportions could correctly identify all the listed health harms of tobacco, and all listed Jordanian anti-tobacco regulations (47.5% and 36.2%, respectively). On multivariate analysis, breadth of knowledge varied by smoking status, age and educational level. CONCLUSIONS There is need for more salient, evocative and multi-faceted anti-tobacco messages in Jordan, tailored to subgroups, given detected variability in knowledge across smoking status and sociodemographic characteristics.

The objectives were to determine the rate of cigarette smoking and correlates of its use among a sample of Jordanian adults (N = 600). A survey-based, cross-sectional study was conducted with a convenient sample. Logistic regression was used to determine predictors of being a cigarette smoker. Approximately half of the population (45%) had smoked a cigarette in the past month, 40% in the past week, and 36% in past 24 hours. These findings underscore the magnitude of the smoking problem in the Jordanian population and the urgent need for effective interventions. Future research should focus on developing interventions that incorporate the predictors identified.

Background: Failure to quit smoking in cancer patients is associated with the development of a second primary tumor and a suboptimal response to chemotherapy. However, data characterizing cancer patients' ability to quit is scarce, particularly in developing countries. Such information is valuable in highlighting the potential of cessation interventions in countries where smoking rates are high and antismoking policies are not yet fully implemented. Objectives: To measure the abstinence rates and identify reasons for the failure to quit smoking in patients visiting a smoking cessation clinic in a comprehensive cancer center in Jordan. Methods: Through retrospective medical chart review and prospective follow-up by phone, we studied long-term abstinence rates and reasons for the failure to quit smoking in 156 cancer patients referred to the smoking cessation clinic to receive counseling and pharmacological treatment. Patient demographics, clinical and smoking characteristics and long-term abstinence at 12 months were recorded, as were reasons for the failure to quit smoking. Results: The 12-month abstinence rate was 21.2%. The main reasons for failing to quit smoking included personal or professional stressful situations, not being able to handle withdrawal and the belief that quitting had no value. Conclusion: Abstinence rates in Jordanian cancer patients fall at the lower end of the range that has been reported in the literature for cancer patients. Efforts to improve these rates should focus on assisting patients in handling stress, and in adjusting medications to improve withdrawal symptoms.

A 22-year-old female patient, with synovial sarcoma of the left thigh, was treated with marginal resection and adjuvant chemoradiotherapy. Two years later, she developed sub-pleural metastatic nodules that were resected. Follow-up chest CT-scans revealed small yet new left lower lobe sub-pleural nodules, which were observed closely. These lesions progressed over time and, 20 months later, the patient underwent pulmonary metastasectomy. Histopathology examination of the lung tissue showed changes consistent with a sarcoid-like reaction. There were no systemic manifestations of sarcoidosis. To date, there have been no reported cases of sarcoid-like reaction associated with synovial sarcoma. Reporting this case, therefore, may help to improve our overall understanding of the relationship between malignancy and sarcoid-like reactions in the lungs.

Background and context: Jordan's Public Health Law bans smoking in public places. However, law-enforcement mechanisms are lagging and Jordanians continue to be exposed to second-hand smoke. The Global Tobacco Control Report 2017 rates enforcement at 2/10 dropping even below the previous 3/10 rating of 2015. Aim: Our intervention aims to provide alternative routes for protection from exposure to second-hand smoke. Strategy/Tactics: The intervention builds on results from a 2012 survey which indicated that 85% of the public supports banning smoking in healthcare institutions, schools, and work places. In 2013 King Hussein Cancer Foundation and Center launched the Smoke-free Zone Certificate Program in collaboration with Global Smoke-free Worksite Challenge. The program, currently in its fifth round, recognizes institutions that voluntarily enforce smoke-free environments. Program/Policy process: Interested institutions submit an application requesting certification. Applications go through a screening process to confirm initial alignment with the program criteria. Institutions passing the initial screening are physically inspected for compliance through unannounced spot-check visits. Those passing the inspection receive certification. To qualify, an institution should meet two criteria. The first is enforcing a 100% smoke-free policy within all indoor premises. Designated smoking areas are not allowed. For schools, the criteria require that the smoke-free policy extends to cover both indoor and outdoor premises. The second criterion is that the smoke-free policy should be in effect for a minimum of 9 months on the day of certification. The appeal of the program builds on (1) the institution's belief in the importance of providing a safe and healthy environment, (2) the association of the program with the name of a well-respected national organization, and (3) the media exposure that the certified institutions receive. Active promotion of the program is performed during the application period to recruit additional applicants. Outcomes: Fig. 1 depicts the growth in numbers of applications and of certified organizations. On average 67% of applicants receive certification. Interest varies by category with schools outweighing all other applicants (62%). What was learned: Incentives for voluntary enforcement of smoke-free policies have the potential to support law enforcement. The growing interest and the modifications that institutions undergo to meet the program criteria are a testimony to our success. Several institutions went through three rounds of applications prior to receiving certification, indicating the ability of the program to motivate compliance. There is a need to continue to grow the number of applicants especially in the 'restaurants' and 'healthcare' categories. Sensitization about the benefits of smoke-free environments, technical assistance to interested institutions, and additional media exposure can help. [Figure: see text]

The use of tobacco dates back to hundreds of years and is considered highly addictive. Nicotine is the predominant substance that causes tobacco dependence. Nicotine exerts its effect via similar neurological pathways used by other recreational drugs resulting in high level of dependence. All forms of exposure to tobacco including active use of tobacco, second-hand as well as third-hand exposure to tobacco smoke are known to be harmful. Tobacco is the only risk factor that is common between all non-communicable diseases including cardiovascular diseases, respiratory illnesses, cancer and diabetes mellitus. International consensus regarding the harms of tobacco is now evident. Many international organizations are mapping the way for the end of tobacco. Until then, aggressive treatment for those subjects interested in quitting must be provided in order to prevent a significant surge in non-communicable diseases especially in low income countries. Tobacco dependence is a chronic relapsing disorder that requires a multidisciplinary approach using psychological and pharmacological techniques.International Journal of Human and Health Sciences Vol. 02 No. 03 July’18. Page : 112-125