Participatory Mathematical Modeling Approach for Policymaking during the First Year of the COVID-19 Crisis, Jordan

We engaged in a participatory modeling approach with health sector stakeholders in Jordan to support government decision-making regarding implementing public health measures to mitigate COVID-19 disease burden. We considered the effect of 4 physical distancing strategies on reducing COVID-19 transmission and mortality in Jordan during March 2020-January 2021: no physical distancing; intermittent physical distancing where all but essential services are closed once a week; intermittent physical distancing where all but essential services are closed twice a week; and a permanent physical distancing intervention. Modeling showed that the fourth strategy would be most effective in reducing cases and deaths; however, this approach was only marginally beneficial to reducing COVID-19 disease compared with an intermittently enforced physical distancing intervention. Scenario-based model influenced policy-making and the evolution of the pandemic in Jordan confirmed the forecasting provided by the modeling exercise and helped confirm the effectiveness of the policy adopted by the government of Jordan.

Real-World Effectiveness of Four Types of COVID-19 Vaccines

BACKGROUND

There is a scarcity of evidence regarding the real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccines. This was the first study to evaluate the effectiveness of four types of vaccines against asymptomatic and symptomatic infection, and COVID-19 outcomes among the general population.

METHODS

This was a matched comparison group quasi-experimental study conducted in Jordan between 1 January and 29 August 2021. In the first part of the study, 1200 fully vaccinated individuals were matched with 1200 unvaccinated control participants. In order to measure vaccine effectiveness, the infection rates of both vaccinated and unvaccinated groups were calculated. The second part of the study included measuring specific anti-SARS CoV-2 immune cells and antibodies.

RESULTS

BNT162b2 (Pfizer, New York, NY, USA) showed a significantly higher effectiveness against asymptomatic COVID-19 infection (91.7%) and hospitalization (99.5%) than BBIBP-CorV (Sinopharm, Beijing, China) (88.4% and 98.7%, respectively) and ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) (84.3%, and 98.9%, respectively). The effectiveness rates of the Sputnik V (Gamaleya Research Institute, Moscow, Russia) vaccine against asymptomatic, symptomatic, and hospitalization were 100%, 100%, and 66.7%, respectively. The highest median anti-spike (S) IgG values were seen in individuals who received BNT162b2 (2.9 AU/mL) and ChAdOx1 nCoV-19 (2.8 AU/mL) vaccines. The levels of anti-S IgG were significantly decreased after 7 months of vaccination with BNT162b2 and BBIBP-CorV. There were significant decreases in the median number of neutralizing antibodies one month and seven months after receiving BNT162b2 (from 88.5 to 75.2 4 Bioequivalent Allergen Unit per milliliter/mL), BBIBP-CorV (from 69.5 to 51.5 BAU/mL), and ChAdOx1 nCoV-19 (from 69.2 to 58.BAU/mL) vaccines. The highest percentage of T cells specific to COVID-19 vaccine was found in individuals who received BNT162b2 (88.5%).

CONCLUSION

All four vaccines evaluated in this study showed effectiveness against asymptomatic COVID-19 infection, symptomatic infection, hospitalization, and death. Furthermore, BNT162b2, BBIBP-CorV, and ChAdOx1 nCoV-19 induced high levels of immunology markers within one month of vaccination.

Pharmacists-physicians collaborative intervention to reduce vaccine hesitancy and resistance: A randomized controlled trial

Purpose

Given their negative influence on community health, vaccine hesitancy and resistance are emerging challenges that require healthcare intervention. Therefore, this study aimed to assess the impact of physician-pharmacist collaborative health coaching on rates of hesitancy and resistance for a COVID-19 vaccine.

Methods

After an initial assessment of rates of hesitancy and resistance for a COVID-19 vaccine was conducted, hesitant and resistant participants were approached, recruited, and randomized into an active and control group. Pharmacists-physicians collaborative coaching intervention was delivered to active group subjects over two months through Facebook live sessions. The outcome measures were assessed in both groups before coaching, directly after coaching, and a month after coaching.

