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Phthalates are endocrine disrupting chemicals that are used in plastic and personal care products. Phthalate exposure has been linked to reproductive and fertility outcomes.This study aimed to assess the phthalate exposures using both urinary level of two DEHP metabolites in females and questionnaires. It also aimed to investigate the association between phthalate levels and reproductive and fertility outcomes.325 females with and without fertility problems at gynaecology clinics filled out a questionnaire and provided a urine sample. Urine samples were analyzed for two DEHP metabolites: MEHHP, mono (2-ethyl-5-hydroxyhexyl) phthalate; MEOHP, mono (2-ethyl-5-oxohexyl) phthalate, using an HPLC/MS/MS analytical method.We observed a significant difference between cases and controls in terms of heating plastic in the microwave and use of skin and eye make-up, sunscreen, and nail polish. Our findings showed that MEOHP exposure is significantly associated with infertility among Jordanian women (Adjusted OR = 1.66, 95% CI: 1.14, 2.40, p-value = 0.002).To the best of our knowledge, our study is the first of its kind done in Jordan to screen for phthalate exposure and investigate its association with infertility. Our study demonstrated high exposure of the Jordanian population to DEHP. It confirms the association between DEHP exposure and infertility.We measured phthalates in infertile and fertile women, in a community unaware of phthalate sources or its impacts, and with no regulation limits set. We aimed to increase awareness to environmental exposure to phthalates, emphasize the importance of implementation of public health interventions to control and minimize the effects of phthalate exposure and provide a base for further studies and future research to aid in the formation of policies and guidelines for the manufacturing and use of phthalates.

Purpose: The aim of the study was to evaluate the usefulness of hard palate measurements in predicting airway dimensions in patients referred for cone-beam CT (CBCT). Materials and Methods: Six hundred forty-three patients (239 males and 404 females) were examined by CBCT. Using dedicated CBCT software (Kodak CS 3D imaging version 3.8.6, Carestream, Rochester, NY, USA); different hard palate (palatal interalveolar length, palatal arch depth, maxillo-palatal arch angle, and alveolar width) and airway measurements (airway volume, minimum cross-sectional area, minimum anteroposterior distance, minimum right to left distance and airway length) were obtained and correlated using Pearson’s correlation coefficients and regression analysis. Results: Although the correlation between hard palate and airway measurements was weak (Pearson coefficient (r) < 0.40), there were significant (P < 0.05) additive effects for hard palate measurements in predicting airway dimensions. Maxillo-palatal arch angle was the only hard palate measurement that had no effect in predicting airway dimensions. Conclusion: Hard palate measurements are considered useful in predicting airway dimensions in patients referred for CBCT.

Nicotine is an alkaloid which only highly exists in tobacco plants. It accounts for 95% of its total alkaloid content. Nicotine is synthesized in the roots and transported via the xylem to the shoo...

Many studies on the toxicity of nanoparticles (NPs) have reported different levels of toxicity for various types of NPs. This study aimed to examine the morpho-ultrastructural impact of iron oxide (Fe3O4) NPs on seed germination in tobacco (Nicotiana tabacum var. Turkish) using different sizes and concentrations of nanoparticles. Seeds were allowed to germinate in the presence of (Fe3O4) NPs of three different sizes (5, 10, and 20 nm) at three different concentrations 3, 10, and 30 mg/L for each size. Seeds were assessed using light and transmission microscopy. Radical lengths and seed germination rate were significantly affected (positively or negatively) in all NPs-treated seeds compared to control seeds. The radical lengths in 5 nm-treated seeds (30 mg/L concentration) and 10 nm-treated seeds (10 and 30 mg/L concentrations) were significantly shorter than control seeds. In contrast, the radical lengths in 10 nm-treated seeds (3 mg/L concentration) and 20 nm-treated seeds (10 mg/L concentration) were significantly longer than control seeds. Most NPs-treated seeds exhibited significant higher seed germination except for seeds treated with 5 nm NPs (3 mg/L concentration). Moreover, thick and thin micrographs of radicles and leaflets of 5 nm NPs-treated seeds (30 mg/L concentration) and 10 nm NPs (30 mg/L concentration) showed structural and ultrastructural deformation. Thus, these findings confirm that the toxicity and the bioaccumulation of (Fe3O4) NPs were size and concentration dependent.

Objective In this study, we aimed to explore the relationship between five selected proinflammatory and immune-mediated genes (TNF rs1800629G>A, rs361525G>A, rs1799964T>C, LTA rs1800683G>A, rs909253A>G, TNFAIP8 rs1042541C>T, LEPR rs1327118G>C, and LEP rs2167270G>A) and the risk and overall survival of DLBCL patients within the Jordanian Arab population. Methods One hundred twenty-five patients (125) diagnosed with DLBCL at the King Abdullah University Hospital (KAUH) between 2013 and 2018 and 238 healthy cancer-free control subjects with similar geographic and ethnic backgrounds to the patients were included in the study. Genomic DNA was extracted from the formalin-fixed paraffin-embedded tissues of the subjects and from peripheral blood samples of the controls. The Sequenom MassARRAY® sequencer system (iPLEX GOLD) was used. The analyses included assessments of population variability and survival. Results Our study showed significant differences in the distribution of the studied polymorphisms of DLBCL between the patients and controls for TNF rs1800629G>A, LTA rs909253 G>A and LEP rs2167270 G>A. TNF rs1800629G>A (p = 0.01), in which the G allele harbors a higher risk of DLBCL (GG and GA genotypes when compared with AA genotype) (p = 0.044). The LTA rs909253 A>G polymorphism is associated with a higher risk of DLBCL in the allelic model (p = .004). LEP rs2167270 G>A polymorphism is associated with a decreased risk of DLBCL in the recessive mode models (p = .03). Subjects with the dominant model for TNF-a rs1799964 (TT genotype in comparison with the combined TT/TC genotype) and patients with the homozygous genotype (GG) of rs361525 have better overall survival rates. Conclusion Our results confirmed the diversity and the heterogeneity of the disease. Although the study has a limitation because of its relatively small size, it clearly emphasizes the significance of ancestry and genetic composition as the determinants of DLBCL risk and behavior. .

