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Purpose: Hookah (water pipe) smoking, an ancient tobacco smoking method, is gaining widespread popularity worldwide. Although research in this field is still lacking, its harmful effect on human health through the increased risk of cardiovascular disease, infection, and cancer has been proven. Cigarette smoking has been found to have a detrimental effect on reproductive function. However, data about the effect of hookah smoking on human fertility or reproductive outcomes are scarce. In this study, we aimed to determine if smoking hookah has a harmful effect on the human ovarian reserve test, anti-Mullerian hormone levels, and cycle regularity. Materials and Methods: A total of 100 healthy non-cigarette smoking women in the 25-35 age range undergoing laboratory investigations were randomly chosen to participate. After obtaining consent, they completed a questionnaire about smoking habits and menstrual data. Blood samples were withdrawn for anti-Mullerian hormone testing. The anti-Mullerian hormone levels of 50 women hookahonly smokers were compared to 50 non-smoking women. Results: There were no significant differences in mean anti-Mullerian hormone levels and cycle regularity between hookah smokers and non-smokers. However, period pain was significantly associated with hookah smokers relative to non-smokers (p = 0.036). There was an inverse relationship between log10 anti-Mullerian hormone levels and log10 hookah smoking index. This correlation was significant as measured by Spearman’s rho test, and the correlation coefficient was -0.331 and p-value = 0.02. Moreover, binary logistic regression for cycle regularity showed that hookah smoking was associated with an increase in the likelihood of having an irregular cycle, but the effect was not significant (p = 0.514) for hookah smoking. Conclusion: Under the conditions of this study, no significant association between hookah smoking and neither AMH levels nor cycle regularity could be observed.

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

Coronavirus disease 2019 (COVID-19) is emerging contagious pneumonia due to the new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It initially appeared in Wuhan China in December 2019 then rapidly spread worldwide and became a pandemic. For the time being, there is no specific therapeutic treatment for this disease. Herein, the "state-of-the-art" of treatment modalities was systematically reviewed and ultimately a practical therapeutic algorithm for the COVID-19 management was proposed. The systematic review was performed by using published articles retrieved from Science Direct, MEDLINE, and Scopus databases concerning this topic. Among 1060 articles collected from the different databases, 19 publications were studied in-depth and incorporated in this review. The most three frequently used medications for the treatment of COVID-19 was: the available anti-viral drugs (n= 9), the antimalarial hydroxychloroquine or chloroquine (n = 8), and the passive antibody transfer therapy (n = 2). Among all treatment modalities, antimalarial hydroxychloroquine ranked the highest cure rate. Therefore, this drug is considered as the first‐line of COVID-19 treatment. The second‐line treatment includes the lopinavir/ritonavir drugs combined with interferon β-1b and ribavirin. Finally, the third‐line treatments include the remdesivir drug and passive antibody transfer therapy. However, our review emphasis the urgent need for adequately designed randomized controlled trials, enabling a more significant comparison between the most used treatment modalities.

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.

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

Objectives To explore knowledge and attitude about Covid‐19, among Syrian refugee mothers in the Governorate of Irbid, where the first outbreak of Covid‐19 in Jordan took place. Methods This is a cross‐section study among Syrian refugee mothers, who were pregnant or having had children. Data was collected through an online questionnaire. The survey link was distributed in April 2020, through the social network's messaging services Facebook and WhatsApp. Contact information was obtained from local community centres and non‐governmental organisations in the town of Irbid, the north of Jordan. Results In total, 389 Syrian refugee mothers participated in the study. It showed that 66% of mother's access information regarding Covid‐19. The main sources of information were Facebook 87%, WhatsApp 69%, television 53%, while 21% indicated that they access professional databases or government websites. In general, Syrian refugee mothers were knowledgeable about Covid‐19 transmission and prevention. However, they lacked adequate knowledge about transmission of Covid‐19 between the mother and the child, and smoking risks associated with Covid‐19. Conclusions There are gaps in the knowledge and attitude of Syrian refugee mothers in the Governorate of Irbid in relation to the Covid‐19 pandemic. There is a need for further health education measures.