Results

The proportions of hesitancy and resistance for a COVID-19 vaccine among subjects in the active group were significantly reduced from 64.3% and 35.7% before coaching to 20.1% and 7.8% directly after coaching, respectively. These proportions were further reduced to 11.1% and 3.3% a month after coaching, respectively. Furthermore, the mean scores for knowledge on, and attitude towards COVID-19 vaccine were significantly increased from 4.6 ± 1.8 and 4.1 ± 1.7 before coaching to 7.5 ± 3.1 and 8.9 ± 3.8 directly after coaching, respectively. However, the change in mean score of beliefs about COVID-19 vaccines among active group subjects was not significant.

Conclusion

High rates of hesitancy and resistance for a COVID-19 vaccine were found in Jordan. These rates can be significantly reduced through online pharmacists-physicians collaborative coaching, which can also improve knowledge of and attitude towards COVID-19 vaccines.

A three-phase population based sero-epidemiological study: Assessing the trend in prevalence of SARS-CoV-2 during COVID-19 pandemic in Jordan

The evolution of the COVID-19 pandemic in Jordan during the first 10 months of the epidemic was peculiar and can be easily categorized in three different phases: a first period featuring a very low number of reported cases, a second period with exponential growth from August with up to 8000 cases on the 18th November 2020, and a third phase with steady and progressive decline of the epidemiological curve. With the aim of better determine the entity of the population exposed to SARS-CoV-2, the Jordan Ministry of Health with the support of the WHO launched three rounds of the nationwide sero-prevalence survey. Using population proportionate to size (PPS) methodology, around 5000 individuals were selected from all Jordan governorates. Blood samples were collected from all participants and ELISA assays for total IgM, IgG antibodies to COVID-19 were used for testing at the National Public Health Laboratory. Results revealed that seroprevalence dramatically increased over time, with only a tiny fraction of seropositive individuals in August (0.3%), to increase up to more than 20-fold in October (7.0%) and to reach one-third of the overall population exposed by the end of 2020 (34.2%). While non age-specific trends were detected in infection rates across different age categories, in all three rounds of the seroprevalence study two out of three positive participants did not report any sign and/or symptom compatible with COVID-19. The serial cross-sectional surveys experience in Jordan allowed to gain additional insights of the epidemic over time in combination with context-specific aspects like adherence to public health and social measures (PHSM). On the other hand, such findings would be helpful for planning of public health mitigation measures like vaccinations and tailored restriction policies.

A three-phase population based sero-epidemiological study: Assessing the trend in prevalence of SARS-CoV-2 during COVID-19 pandemic in Jordan

The evolution of the COVID-19 pandemic in Jordan during the first 10 months of the epidemic was peculiar and can be easily categorized in three different phases: a first period featuring a very low number of reported cases, a second period with exponential growth from August with up to 8000 cases on the 18th November 2020, and a third phase with steady and progressive decline of the epidemiological curve. With the aim of better determine the entity of the population exposed to SARS-CoV-2, the Jordan Ministry of Health with the support of the WHO launched three rounds of the nationwide sero-prevalence survey. Using population proportionate to size (PPS) methodology, around 5000 individuals were selected from all Jordan governorates. Blood samples were collected from all participants and ELISA assays for total IgM, IgG antibodies to COVID-19 were used for testing at the National Public Health Laboratory. Results revealed that seroprevalence dramatically increased over time, with only a tiny fraction of seropositive individuals in August (0.3%), to increase up to more than 20-fold in October (7.0%) and to reach one-third of the overall population exposed by the end of 2020 (34.2%). While non age-specific trends were detected in infection rates across different age categories, in all three rounds of the seroprevalence study two out of three positive participants did not report any sign and/or symptom compatible with COVID-19. The serial cross-sectional surveys experience in Jordan allowed to gain additional insights of the epidemic over time in combination with context-specific aspects like adherence to public health and social measures (PHSM). On the other hand, such findings would be helpful for planning of public health mitigation measures like vaccinations and tailored restriction policies.

Use of health care resources for varicella in the paediatric population, Jordan

Background

The exact burden of varicella is not well quantified in Jordan.

Aims

This study aimed to estimate the varicella burden in paediatric patients in Jordan who sought care in a hospital-based setting.