Introduction Among the Jordanian population, brain tumors are the tenth most common type of cancers in both males and females, comprising 2.8% of all newly diagnosed neoplasms. Diffuse gliomas are the most prevalent and the most aggressive primary brain tumors in adults. The incidence of diffuse gliomas varies among different populations; this variation is partially linked to genetic polymorphisms. The purpose of the study is to examine the association between (BRCA1 rs799917G>A, rs1799966T>C, EXO1 rs1047840G>A, EME1 rs12450550T>C, ERCC2 rs13181T>G, rs1799793C>T, and XRCC1 rs1799782G>A) DNA repair gene polymorphisms and glioblastoma multiforme (GBM) susceptibility, and survival in the Jordanian Arab population. Methods Eighty-four patients diagnosed with glioblastoma multiforme at the King Abdullah University Hospital (KAUH) between 2013 and 2018 and 225 healthy cancer-free control subjects with similar geographic and ethnic backgrounds to the patients were included in the study. Genomic DNA was extracted from the formalin-fixed paraffin-embedded tissues of the subjects. The Sequenom MassARRAY® sequencer system (iPLEX GOLD) was used. The analyses included assessments of population variability and survival. Results This study is the first to address the relationship between BRCA1 rs1799966 and rs799917 SNP, and the risk of GBM among the Arab Jordanian population. The findings of the study show that BRCA1 rs799917 is associated with decreased risk of GBM in the recessive model (AA vs G/G-A/G: OR, 0.46, 95% CI, 0.26-0.82, p=0.01) and the same SNP is associated with increased risk of GBM in the overdominant model (AG vs G/G-A/A: OR, 1.72, 95% CI, 1.02-2.89, p=0.04).

Magnetism is one of the physical methods affecting water properties. It is considered as an environmental factor that plays a role in the physiological and biochemical reactions. A hydroponic experiment was conducted using four types of treated water (distilled water, magnetically treated distilled water, magnetically treated tap water, and tap water). Tobacco plants (Nicotiana tabacum var. Turkish) were placed in a growth chamber for three weeks. Plants irrigated with magnetically treated distilled water had a significant increase in the physiological parameters including shoot height and root length (P

Background Leptin is a polypeptide hormone that may be implicated in the pathogenesis of various disorders during pregnancy. We sought to determine serum leptin levels among pregnant women and their fetuses and to investigate their association with fetal and maternal variables. Method 452 pregnant women who attended to labor ward between January 2020 and August 2020 were included in the study. Serum leptin concentrations were measured using enzyme-linked immunosorbent assay method. Mann-Whitney U test and Spearman's correlation test were used for statistical analysis. A multivariate linear regression analysis was then performed. Significance level was considered at alpha, Highlights • Leptin is a polypeptide hormone that may be implicated in the pathogenesis of various disorders during pregnancy. • Leptin correlate mainly with adiposity. • Maternal leptin levels are influenced by parity and labour status.

Background: High-grade prostatic intraepithelial neoplasia (HGPIN) is the most likely precancerous lesion for prostatic adenocarcinoma (PCa). Recent molecular studies have shown that HGPIN can harbor TMPRSS2-ERG fusion, a genetic marker also associated with PCa, which may provide an additional risk stratification tool for HGPIN, especially when present as an isolated lesion. Our aim was to assess the frequency of HGPIN and ERG expression in a cohort of prostatic needle core biopsies from Jordanian-Arab patients with PCa. Materials and methods: We studied 109 needle core biopsies from patients with PCa. Clinical data, including age and preoperative prostate specific antigen (PSA) level, were obtained from patients' medical records. Results: HGPIN was present in 31 (28.4 %) of the 109 cases. Of the HGPIN cases, 13 (41.9%) expressed ERG immunostain. ERG expression in HGPIN was independent of patient age at presentation (P=0.4), pre-operative PSA (P=0.9), and the grade, using the novel Grade Groups (P=0.5). Conclusion: The frequency of HGPIN in our cohort appears similar to the one found in the Western patient populations and demonstrates a comparable frequency of ERG expression in these lesions.