Objectives: This study aimed to assess the knowledge and attitude of babysitters and nursemaids toward providing basic life support (BLS) to infants. Setting: This study was conducted at registered nurseries and daycare centers in rural northern Jordan. Participants: The study involved a convenience sample of 77 child caretakers who were looking after infants. Results: Findings showed that majority of participants were unaware of skills needed to manage foreign body aspiration or administer cardiopulmonary resuscitation on infants. More than two-thirds of the participants had never attended any training or educational session on managing foreign body aspiration among infants. Conclusions: The findings indicated that caregivers in kindergartens and nurseries in rural areas in Jordan lacked awareness of safe infant care. Basic resuscitation skills for urgent cases were insufficient, which could increase the risk of sudden and unexpected child death. Thus, this study strongly recommends training, such as a course on infant life support, for babysitters and care center staff.

Objectives: To explore Knowledge and perceptions about COVID-19, among Syrian refugee mothers in Irbid governorate, the first outbreak of coronavirus in Jordan. Methods: This is an exploratory cross-section study was conducted among Syrian refugee mothers, who were currently pregnant or have a newborn child. The data collected through an online survey in April 2020 in North Jordan. Results: A total of 389 Syrian refugee mothers have participated in the study. The study showed that 66% of mothers often access information regarding COVID-19. The main used resources for information, were Facebook pages’ posters (87%), WhatsApp groups’ messages (69%), Television News (53%). While 21% indicated that they access a professional database or governmental websites. In general, Syrian refugee mothers appear well knowledgeable about COVID-19 the transition ways and prevention measures, and aspects that should be considered when diagnosing Coronavirus cases. However, they appeared to have a lack of knowledge about the aspects that should be considered for the transition of COVID-19 between the mother and the child and the concepts about the smoking risks associated with COVID-19. Conclusions: There is less focusing on media on aspects or still understudying of concepts about the smoking risks associated with COVID-19 and concepts around the transition of COVID-19 between the mother and the child. Providing health education regarding COVID-19 to mothers in Irbid would be helpful.

Emergency peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum hemorrhage. It is associated with a high rate of maternal morbidity among survivors. This work aims to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over 15 years. A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormally adherent placenta were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The chi-square test, Fisher’s exact, and independent sample T test were used for analysis. Statistical significance was declared at α < 0.05. The incidence of peripartum hysterectomy was 1.38 per 1000 births. Fifty-nine were performed after cesarean section and three were performed after vaginal delivery (PP=0.001, OR 16.25, 95% CI 1.95-135.01). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (27.11%). No difference in morbidity was noted between total and subtotal hysterectomy. The incidence of emergency peripartum hysterectomy is increasing steadily over the last two decades in the north of Jordan. Abnormally adherent placenta is the most common indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications’ development, admission to the intensive care unit, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant.

This research study examines academic self-perceptions and course satisfaction among university students and associated factors during virtual classes. A cross-sectional online survey of (n = 328) undergraduate and postgraduate Saudi students who took virtual classes during the second semester of the academic year 2019–2020 and the first semester of the academic year 2020–2021 during the coronavirus disease 2019 (COVID-19) pandemic. The findings demonstrated students’ scores on negative academic self-perceptions (mean (M) = 9.84, standard deviation (S.D.) = 3.09) are significantly higher in comparison to positive academic self-perceptions (M = 7.71, S.D. = 2.46) and the difference was statistically significant, t(327) = 3.69, p &lt, 0.001. The analysis demonstrated that mean differences were significant across ‘year of study’, ‘field of study’, ‘CGPA’ (cumulative grade points average), ‘employment status’, ‘on-site work’ and ‘being a parent of young child’ (p &lt, 0.01). Correlation analysis shows a linear positive association between perceptions of workload and low technical support with negative academic self-perceptions (p &lt, 0.001) and an inverse relationship with positive academic self-perceptions (p &lt, 0.001). The multiple regression analysis demonstrated that the predictor variables in the model (perceptions of workload and technical support) explain 62% variance in negative academic self-perceptions and 41% variance in positive academic self-perceptions. Furthermore, the analysis demonstrated that positive academic self-perceptions bring a 32% variance in course satisfaction. These findings underscore the importance of balancing workload during online studies in higher education and provision of adequate technical support to reduce the negative academic self-perceptions which are associated with lower levels of course satisfaction. Students’ academic self-perceptions and course satisfaction during virtual studies are important factors to retain students’ motivation in learning and academic performance.