Methods

This was a multicentre, retrospective review of medical records of patients aged 0-14 years with a primary varicella diagnosis in Jordan between 2013 and 2018. The data assessed were: use of health care resources for varicella (outpatient and inpatient visits, tests and procedures, and medication use), and clinical complications of the infection. Estimated costs were based on health care resources used (direct costs) and lost revenue to the child's caregiver (indirect costs) for outpatients and inpatients.

Results

In total, 140 children with varicella were included: 78 outpatients, mean age (standard deviation) 4.4 (3.2) years, and 62 inpatients, mean age 4.0 (3.8) years. No outpatients had varicella-related complications, while 32 (52%) inpatients had ≥ 1 complication. The use of health care resources was higher for inpatients than outpatients, including prescription medication use - 94% of inpatients versus 6% of outpatients. Total costs of varicella were estimated at US$ 66.1 (95% CI: 64.1-68.1) per outpatient and US$ 914.7 (95% CI: 455.6-1373.9) per inpatient.

Conclusions

Varicella is associated with considerable use of health care resources in Jordan and may be responsible for annual costs of US$ 11.5 million. These results support universal varicella vaccination in Jordan.

The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries-Argentina, Jordan, and South Africa (2017-2018)

INTRODUCTION

Toward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.

METHODS

In 2017-2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).

RESULTS

Document review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.

CONCLUSIONS

Systematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.

Personal, professional and workplace factors associated with burnout in Jordanian midwives: A national study

OBJECTIVE

To investigate the prevalence of burnout and explore associated socio-demographic and work-related factors among Jordanian midwives.

DESIGN

A cross-sectional survey design. The survey tool included the Copenhagen Burnout Inventory (CBI) and socio-demographic and work-related data forms.

SETTING

All government-funded hospitals in Jordan (18 hospitals) that provide antenatal, labour and birth, or postnatal care for women.

PARTICIPANTS

A sample of 321 midwives participated.

DATA ANALYSIS

Frequencies, means, and standard deviations were calculated as appropriate on the demographic variables and scale scores. The CBI was assessed for internal consistency using Cronbach's alpha. Multiple regression analyses using backward elimination were undertaken to determine associations between variables and CBI subscales. An alpha level of 0.05 was used for all statistical tests.

FINDINGS

Over three-quarters of midwives reported personal (78.1%), work-related (82.2%), and client-related (71.3%) burnout (scored >50 on CBI). Compared to midwives aged between 21 - 30 years, those between 31 - 40 years of age scored on average a 11.75 (95% CI = 7.05 - 16.45) points lower personal burnout score. Married midwives had on average a 6.44 (95% CI = 1.57 - 11.31) points higher personal burnout score compared to single midwives. Midwives with ≥ 10 years' experience had on average a 4.29 (95% CI = 1.93 - 6.64), 5.27 (95% CI = 3.17 - 7.36), and 7.31 (95% CI = 4.84 - 9.78) points lower personal, work-related, and client-related burnout scores respectively compared to midwives with < 10 years' experience.Compared to midwives providing care for 1 - 5 women per shift, those providing care for > 10 women per shift reported 9.98 (95% CI = 6.06 - 13.90) and 5.35 (95% CI = 0.71 - 9.99) points higher work-related and client-related burnout scores respectively. Midwives who rotated between shifts had on average a 5.87 (95% CI = 1.27 - 10.48) and 11.2 (95% CI = 5.78 - 16.66) points higher work-related and client-related burnout scores respectively than those who did not rotate.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The high prevalence of burnout identifies the urgent need for a national plan to address midwives' psychological health in Jordan. Midwives should be appropriately trained to recognize the signs and symptoms of burnout in a timely way, and for support services to be offered. The government could consider implementing continuity of midwifery care models, reducing the administrative burden on midwives, and empowering them to work to their full scope of practice.

Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan

In March 2020, a wedding in Jordan led to a large outbreak of coronavirus disease (COVID-19). We collected data on 350 wedding attendees, 76 who of whom developed COVID-19. Our study shows high communicability of COVID-19 and the enormous risk for severe acute respiratory syndrome 2 virus transmission during mass gatherings.

Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan

INTRODUCTION

Bronchiolitis is a leading cause of hospital admissions and death in young children. Clinical practice guidelines (CPG) to diagnose and manage bronchiolitis have helped healthcare providers to avoid unnecessary investigations and interventions and to provide evidence-based treatment. Aim of this study is to determine the effect of implementing CPG for the diagnosis and management of bronchiolitis in a tertiary hospital in Jordan.

METHODS

The study compared children (age <24 months) diagnosed with bronchiolitis and who required admission to King Abdullah University Hospital in Irbid during the winter of 2017 (after CPG implementation) and age-matched children admitted in the winter of 2016. The proportion of patients receiving diagnostic tests and treatments in the two groups were compared.

RESULTS

Eighty-eight and 91 patients were diagnosed with bronchiolitis before and after CPG implementation, respectively. Respiratory syncytial virus rapid antigen detection testing decreased after CPG implementation [n=64 (72.7%) vs n=46 (50.5%), p=0.002]. However, there was no significant change in terms of other diagnostic tests. The use of nebulized salbutamol [n=44 (50%) vs n=29 (31.9%), p=0.01], hypertonic saline [n=39 (44.3%) vs n=8 (8.8%), p<0.001], and inappropriate antibiotics [n=31 (35.2%) vs n=15 (16.5%), p=0.004] decreased after CPG implementation. There was no difference in mean LOS (standard deviation; SD) between the pre- and post-CPG groups [3.5(2) vs 4 (3.4) days, p=0.19]. The mean cost of stay (SD) was 449.4 (329.1) US dollars for pre-CPG compared to 507.3 (286.1) US dollars for the post-CPG group (p=0.24).

CONCLUSION

We observed that the implementation of CPG for bronchiolitis diagnosis and management helped change physicians' behavior toward evidence-based practices. However, adherence to guidelines must be emphasized to improve practices in developing countries, focusing on the rational use of diagnostic testing, and avoiding use of unnecessary medications when managing children with a diagnosis of bronchiolitis.

Post Syrian war impact on susceptibility rates and trends in molecular characterization of Enterobacteriaceae

Objective: Describe susceptibility and molecular profiles among Enterobacteriaceae pathogens and to explore if war, among other factors, can affect antimicrobial resistance. Methods: Clinical isolates from the Study for Monitoring Antimicrobial Resistance Trends associated with urinary tract and intra-abdominal infections between 2011 and 2015 were identified in Lebanon and Jordan. Susceptibility testing and molecular characterization were performed as per standard methods. Results: A total of 1486 Enterobacteriaceae pathogens (including unusual pathogens) were identified. Incidence rates of  extended spectrum β-lactamases were high with an overall higher prevalence of resistance in Jordan compared with Lebanon. CTX-M-15 was the most prevalent extended spectrum β-lactamases produced and OXA-48 the most reported carbapenemases subtype. Conclusion: Changes in healthcare system due to war could impact regional resistance patterns and which requires a continuous surveillance program and containment plan.

Antibiograms, toxin profiling and molecular typing of Staphylococcus aureus isolates from two tertiary hospitals in Jordan

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-associated infections. This study was undertaken to investigate toxin profiles as well as antibiotic resistance patterns of S. aureus isolates form two tertiary hospitals in Jordan.

METHODOLOGY

A total of 250 S. aureus isolates from clinical samples of two tertiary hospitals were analyzed for the presence of the mecA, vanA, vanB, and 16 Staphylococcus toxin encoding genes using PCR. The isolates were further tested for antimicrobial sensitivities using the disc diffusion method. DNA from all the isolates were fingerprinted by coa gene Restriction Fragment Length Polymorphism (RFLP) to study relationships between isolates from the two hospitals.

RESULTS

73.2% of the isolates contained the mecA gene and thus were designated MRSA. All MRSA isolates showed high levels of resistance to many of the antibiotics compared to those of MSSA. All MRSA isolates were susceptible to vancomycin and teicoplanin while all MSSA isolates were susceptible to nitrofurantoin, teicoplanin, vancomycin, cefoxitin, clindamycin, erythromycin and gentamycin. The isolates exhibited high prevalence of the toxin genes and none of the isolates contained less than 4 genes with one isolate contained 14 genes with no apparent differences in gene profiles among MRSA and MSSA. About 60% of the isolates contained 12 to 13 toxin genes and were isolated either from pus or blood.