Anaemia is a global public health problem particularly in low- and middle-income countries and may be associated with serious health consequences. Limited studies, if any, have examined the prevalence and risk factors of anaemia in Jordan at the national level.This study aimed to assess the prevalence of anaemia in Jordan for both sexes at the national level and to identify high-risk population subgroups.A national population-based household sample was selected from the 12 governorates of Jordan in 2017. A total of 1125 males and 2797 females aged between 18 and 90 years were included. The prevalence of anaemia, overall and among subgroups of the population was estimated using Hb level as per WHO definition.Results showed prevalence of anaemia to be 4.9% in males, 19.3% in non-pregnant females, and 27.4% in pregnant females. The age standardized prevalence rates were 4.9% in males and 19.3% in females. The age standardized prevalence rates were 4.9% in males and 19.3% in females. Anaemia was predominantly mild (males: 81%, non-pregnant females: 57%, and pregnant females: 65.2%). Sex, age, region, marital status, and education were significantly associated with anaemia. Iron deficiency anaemia (IDA) accounted for 68% of anaemic females and 38% of anaemic males.The prevalence of anaemia in Jordan is lower than previously reported by WHO and the majority of anaemia was mild. Iron deficiency anaemia was the the most common type of anaemia, particularly in females. Flour fortification with iron and folic acid could have accounted for the decline of anaemia in Jordan.معدل انتشار فقر الدم والعوامل المحددة له في الأردن.نور عبده، شهد دوجلاس، أنور بطيحة، يوسف خضر، هاشم جدوع، صهيب الخطيب، محمد الخطيب، حسين أبو زيد، كامل عجلوني.يُمثِّل فقر الدم مشكلة عالمية بالنسبة للصحة العامة، لا سيّما في البلدان منخفضة ومتوسطة الدخل، وقد يرتبط بعواقب صحية خطيرة. ولقد قامت دراسات محدودة، إن وجدت، ببحث معدل انتشار فقر الدم وعوامل الخطر المرتبطة به في الأردن على المستوى الوطني.هدفت هذه الدراسة إلى تقييم معدل انتشار فقر الدم في الأردن بين الجنسين على المستوى الوطني، وتحديد الفئات السكانية الفرعية المعرضة للمخاطر المرتفعة.تم اختيار عينة وطنية من الأسر قائمة على السكان من 12 محافظة بالأردن في عام 2017. وشملت 1125 من الذكور و 2797 من الإناث، وتراوحت أعمارهم بين 18 و 90 عامًا. وتم تقدير معدل انتشار فقر الدم بشكل عام وبين الفئات الفرعية من السكان، باستخدام مستوى الهيموجلوبين حسب تعريف منظمة الصحة العالمية.أوضحت النتائج أن معدل انتشار فقر الدم بلغ 4.9 % بين الذكور، و 19.3 % بين الإناث غير الحوامل، و 27.4 % بين الإناث الحوامل. إن معدلات الانتشار الموحدة حسب السن وجدت أنها 4.9 % (للذكور) و 19.3 % (للإناث). ويعد فقر الدم في الغالب خفيفًا (الذكور: 81 % ، الإناث غير الحوامل: 57 %، الإناث الحوامل: 65.2 %). وارتبط نوع الجنس والعمر والمنطقة والحالة الاجتماعية والمستوى التعليمي بفقر الدم بشكل كبير. وبلغ معدل فقر الدم الناجم عن نقص الحديد 68 % عند الإناث المصابات بفقر الدم و 38 % عند الذكور المصابين بفقر الدم.يعد معدل انتشار فقر الدم في الأردن أقل مما أبلغت عنه سابقًا منظمة الصحة العالمية، وكانت أغلب الإصابات بفقر الدم خفيفة. وكان معدل فقر الدم الناجم عن نقص الحديد النوع الأكثر انتشارًا من فقر الدم، لا سيّما بين الإناث. ومن المحتمل أن يكون إغناء الدقيق بالحديد وحمض الفوليك قد أدى إلى انخفاض فقر الدم في الأردن.Prévalence et déterminants de l’anémie en Jordanie.L’anémie est un problème de santé publique mondial, en particulier dans les pays à revenu faible et intermédiaire, qui peut être associé à de graves conséquences pour la santé. Des études limitées ont examiné la prévalence et les facteurs de risque de l’anémie en Jordanie au niveau national.La présente étude visait à évaluer la prévalence de l’anémie au niveau national en Jordanie pour les deux sexes et à identifier les sous-groupes de population à haut risque.Un échantillon national de ménages représentatif de la population a été sélectionné dans les 12 gouvernorats de Jordanie en 2017. Au total, 1125 hommes et 2797 femmes âgés de 18 à 90 ans ont été inclus. La prévalence de l’anémie, dans l’ensemble et parmi les sous-groupes de population, a été estimée en utilisant le taux d’hémoglobine selon la définition de l’OMS.Les résultats ont montré que la prévalence de l’anémie était de 4,9 % chez les hommes, de 19,3 % chez les femmes non enceintes et de 27,4 % chez les femmes enceintes. Les taux de prévalence standardisée selon l’âge s’élevaient à 4,9 % chez l’homme et 19,3 % chez la femme. L’anémie était principalement bénigne (hommes : 81 %, femmes non enceintes : 57 %, et femmes enceintes : 65,2 %). Le sexe, l’âge, la région, la situation de famille et le niveau de scolarité étaient significativement associés à l’anémie. L’anémie ferriprive touchait 68 % des femmes anémiques et 38 % des hommes anémiques.La prévalence de l’anémie en Jordanie est inférieure à celle précédemment signalée par l’OMS et la majorité des cas d’anémie étaient de forme légère. L’anémie ferriprive était le type d’anémie le plus fréquent, en particulier chez les femmes. L’enrichissement de la farine en fer et en acide folique pourrait expliquer la diminution de l’anémie en Jordanie.

Background Influenza infection is associated with a significant health burden in children, especially in developing countries. The influenza vaccine is an important preventive strategy for flu illness. Aim of this study to assess knowledge, attitudes and practices (KAP) related to influenza illness and vaccination in children in the Jordanian population and to study the effect of awareness campaigns on changing the attitudes of parents toward vaccinating their children against influenza. Methods A cross-sectional study was conducted among families visiting shopping malls and parks in November 2016. A questionnaire was administered via in-person interviews. Answers to KAP questions regarding influenza illness and vaccination were summed, with a total KAP score of 30. Facts about influenza illness and vaccination were explained to parents and provided in printed pamphlets. Results There were 1241 respondents. 10.9% of participants had vaccinated their children during the last season 2015/2016. The mean KAP score (standard deviation) was 16.21 (4.61). People living in urban areas, with high monthly income >600 JD and healthcare workers had higher KAP scores than their counterparts. Compared to other sources of information about the influenza vaccine, health resources correlated most with vaccinating children. Awareness and educational pamphlets changed attitudes positively in 29% of parents who refused the influenza vaccine for their children. Conclusions Awareness about influenza illness and vaccination is insufficient, and the coverage rate of influenza vaccination in children is low in the Jordanian population. Implementing public health policies is necessary to spread knowledge about influenza illness and vaccination and to promote the practice of receiving the influenza vaccine in children. Educational campaigns are helpful in changing the attitudes of parents toward vaccinating their children against the flu.