Background: Dependent on local policies and availability of expertise it can be normal practice to refer patients will postcoital bleeding (PCB) to the colposcopy clinic despite having a prior negative smear. It is thought that anxiety over concern over the possibility of occult cancer or high grade CIN (CIN2/3) prompts referral. We therefore studied the prevalence of these abnormalities in this patient group and their outcomes. Methods: A retrospective study of all patients referred to the Leeds colposcopy clinics with PCB during the 69-month period from March 2005 to December 2010. Patients were identified from the colposcopy clinic database. Those with an overtly suspicious-looking cervix were excluded. Subsequent histology and cytology results were obtained from the Leeds Teaching Hospitals pathology results server. Smear results not available through the results server were obtained from the West Yorkshire Cervical Screening Authority where possible. Results: A total of 1470 patients were referred to our colposcopy clinics during the study period due to PCB. The overall prevalence of CIN was 12.1% (179/1470) and of high grade CIN was 3.8% (56/1470). There were six cases of cervical cancer (0.4%) (6/1470), all of which had abnormal smears (five had severe dyskaryosis and one with suspected invasion). There was one case of CGIN and one case of endometrial cancer identified in the study group. 1074 out of 1470 women had a negative smear within the previous three years of their referral to the colposcopy clinics. Of the women with a negative smear history, one patient had CGIN (0.09%) (1/1074) in a cervical biopsy, but not in the subsequent LLETZ. The prevalence of CIN was 9.0% (97/1074) and of high grade CIN was 2.2% (24/1073). There were no cases of cervical cancer detected. Conclusion: Postcoital bleeding is a common problem and is reported to be associated with a higher incidence of CIN than in the general population. However, in a woman with a negative smear history and a normal-looking cervix is rarely a sign of significant pathology. It is therefore inappropriate to refer such patients to the colposcopy clinic. Referral to colposcopy should be reserved for selected cases in accordance with NHSCSP guidance. Further study is also needed to standardise the management of post-coital bleeding and indications for referral to the colposcopy clinic.

The association of struma ovarii with Pseudo-Meigs’ syndrome and elevation of CA 125 has been reported in literature. Here we report a 55-year-old with benign struma ovarii who presented with ascites, small left pleural effusion, suspicious left ovarian mass and elevated serum CA 125 level. Repeated cytology tests were negative for malignancy. The radiologic appearance was highly suggestive of an ovarian malignancy and due to her overall state of illness the patient received 3 cycles of chemotherapy. Chemotherapy had no impact on the rate of accumulation of ascites, CA 125 level or the size of the ovarian mass highlighting the need to reconsider the initial diagnosis. Diagnostic left oophorectomy revealed struma ovarii and was followed by resolution of the ascites and normalization of the serum CA 125. No recurrence of the ascites or of the tumor has been observed during the 5 months follow-up. Struma ovarii or other dermoid variants should be considered in the differential diagnosis in patients with ascites, pleural effusions and elevated CA125 level but with negative cytology. Diagnostic laparoscopic oophorectomy should also be considered within the standard protocol for diagnosis of indeterminate adnexal masses.