CONCLUSION

Antibiograms of the MRSA isolates were significantly different from MSSA antibiograms while there were no apparent differences in the toxin genes profiles. Further, coagulase gene RFLP of the isolates showed that the isolates are very heterogenic.

Estimating the Health and Economic Impact of Universal Varicella Vaccination in Jordan

Background

To evaluate the impact of adding universal varicella vaccination (UVV) to the existing childhood vaccination programme in Jordan, and identify the most cost-effective strategy.

Methods

A dynamic transmission model of varicella infection was calibrated to available varicella seroprevalence data within the region and validated against local epidemiological data. Local direct and indirect costs and healthcare utilization data were used. We considered the health and economic impact of one dose UVV administered concurrently with MMR at 12 months of age with 95% coverage, and two dose strategies with short (6 month) and long (4 year) intervals between First and Second dose. We took the societal perspective (direct and indirect costs) and discounted costs and QALYs by 3%/year to assess cost-effectiveness.

Results

The model estimated the current burden of varicella at 172,000 cases/year, an incidence rate of 2,200/100,000 persons. In the 5^th/25^th year after vaccination, all strategies substantially reduced total varicella incidence by 89.5%/96.6% (1 dose), 92.3%/98.0% (2 dose short), and 90.5%/98.3% (2 dose long), compared with no vaccine (Figure 1). In the absence of vaccination, an estimated $47.89 M ($28.81 M direct, $19.08 indirect) was spent annually on varicella treatment. The average annual total treatment costs over 25 years from the societal perspective were $4.01M (1 dose), $3.34M (2 dose short), and $3.43M (2 dose long). Considering a willingness to pay (WTP) threshold of $3,600 USD / QALY and the societal perspective, the 1 dose program was the most cost-effective with cost savings of $83.40 USD and health gain of 4.127 × 10⁻⁵ QALYs per person. 2 dose programs are similarly cost-saving and highly effective, compared with a scenario of no vaccination; however, moving incrementally from a 1 dose strategy, incremental cost-effectiveness ratios (ICERS) were $6.9M/QALY (short vs. 1 dose) and $13.5M/QALY (long vs. short), both well as above the WTP threshold. All strategies reached.

Conclusion

One or two dose UVV in Jordan will significantly reduce varicella disease burden and is cost saving relative to no vaccine over 25 years.

Disclosures

W. Hayajneh, Merck & Co., Inc.: Consultant, Consulting fee. J. Maalouf, Merck & Co., Inc.: Employee, Salary. B. Kuter, Merck & Co., Inc.: Employee, Salary.T. Weiss, Merck & Co., Inc.: Employee, Salary. V. Daniels, Merck & Co., Inc.: Employee, Salary. L. Wolfson, Merck & Co., Inc.: Employee, Salary.

Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii

Introduction: There has been increased incidence and high mortality in cases with ventilator-associated pneumonia (VAP) caused by colistin-only-susceptible Acinetobacter baumannii (COS-AB). Colistin has emerged as a therapeutic option for VAP caused by multidrug-resistant Gram-negative organisms including COS-AB. A retrospective study was conducted to examine the impact of early versus late initiation of colistin on 30-day mortality of critically ill patients with VAP caused by COS-AB. Methodology: Critically ill patients with VAP caused by COS-AB who received colistin were enrolled. The receiver operating characteristic (ROC) curve was used to identify the temporal breakpoint that maximized the difference in 30-day mortality. Results: A total of 56 patients (34 men and 22 women) were included in the study. About 86% of all cases were late-onset VAP. The 30-day mortality was 46.4%. The rate was higher among patients with admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 18 and patients with a delay of more than four days in initiating colistin treatment. The mortality rate was 26.9% among patients with treatment delay of four or fewer days and 63.3% for patients with a treatment delay of more than four days. Conclusions: A delay of four days or more in initiating colistin in patients with VAP caused by COS-AB significantly increases mortality. Colistin should be considered in the empirical protocols in late-onset VAP cases when COS-AB is highly suspected.