Purpose. To investigate the association between obesity and breast cancer clinicopathologic characteristics at presentation along with prognostic impact among Jordanian breast cancer patients. Such data are lacking in Arabian countries. Methods. In this retrospective study, 348 breast cancer patients were included. Analyses were conducted for associations between body mass index (BMI) and age at diagnosis, tumor clinicopathologic characteristics, and molecular subtypes. Eight prognostic factors were considered, and total prognostic scores were calculated. The analysis was stratified by menopausal status. Multivariate logistic stepwise regression analysis was conducted to identify predictors for breast cancer recurrence and death. Results. Mean age at diagnosis was 50.98 ± 10.96 years. Mean BMI at diagnosis was 29.52 ± 5.32 kg/m2. Mean age at diagnosis was significantly higher for overweight and obese patients compared to underweight/normal patients (P<0.001). A significant positive correlation was observed between patient age and BMI at diagnosis (r = 0.251, P<0.001). Grade of carcinoma was significantly correlated with BMI in the whole population examined (P=0.003). Obese breast cancer patients had significantly higher prognostic scores compared to nonobese cases, indicating worse prognostic features at presentation (P=0.034). Stratification of data analysis based on menopausal status revealed significant associations between obesity and each of tumor stage and grade among postmenopausal but not premenopausal patients (P=0.019 and P=0.031, respectively). Similarly, postmenopausal obese patients had significantly higher prognostic scores compared to nonobese counterparts (P=0.007), indicating worse prognosis, a finding which was also absent among premenopausal breast cancer patients. No significant association between BMI with expression status of hormone receptors, HER2, lymphovascular invasion, and molecular subtypes was found among patients. BMI was a significant predictor for disease recurrence in which obese breast cancer patients had greater odds (2-fold) to develop locoregional and distant recurrence compared to nonobese cases (P=0.011). Conclusions. Obesity was associated with advanced stage and grade of breast carcinoma at diagnosis. The impact of BMI on clinicopathologic characteristics and prognosis was confined to postmenopausal cases. Jordanian obese breast cancer patients are at greater risk of breast cancer recurrence and reduced survival compared to their nonobese counterparts.

Nicotine is an alkaloid which only highly exists in tobacco plants. It accounts for 95% of its total alkaloid content. Nicotine is synthesized in the roots and transportedThis is one of few studies that deal with the impact of exogenous nicotine on plants. However, to the best of our knowledge, this is the first hydroponic study that used liquid pure nicotine implied to the plants. The morphological, physio-biochemical, and anatomical characteristics were investigated using

Study Design: Retrospective study. Objective: To describe the MRI findings of RNRs in patients with low back pain, and observe the imaging findings and the clinical outcome post decompression surgery. Methods: The lumbar spine MRI of 202 patients (122 females) with proven RNRs were retrospectively reviewed. The morphology and the location of the RNRs in relation to the level of stenosis were described. The level(s), grade and cause of lumbar canal stenosis were recorded. The persistence of symptoms and the imaging findings on follow up post decompression surgery were recorded. The imaging findings were correlated among each other and with patients’ demographics. Results: Two distinctive morphological appearance of the RNRs were noted: loop (56.4%), and serpentine-shaped. In the majority of the cases the RNRs were located above the level of stenosis (79.7%). Eighteen patients underwent decompression surgery, only 4 patients remained symptomatic post decompression surgery. The RNRs changed in shape and location after decompression surgery. Age was a strong predictor value in the location of the RNRs. There was no correlation between the shape and location of the RNRs, or with the gender of the patients. Conclusion: RNRs is not an uncommon finding on lumbar spine MRI with lumbar canal stenosis. Its importance remains a controversy. A common language between the radiologists and the clinicians is mandatory to aid in the management planning.

Background Substantial evidence supports a bidirectional relationship between diabetes and clinical depression. However, little is known about the effect of treating one condition on the control of the other. Thus, this study aimed to determine the prevalence of depression among Type II diabetes mellitus (T2DM) patients and to assess the efficacy and feasibility of escitalopram treatment of depression on their metabolic control parameters. Methods T2DM patients attending primary care clinics in the North of Jordan were enrolled in a cross-sectional study during the period from February to December 2019 (n = 157). Depressive symptoms were screened utilising the patient health questionnaire-9 (PHQ-9) tool. Metabolic control was assessed by measurement of glycated haemoglobin (HbA1c), triglycerides, cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Patients with moderate to severe depressive symptoms by PHQ-9 (n = 58) were interviewed by a psychiatrist to confirm a clinical diagnosis of depression. Eligible depressed patients were administered escitalopram 10 mg orally once daily for 3 months (n = 12). Thereafter, depressive symptoms and metabolic control measures were reassessed. Results The prevalence of moderate to severe depressive symptoms among T2DM patients, according to PHQ-9, was 36.94%, while the prevalence of clinical depression based on interview was 7.64%. Baseline PHQ-9 scores correlated significantly with baseline levels of HbA1c, HDL, cholesterol and triglycerides. Escitalopram treatment intervention resulted in significant improvement of PHQ-9 scores without significantly improving any of the metabolic control measures. Conclusion The relationship between depression and T2DM in the context of metabolic syndrome is plausible. However, our results show that escitalopram treatment may not be associated with significant improvement in metabolic control parameters among these patients. Our study has laid the groundwork for future randomised clinical trials with larger sample size and longer follow-up.

Many studies on the toxicity of nanoparticles (NPs) have reported different levels of toxicity for various types of NPs. This study aimed to examine the morpho-ultrastructural impact of iron oxide (Fe

The aim of this study is to genotype thirteen Single Nucleotide Polymorphisms (SNPs) within the paired box gene 9 (PAX9) in 36 Jordanian Arab families with peg-shaped teeth, and also to investigate the association between the PAX9 gene and peg-shaped teeth disorder.Genomic DNA samples were extracted from families according to distinguished processes. Then, DNA was amplified by polymerase chain reaction technique (PCR) using specified primers for the exons of the PAX9 gene. In addition, single nucleotide polymorphisms analysis was conducted using the DNA sequencing genotyping method to identify specific single nucleotide polymorphisms in the PAX9 gene associated with peg-shaped teeth.Thirteen single nucleotide polymorphisms in the PAX9 gene (Chromosome 14q13.3) were used; seven of them (rs104894467, rs104894469, rs28933373, rs28933970, rs28933971, rs28933972, and rs7143727) were non-polymorphic, and the other six were polymorphic (rs2073244, rs2073246, rs2295222, rs4904155, rs4904210, and rs12881240). Both rs12881240 and rs2295222 SNPs showed significant association with peg-shaped teeth disorder (P0.05). Moreover, the haplotype genetic analysis revealed that there is a genetic association with peg-shaped teeth disorder susceptibility (P0.05) in the Jordanian families of Arab descent.Our findings exhibited significant variations compared to the data recorded from other countries.

AIM The prevalence of diabetes has been increasing over the past few decades. The objective of this study is to assess the time trends in diabetes between 1994 and 2017 in Jordan. METHODS Surveys were conducted in 1994, 2004, 2009 and 2017 by the same investigators using generally similar methods. Fasting blood glucose was measured in all surveys. Variables were obtained using structured questionnaires designed specifically for the surveys. Crude and age-specific diabetes prevalence rates were derived for each sex, together with overall, crude and age-standardized prevalence rates. RESULTS The prevalence of diabetes in men aged ≥ 25 years increased from 14.2% in 1994 to 18.3% in 2004, 26.8% in 2009 and 32.4% in 2017. The corresponding prevalence rates in women were 12.3%, 16.9%, 18.8%, and 18.1%, respectively. The overall age-standardized prevalence rate increased from 13.0% in 1994 to 17.1% in 2004, 22.2% in 2009 and 23.7% in 2017. Known diabetes in the 2017 survey accounted for 82.6% of people with diabetes. A HbA1c of

Objectives This study investigated the magnitude of catastrophic health expenditure (CHE) among ex-Gazan households in Jerash camp in Jordan. Study design This retrospective survey used a systematic sample. Methods A systematic sample was used wherein every fifth house in Jerash camp was invited to participate in the study. The camp represents the largest community of ex-Gazan refugees in Jerash camp. Of the 1038 households who were invited, 976 households agreed to participate (response rate = 94%) and filled the pilot-structured questionnaire with information related to their socio-economic characteristics, health status, and their healthcare and total household expenditures. van Doorslaer's method was used to calculate the frequency of CHE, wherein the expenditure on health care was considered catastrophic if it exceeded 10% of a household's total expenditure. Results Of the sample, 41.8% suffered from CHE. Moreover, we calculated the frequency of CHE using 15%, 20%, 30%, and 40% as threshold values, and the total rates were 14.7, 6.3, 1, and 0.3%, respectively. In addition, the statistical analysis of the results showed higher frequencies of CHE in households with larger number of dependents, those headed by widowed women, and those with history of hospitalizations. Conclusions The study shows that the rate of CHE in Jerash camp is very high and mainly due to the cost of hospitalization. Special attention should be paid for the residents of that area.

Caffeine, a purine alkaloid, is reported to act both as an inducer or inhibitor to plant growth in various species. The aim of this study was to examine the effect of exogenous caffeine on tobacco (Nicotiana tabacum) plants, a plant that does not naturally synthesise caffeine. A hydroponic experiment was carried out in a growth chamber for 14 d using Hoagland’s solution supplemented with 0 (control), 25, 50, 100, 1,000; and 5,000 μM caffeine. None of the investigated caffeine concentrations significantly decreased the net photosynthetic rate except the highest concentrations of 1,000 and 5,000 μM. Light microscopy of thick-sectioned roots showed that 1,000 μM and 5,000 μM caffeine-treated plants possessed deformed epidermal cells, reduced number of cortical cells, and deformed vascular tissues with cells exhibiting thickened xylem walls as compared with control plants. Moreover, transmission electron micrographs of roots revealed that mitochondria and the plasma membrane were affected.

Prostate intraepithelial neoplasia is described as a precursor lesion to prostatic adenocarcinoma. High-grade prostate intraepithelial neoplasia (HGPIN) is classified as both grade 2 and 3 prostate intraepithelial neoplasia due to inconsistency between pathologists’ findings. In our study, we assessed the interobserver variability in the diagnosis of HGPIN among genitourinary and nongenitourinary pathologists. All cases with prostate adenocarcinoma diagnosis on needle core biopsy, radical prostatectomy, and transurethral resection of prostate (TURP) between the years 2005 and 2014 were included. In total, 191 prostate cancer cases were included: 109 needle core biopsies, 45 radical prostatectomies, and 37 TURP. All were independently reviewed by 2 urologic pathologists for the presence of HGPIN. High-grade prostate intraepithelial neoplasia was diagnosed in 65 cases (34%), among which the lesion was recognized by the reporting pathologists in 36 (55%) of the cases and was missed in 29 (45%) of the cases with a κ coefficient of 0.53. There was a moderate interobserver agreement in the diagnosis of HGPIN. Consultation with genitourinary pathologist can improve HGPIN diagnosis.

ObjectivesIt is challenging to distinguish between primary ovarian mucinous tumors and metastatic mucinous neoplasms from the lower gastrointestinal tract, including appendiceal tumors. A combination of PAX8 and SATB2 immunohistochemical stains can be used as a diagnostic tool to distinguish between these cases.ResultsImmunostaining for SATB2, PAX8, CK7, CK20 and CDX2 was performed on 50 ovarian mucinous neoplasms (OMN) (39 cystadenomas, 4 borderline and 7 adenocarcinomas), 63 mucinous colorectal carcinoma (CRC), and 9 appendiceal mucinous neoplasms (AMN) [8 low grade appendiceal mucinous neoplasms (LAMN) and 1 adenocarcinoma]. PAX8 was positive in 32% of OMN and negative in all CRC and AMN cases. SATB2 was expressed in 2.0% of OMN, 77.8% of AMN, and 49.2% of CRC cases. CK7 was positive in 78.0% of OMN, 33.3% of AMN, and 9.5% of CRC cases. CK20 was expressed in 24.0% of OMN, 88.9% of OMN, and 87.3% of CRC cases. CDX2 was positive in 14.0% of OMN, 100% of AMN, and 90.5% of CRC cases. PAX8 can differentiate between OMN and AMN with high specificity but low sensitivity. CDX2 is the most sensitive marker for CRC and AMN, whereas SATB2 has better specificity.