Seroprevalence and genotyping of hepatitis C virus in multiple transfused Jordanian patients with β-thalassemia major

OBJECTIVE

The main objectives of this study are to investigate the prevalence of HCV among patients with β-thalassemia major and to determine the most prevalent genotype for this virus among them.

METHODS

One hundred twenty-two β-thalassemia major patients who were previously diagnosed at the molecular level were included. All plasma samples were tested for the presence of antibodies by ELISA. Real-time polymerase chain reaction (PCR) was used in the quantitation the HCV RNA viral loads, and consequently, patients with high virus titer were genotyped by the linear array.

RESULTS

Forty of the patients were anti-HCV positive. The prevalence of anti-HCV was significantly higher in patients who received blood transfusion before 1993 (83.7%) than in those who received it after 1993 (16.3%) (p=0.000). β-thalassemia major patients with HCV infection had significantly higher rates of elevated aspartate aminotransferase (54.4% vs 40.5%, p=0.045) and alanine aminotransferase (72.47% vs 37.47%, p=0.00) and of splenectomy (54.8% vs 45.2%, p=0.004) than β-thalassemia major patients without HCV.

CONCLUSION

HCV genotype 4 is the commonest genotype in multi-transfused patients with β-thalassemia major in Jordan.

Sonographic assessment of liver and spleen size based on age, height, and weight: evaluation of Jordanian children

BACKGROUND

The growth of the liver and spleen is a dynamic process in children, and is related to the somatic parameters of the child, and may be affected by many diseases in children. It is of paramount importance to have standard reference values for the size of these organs for diagnostic and prognostic purposes. The aim of our study was to provide practical and reliable normal reference values for the size of the liver and spleen in children and to correlate the values with age, height, and weight.

METHODS

Three hundred fifteen children (142 boys and 173 girls) were prospectively examined by ultrasound due to problems unrelated to the liver or spleen. All of the subjects had normal sonographic appearance of their organs. The ages of the subjects ranged from newborns to 14 years. The liver and spleen size was correlated with age, height, and weight. The spleen size was compared with previous internationally published data.

RESULTS

There was no statistical significant difference in the size of the liver and spleen between boys and girls (P>0.05). There was steady increase in the size of the liver and spleen, with good correlation with age and all the somatic parameters. The spleen size was in close proximity to those previously reported in the literature.

CONCLUSIONS

Standard spleen and liver size reference values were obtained by ultrasound for Jordanian children and were in concordance with international values.

Clinical presentations and outcomes of influenza infection among hematology/oncology patients from a single cancer center: pandemic and post-pandemic seasons

BACKGROUND

Influenza can cause severe infection in hematology/oncology patients. The occurrence of the 2009 pandemic represented an opportunity to study the impact of influenza on such patients in pandemic and post-pandemic seasons.

METHODS

We retrospectively reviewed medical records of hematology/oncology patients who had laboratory-confirmed influenza infection during the 2009 pandemic and the first post-pandemic seasons. We assessed influenza-related outcomes in both seasons with emphasis on the development of pneumonia and mortality. We also analyzed factors associated with poor outcomes.

RESULTS

We included 350 patients; 207 were diagnosed in the pandemic and 143 in the post-pandemic seasons. Influenza severity was similar in both seasons with no significant differences in the development of pneumonia or death. Infection with the pH1N1 virus was associated with the development of pneumonia (24.7% vs 14.9%, p = 0.029) but did not affect mortality. A multivariate analysis showed that initiation of antiviral treatment after > 48 h, healthcare acquisition of influenza, and low albumin were independent risk factors for the development of pneumonia (p values 0.022, 0.003, and < 0.0001, respectively). A log-rank test showed increased mortality in patients who received therapy > 48 h after onset of symptoms (p = 0.001).

CONCLUSIONS

In hematology/oncology patients, influenza was as severe in the post-pandemic as in the pandemic season. Pneumonia developed more commonly in patients infected with pH1N1 virus. Healthcare acquisition of infection and low albumin were associated with the development of pneumonia. Delayed initiation of antiviral treatment was associated with both pneumonia and mortality.