Magnetism is one of the physical methods affecting water properties. It is considered as an environmental factor that plays a role in the physiological and biochemical reactions. A hydroponic experiment was conducted using four types of treated water (distilled water, magnetically treated distilled water, magnetically treated tap water, and tap water). Tobacco plants (Nicotiana tabacum var. Turkish) were placed in a growth chamber for three weeks. Plants irrigated with magnetically treated distilled water had a significant increase in the physiological parameters including shoot height and root length (P

Background: High-grade prostatic intraepithelial neoplasia (HGPIN) is the most likely precancerous lesion for prostatic adenocarcinoma (PCa). Recent molecular studies have shown that HGPIN can harbor TMPRSS2-ERG fusion, a genetic marker also associated with PCa, which may provide an additional risk stratification tool for HGPIN, especially when present as an isolated lesion. Our aim was to assess the frequency of HGPIN and ERG expression in a cohort of prostatic needle core biopsies from Jordanian-Arab patients with PCa. Materials and methods: We studied 109 needle core biopsies from patients with PCa. Clinical data, including age and preoperative prostate specific antigen (PSA) level, were obtained from patients’ medical records. Results: HGPIN was present in 31 (28.4 %) of the 109 cases. Of the HGPIN cases, 13 (41.9%) expressed ERG immunostain. ERG expression in HGPIN was independent of patient age at presentation (P=0.4), pre-operative PSA (P=0.9), and the grade, using the novel Grade Groups (P=0.5). Conclusion: The frequency of HGPIN in our cohort appears similar to the one found in the Western patient populations and demonstrates a comparable frequency of ERG expression in these lesions.

Background Since the beginning of the Syrian humanitarian crisis, Syrians sought refuge in many safer countries. Many aspects of Syrian refugees’ lives have been affected, hence affecting the overall quality of their lives. However, only one study has investigated their quality of life (QOL). The aim of this study was to assess the QOL of Syrian refugees residing outside camps in Jordan and compare it to the QOL of Jordanians and to other refugees and populations around the globe. Methods Data were obtained from Syrian refugees residing outside camps in Jordan, and from two Jordanian groups; low socioeconomic status (LSES) Jordanians and average socioeconomic status (ASES) Jordanians in 2017. A total of 661 Syrians, 208 LSES Jordanians and 714 ASES Jordanians, aged between 18 and 75 years were included. The World Health Organization Quality of Life instrument (WHOQOL-BREF) questionnaire was used as the QOL assessment tool. Analysis of Variance “ANOVA” and post hoc Tukey-Honest tests were used to find the differences between the means of QOL questions in the three groups (Syrians, ASES, and LSES). Stepwise multivariate linear regression was performed for each domain to determine the most associated risk factors. Results No significant difference was found between Syrian refugees and LSES Jordanians in the physical health domain. Syrian refugees scored significantly lower than LSES Jordanians in the psychological health and social relationship domain. Syrian refugees scored significantly higher than LSES Jordanians in the environmental domain. ASES Jordanians scored significantly higher than the other two groups in all domains, with all its scores above the average. Discussion Despite the support Jordan provides to the Syrian refugees, they still seem to suffer from poor psychological health, social relationships and environmental domains, with scores below 50 on (0–100) scale. Nonetheless, no significant difference was found between Syrian refugees and LSES Jordanians in the physical health domain, furthermore they scored significantly higher than LSES Jordanians in the environmental domain despite both scoring below 50 on (0–100) scale in this domain. Physical, psychological, and social domains were mainly affected by having a job, having higher income, and being married and free from diseases.

Caffeine (1,3,7-trimethylxanthine) is purine alkaloid, and it is secondary metabolite produced naturally in plants. It plays a crucial role in defense and stress tolerance. A hydroponic experiment was carried out to study the morphological, biochemical, and ultrastructural effects of caffeine treatment on seedlings of tobacco (Nicotiana tabacum L. cv. Turkish). The plants were grown in a growth chamber for 14 d in Hoagland’s nutrient solution supplemented with 0 (control), 25, 50, 100, 1000, and 5000 μM caffeine. Shoot heights as well as root lengths significantly decreased in the plants treated with 1000 and 5000 μM caffeine. Total protein and sugar content in leaves increased significantly in the 5000 μM caffeine-treated plants. Moreover, electron microscopic analysis shows that in plants exposed to 1000 and 5000 μM caffeine, mesophyll cells possessed enlarged chloroplasts with disrupted thylakoid membranes associated with large starch grains and plastoglobules. Scanning electron micrographs exhibit that the vast majority of stomata in the plants treated with 1000 and 5000 μM were closed. In contrast, the 25 and 50 μM caffeine-treated plants showed an enhanced growth and no signs of injury.

Fatigue is a common symptom in multiple sclerosis and has significant impacts on participation and quality of life. Thus, fatigue assessment in this population is always a necessity.to examine the underlying structure, validity and test-retest reliability of an Arabic translated and culturally adapted version of the Modified Fatigue Impact scale (A-MFIS).The study was carried out into two phases: firstly, the English version of the MFIS was translated into Arabic and secondly, a detailed analysis of the psychometric properties and the structure of the translated version was conducted using Principle Component Analysis (PCA). Convergent validity was assessed by comparison with measures of disease severity, quality of life and with another measure of fatigue. Test retest reliability was assessed with intra-class correlations.145 subjects participated in the study. The PCA revealed that the instrument has two main factors "cognitive" and "physical", rather than the original three factors scale. Significant correlations were found between the A-MFIS and measures of disease severity and quality of life (P0.05). Furthermore, the A-MFIS subscale and total scores have good to high test-retest reliability.The A-MFIS has high reliability and concurrent validity with other measures of disease severity and quality of life.

Objective: Using cone beam computed tomography (CBCT) images, the aim of the study was to evaluate the usefulness of measuring bone density of mandibular condyle (BDMC) in patients at risk of osteoporosis. Materials and Methods: Two hundred and four mandibular condyles (46 condyles from males and 158 condyles from females) were examined by CBCT. Using inVivo software (Anatomage, San Jose, Calif), BDMC and mental index (MI) were measured by two observers and correlated using Pearson's correlation coefficients. Patients were divided into high risk and low risk of osteoporosis using 3.1 mm of MI as a cutoff value, and the mean value of BDMC was compared and correlated using independent samples t-test and regression analysis. Receiver-operating characteristic (ROC) curve analyses were also used to examine the predictive power of BDMC. Results: The mean value of BDMC was moderately correlated with MI (r = 0.38), and in female patients at low risk of osteoporosis, the mean value of BDMC was significantly higher than in patients at high risk of osteoporosis. In multivariate linear regression analysis, being at risk of osteoporosis is significantly affected by BDMC, age, and gender. ROC analysis showed that the mean value of BDMC had a moderate predictive power for predicting patients at risk of osteoporosis (area under the curve = 0.621 for females and 0.649 for males). Conclusions: Measuring BDMC is considered useful in predicting patients at risk of osteoporosis.

The East Mediterranean region suffers from high levels of air pollution which has a negative impact on pregnancy outcomes. This work systematically reviews the epidemiological evidence on maternal exposure to air pollution and adverse pregnancy outcomes in the region. Relevant papers and reports published between 2000 and 2014 were searched. Combinations of search terms including countries, exposures, and pregnancy outcomes were used to search for the relevant literature. Twelve articles from 6 countries met the inclusion criteria. There was a pattern of an association between outdoor air pollution and preterm birth and spontaneous abortion; indoor wood fuel smoke and birth weight; and second-hand smoke and birth weight, preterm birth, and spontaneous abortion.The quality of evidence on the impact of air pollution on pregnancy outcomes in the EMR is inadequate to form a base for future adaptation strategies and action plans. Therefore, more quality research is needed to portrait the actual situation in the region

Population-based human in vitro models offer exceptional opportunities for evaluating the potential hazard and mode of action of chemicals, as well as variability in responses to toxic insults among individuals. This study was designed to test the hypothesis that comparative population genomics with efficient in vitro experimental design can be used for evaluation of the potential for hazard, mode of action, and the extent of population variability in responses to chemical mixtures. We selected 146 lymphoblast cell lines from 4 ancestrally and geographically diverse human populations based on the availability of genome sequence and basal RNA-seq data. Cells were exposed to two pesticide mixtures – an environmental surface water sample comprised primarily of organochlorine pesticides and a laboratory-prepared mixture of 36 currently used pesticides – in concentration response and evaluated for cytotoxicity. On average, the two mixtures exhibited a similar range of in vitro cytotoxicity and showed considerable inter-individual variability across screened cell lines. However, when in vitro-to-in vivo extrapolation (IVIVE) coupled with reverse dosimetry was employed to convert the in vitro cytotoxic concentrations to oral equivalent doses and compared to the upper bound of predicted human exposure, we found that a nominally more cytotoxic chlorinated pesticide mixture is expected to have greater margin of safety (more than 5 orders of magnitude) as compared to the current use pesticide mixture (less than 2 orders of magnitude) due primarily to differences in exposure predictions. Multivariate genome-wide association mapping revealed an association between the toxicity of current use pesticide mixture and a polymorphism in rs1947825 in C17orf54. We conclude that a combination of in vitro human population-based cytotoxicity screening followed by dosimetric adjustment and comparative population genomics analyses enables quantitative evaluation of human health hazard from complex environmental mixtures. Additionally, such an approach yields testable hypotheses regarding potential toxicity mechanisms. Keywords: Pesticide, Mixture, Population

Diabetes is a major public health problem worldwide. Depression is a serious mental condition that decreases mental and physical functioning and reduces the quality of life. Several lines of evidence suggest a bidirectional relationship between diabetes and depression: diabetes patients are twice as likely to experience depression than nondiabetic individuals. In contrast, depression increases the risk of diabetes and interferes with its daily self-management. Diabetes patients with depression have poor glycemic control, reduced quality of life, and an increased risk of diabetes complications, consequently having an increased mortality rate. Conflicting evidence exists on the potential role of factors that may account for or modulate the relationship between diabetes and depression. Therefore, this review aims to highlight the most notable body of literature that dissects the various facets of the bidirectional relationship between diabetes and depression. A focused discussion of the proposed mechanisms underlying this relationship is also provided. We systematically reviewed the relevant literature in the PubMed database, using the keywords "Diabetes AND Depression". After exclusion of duplicate and irrelevant material, literature eligible for inclusion in this review was based on meta-analysis studies, clinical trials with large sample sizes (n≥1,000), randomized clinical trials, and comprehensive national and cross-country clinical studies. The evidence we present in this review supports the pressing need for long, outcome-oriented, randomized clinical trials to determine whether the identification and treatment of patients with these comorbid conditions will improve their medical outcomes and quality of life.

TMPRSS2/ERG fusion was found to be the most common genetic event in prostate adenocarcinoma. There is a strong correlation between the fusion and ERG-positive immunostaining. Many studies showed racial variation in ERG expression in prostate cancer patients. There is no data however on the rate of ERG-positive cancer in Jordanian or Arab population. We evaluated the frequency and the significance of ERG fusion in Jordanian-Arab population using immunohistochemistry for ERG. The cohort included 193 prostate cancer specimens: 109 needle core biopsies, 45 radical prostatectomies, 37 transurethral resections of prostate, and 2 enucleation specimens. We found ERG reactivity in 64 (33.2%) of evaluated cases. The observed ERG frequency in the Jordanian-Arab population is lower than the one documented in North America, but it is higher than in Asian patient cohorts. The ERG positivity was significantly associated with lower baseline prostate-specific antigen but was unrelated to patient age, Gleason Score, or the novel Gleason Grade Groups. In the 45 prostatectomy cases, ERG did not correlate with the pathologic stage, margin, nodal status, and the biochemical recurrence, and it did not appear to represent an important prognosticator.

B-cell lymphomas can be classified as Hodgkin and non-Hodgkin lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin Lymphoma (NHL). The incidence of NHL is variable and affected by age, gender, racial, and geographic factors. There is strong evidence that the immune-regulatory cytokines have a major role in hematologic malignancies. In this study, we analyzed the relationship between seven single nucleotide polymorphisms (SNPs) in two selected cytokines (IL-6 rs1800795G &gt, C, rs1800796G &gt, C, rs1800797G &gt, A, IL-10 rs1800871G &gt, A, rs1800872G &gt, T, rs1800890A &gt, T, rs1800896T &gt, C) and the risk and overall survival of DLBCL patients in a Jordanian Arab population. One hundred and twenty-five DLBCL patients diagnosed at King Abdullah University Hospital (KAUH) from the period 2013&ndash, 2018 and 238 matched healthy controls were included in the study. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissues. Genotyping of the genetic polymorphisms was conducted using a sequencing protocol. Our study showed no significant differences in the distribution of all studied polymorphisms of DLBCL between patients and controls. The IL-6 rs1800797 was the only SNP to show significant survival results, DLBCL subjects with the codominant model (GG/AG/AA) genotypes and recessive model (AA genotype in comparison with the combined GG/GA genotype) had worse overall survival (p = 0.028 and 0.016, respectively).