Disseminated peritoneal tuberculosis mimicking advanced ovarian cancer

The objective was to evaluate the clinical and radiological features of peritoneal tuberculosis (PTB) that resembled advanced ovarian malignancy. A retrospective review of all patients diagnosed with PTB over a period of 10 years was made. The data included: age, presenting symptom(s), CA125 level, microbiological, histological and cytological studies of the surgical specimens. The radiological and operative findings were also reviewed. A total of 16 patients were identified. The median age was 29.5 years (range 13-65 years). The median CA125 level was 319 U/ml (range 45-1,072 U/ml). The most common symptoms were abdominal distention and pain in 13 patients. Imaging studies showed ascites in all patients. Six patients had laparotomy and 10 had laparoscopy procedure. All patients received anti-tuberculosis treatment and had complete cure. A high index of suspicion of PTB is important to avoid unnecessary extended surgery in relatively young patients with nonspecific clinical features.

Prevalence and distribution of high-risk human papillomavirus genotypes in cervical carcinoma, low-grade, and high-grade squamous intraepithelial lesions in Jordanian women

PURPOSE

To assess high-risk human papillomavirus (HR-HPV) prevalence, and genotype distribution in invasive cervical cancer (CC) and its precursors in Jordanian patients.

MATERIALS AND METHODS

A total of 124 different specimens of formalin-fixed, paraffin embedded samples, including 18 low-grade squamous intraepithelial lesions (LSILs), 28 high grade squamous intraepithelial lesions (HSILs), and 78 CCs were included in this study. HPV detection and typing was done using HPV High Risk Typing Real-TM Kit that enables the concomitant detection of the 12 most common HR-HPVs.

RESULTS

Overall, HR-HPV prevalence was 87.2%, 78.6%, and 72.2% in CC, HSIL, and LSIL respectively. Genotype 16 was the most predominant in all cervical lesions, detected in 53.8%, 46.4%, and 38.9% of CC, HSIL, and LSIL, respectively. Among all HPV genotypes, HPV-16 and HPV-18 were found separately or together in 50% of LSILs, 60.7% of HSILs, and 76.9% of CC specimens. HPV-31 was the second most common type detected in LSILs (22.2%) and HSILs (21.4%). HPV-45 was the third most common type detected in CC (11.5%).

CONCLUSION

The prevalence and genotypes distribution patterns of HR-HPV types among patients with CC and its precursors in Jordan are similar to known international patterns. The results of this study provide baseline information on the HPV type distribution, which may guide the development of CC prevention and control programs in Jordan.

Simultaneous determination of Cd, Pb, Cu, Zn, and Se in human blood of jordanian smokers by ICP-OES

A total of 73 blood samples (56 from smokers and 17 from nonsmokers) were collected to determine the concentrations of selected heavy metal in the whole blood of smokers and nonsmokers living in and around the city of Amman, Jordan. Analysis of heavy metals in the whole blood samples of various groups took in consideration the number of cigarettes smoked per day. The analysis of blood samples was carried out using inductively coupled plasma optical emission spectrometry. This study aimed to evaluate the blood metal levels in smokers and nonsmokers and to assess the influence of smoking cigarettes on blood metal levels. The results were compared with those from a control group. The results indicated that the average concentrations of cadmium (Cd), lead (Pb), copper (Cu), zinc (Zn), and selenium (Se) were 0.0313, 0.344, 2.328, 3.214, and 0.332 mg/L, respectively. Statistical analysis of results indicated that these average concentrations were significantly higher compared with the average concentrations in nonsmokers (P < 0.05). Moreover, the correlations between blood metal and other blood metal levels in smokers, the correlations between blood metal and other blood metal levels in nonsmokers, and the correlations between blood metal concentration in smokers and its concentration in nonsmokers were calculated. The standard reference material (blood serum National Institute of Standards and Technology 1598) and the quality control were used to validate the reliability of the method used for the estimation of heavy metals in blood samples. Results revealed that there was an agreement between the certified values and the measured values.