Objective Scorpionism is an endemic public health problem in Jordan encountered by health providers in all parts of the country. This study updates epidemiological data on scorpion sting encounters in Jordan. Methods Data on scorpion sting encounters were obtained from government and military hospitals around the country, and the National Drug and Poison Information Center (NDPIC). P values and 95% confidence intervals (CIs) were calculated using SPSS Professional Statistics Package version 22 (IBM Corp., Armonk, NY) program. Results Epidemiological data on 1205 scorpion sting cases reported between 2006 and 2012 are reported. Male to female ratio was 1.18:1, aged 23.3±16 (mean±SD) and 26.4±16.9 years for males and females, respectively. Age groups between 1 to 20 years old constituted 44.6% of the total sting encounters, while adults aged >30 years constituted 30%. Scorpion sting encounters peaked in July (22.5%) and August (23%), with the lowest numbers of recorded cases in February and January (1.6 and 1.9%, respectively). Scorpion stings occurred mostly outdoors (66%). Medical complications associated with scorpion sting cases included fever, difficulty in breathing, drowsiness and dizziness, and numbness, while severe complications include respiratory failure and tachycardia. Hospitalization required 1 to 3 days among admitted patients with no fatalities. Conclusions Scorpion stings remain a medical problem in Jordan that requires more attention by health providers. Reporting of scorpion sting cases should be enforced from all healthcare centers throughout the country to better understand the epidemiology and health implications of human encounters.

Background. Fear of falling (FOF) is an important risk indicator for health-related outcomes and quality of life in patients with multiple sclerosis (MS). However, factors associated with FOF in MS are not well investigated. Objectives. This study was done to explore predictors of FOF in this population. Methods. Seventy relapsing remitting patients with MS were evaluated. Fear of falling was assessed using the Fall Efficacy Scale–International (FES-I). Motor outcomes included: 30-second chair stand test (30s-CST), Berg Balance Scale (BBS), 10-Meter Walk Test (10MWT), and 6-Minute Walk Test (6MWT). Cognitive status was determined using the Montréal Cognitive Assessment (MOCA) and Symbol Digit Modalities Test (SDMT). Affective factors including depression, fatigue, and sleep were also assessed using the Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Results. Fear of falling was significantly correlated with all motor and affective measures used. However, a stepwise regression found that only BBS from motor measures, MOCA from cognitive measures, and sleep disorders from affective factors were significantly predictive of the FOF. Conclusions. Fear of falling in patients with MS is multifactorial and includes motor and nonmotor factors. Thus, therapies that aim to reduce risk of falling in this population should address motor functions, cognitive abilities, and sleep quality.

Background Cataract, glaucoma, diabetic retinopathy and dry eye disease are common with high prevalence in Jordan. This study aims to assess the awareness of these ocular diseases among Jordanian population. Method A self-designed questionnaire was developed in Arabic and used to interview people in different provinces of Jordan. Socio-demographic data e.g. age, gender and level of education was reported. Public awareness of four ocular diseases; cataract, glaucoma, diabetic retinopathy (DR) and dry eye disease (DED) was assessed. Questions about familiarity with the diseases, familiarity with their risk factors and participants’ source of knowledge were asked. Moreover, awareness of the effect of these disease on the eye whether they are blinding, preventable, treatable and/or the vision is back to normal following treatment was also assessed. Results A total of 802 participants (232 males and 570 females) completed the questionnaire. The average age (± standard deviation) of the study participants was 28 ± 11.6 (range 18 to 80 years old). Awareness of cataract, glaucoma, DR and DED was reported by 31%, 38%, 37% and 52% of the study population, respectively. Family/relatives/friends and mass media appeared to be the most common sources of knowledge. Age and level of education of the participants were significantly associated with the level of disease awareness. Conclusion This work shows that the level of awareness of the four ocular diseases among Jordanians is good and compares with many reports in the developed and developing countries. Familiarity and knowledge about ocular diseases is essential as it would increase the chance of the subject being tested and thus diagnosed early enough if any problem occurred. Better understanding of the disease would encourage subjects to seek medical care sooner which in turn would prevent visual impairment. Therefore, awareness campaigns should be made to target unaware population. Electronic supplementary material The online version of this article (10.1186/s12886-017-0575-3) contains supplementary material, which is available to authorized users.

Exposure to air pollution can cause detrimental health and be an economic burden. With newly developed equipment, monitoring of different air pollutants, identifying the sources, types of air pollutants and their corresponding concentrations, and applying mitigation intervention techniques became a crucial step in public health protection. Countries in the Eastern Mediterranean Region (EMR) are highly exposed to dust storms, have high levels of particulate matter (PM) concentrations, and have a unique climatic as well as topographic and socio-economic structure. This is the first study conducted to systemically and qualitatively assess the health impacts of air pollution in the EMR, identify susceptible populations, and ascertain research and knowledge gaps in the literature to better inform decisions by policy makers. We screened relevant papers and reports published between 2000 and 2014 in research databases. A total of 36 published studies met the inclusion criteria. A variety of indoor and outdoor exposures associated with various acute and chronic respiratory health outcomes were included. Respiratory health outcomes ranged in severity, from allergies and general respiratory complaints to lung cancer and mortality. Several adverse health outcomes were positively associated with various indoor/outdoor air pollutants throughout the EMR. However, epidemiological literature concerning the EMR is limited to a few studies in a few countries. More research is needed to elucidate the health outcomes of air pollution. Standardized reliable assessments on the national level for various air pollutants in different regions should be implemented and made publically available for researchers to utilize in their research. Moreover, advancing and utilizing more sound epidemiological designs and studies on the effect of air pollution on the respiratory health outcomes is needed to portray the actual situation in the region.