King Hussein Medical Center

Heart failure with preserved ejection fraction (HFpEF) a major cause of morbidity may be under-diagnosed in primary care, particularly among elderly patients with non-specific complaints. This case describes a 70-year-old hypertensive and obese female patient referred for progressive exertional dyspnea during the previous six months. On presentation, her BNP level was 210 pg/mL, and transthoracic echocardiography demonstrated preserved left ventricular ejection fraction of 60% with diastolic dysfunction consistent with HFpEF. The use of an aggressive multidisciplinary approach to management including diet and lifestyle modification as well as pharmacologic therapy, altogether yielding significant symptomatic improvement and sustained reduction in cardiac biomarkers was noted at 1 year. Ultimately, the patient became asymptomatic with BNP improved significantly and echocardiographic status stabilized. This case demonstrates the need for a low threshold for suspicion of HFpEF in high risk patients and the role of early identification and structured follow up in primary care.

introduction: Triazole compounds and their Acetamide derivatives have received great attention due to their intriguing pharmacological properties. They have become increasingly useful and important in constructing bioactive and functional molecules. materials and methods: Compounds were derived from isophthalic and terephthalic acids. The compounds 6a-d were prepared by reacting the hydrazides of acids with various aryl isothiocyanate followed by refluxing with potassium hydroxide for 6 hours. Different 2-bromo-N-(4-substitutedphenyl) acetamide 3a-f were prepared by reacting different substituted anilines with bromoacetyl bromide in an aqueous solution of sodium carbonate. The compounds 7a-p were then derived by reacting 6a-d with 3a-f for about 30 minutes in an ethanolic solution of potassium hydroxide. The new compounds were fully characterized by 1H-NMR, 13C-NMR, and IR spectroscopy. ABTS and DPPH assays were performed to explore the antioxidant and antimicrobial activity of the compounds 6a-c and 7a-p investigated by employing the broth micro broth dilution method. The cytotoxicity of the newly synthesized compounds was evaluated using CCK-8 kit. results: New compounds were produced with good yields of 60-93%. Thiol compounds 6a-c demonstrated radical inhibition behavior. The inhibition percentage increases with increasing concentration of the compounds in both scavenging assays. Most new compounds 6a-c and 7a-p displayed a MIC value of 128 µg/mL against examined gram negative and gram positive bacteria. All new compounds tested in this study were relatively safe in normal cells and did not instigate undesirable toxic effects. discussion: - conclusion: new compounds were successfully synthesized with good yield, fully characterized, and proved radical scavenging, moderate antibacterial activity and didn’t show desirable cytotoxicity in normal cells.

This study aimed to sequence the PAX9 and MSX1 genes in a group of Jordanian patients diagnosed with non-syndromic hypodontia. The study also examined whether the identified genetic variants in these key odontogenic genes could be used to assess susceptibility to hypodontia. Fifty Jordanian individuals diagnosed with non-syndromic hypodontia were enrolled in this study. Genomic DNA was extracted, and all exons of PAX9 (Exons 1,2, 3, and 4) and MSX1 (Exons 1 and 2) were amplified using PCR. The Sanger sequencing technique was used to detect genetic variants, which were analyzed for their clinical significance and evolutionary conservation. Several previously reported genetic variants were detected. In MSX1, two missense variants, c. 77G>C; p. (Gly26Ala)(rs567549350) and c. 119C>G; p. (Ala40Gly)(rs36059701), and a regulatory variant, c. *6C > T(rs8670), were identified. In PAX9, six genetic variants were found: c. 5-109G>C (rs12883298), c. 5-54A>G (rs1288923), c. 5-41A>G(rs12883049), c. 631+41G>A(rs2236007), c. 717C>T; p. (His239His)(rs12881240) and c. 718G>C; p. (Ala240Pro)(rs4904210). Additionally, the c. *6C > T (rs8670) variant in MSX1 was associated with upper lateral incisor agenesis. The c. -18G>A (rs186861426) variant in MSX1 was evolutionarily conserved across multiple species, suggesting a potential regulatory role in odontogenesis. This study confirmed the presence of several previously reported PAX9 and MSX1 variants among Jordanian individuals with hypodontia. The findings emphasize the importance of genetic screening for hypodontia but suggest that the identified variants are likely benign polymorphisms rather than causative variants. Further studies with larger sample sizes and functional analyses are needed to determine the regulatory impact of non-coding variants and their role in tooth agenesis.

Cocaine use disorder prevalence is around 2.2% for individuals age 12 and older, with higher rates reaching 6.2% in young adults ages 18-25. In 2021 around 23% of all US overdose deaths were related to cocaine. Cannabis use disorder is more prevalent than cocaine use disorder with prevalence reaching 14.7%. This study aims to evaluate the impact of cocaine and cannabis on clinical cardiovascular outcomes. Specifically, it investigates the incidence of new-onset cardiac arrhythmia between the cocaine and cannabis users, as well as the incidence of cardiac arrest events, major adverse cardiovascular events including myocardial infarction (MI) and stroke, and all-cause mortality. We did a retrospective cohort analysis using the TriNetX database of cocaine and cannabis users patients and created two cohorts: cocaine and cannabis. Propensity score matching was employed to reduce baseline disparities.The primary outcome was the incidence of new-onset cardiac arrhythmia. Secondary outcomes included cardiac arrest events, all cause mortality, and occurrence of major adverse cardiovascular events (MI and stroke). After matching, 248,769 patients were included in each cohort (cocaine and cannabis users). New-onset cardiac arrhythmia occurred more frequently in the cocaine group (0.2%) compared to the cannabis group (0.15%) (HR: 1.067; 95% CI: 1.022-1.115, P < 0.035). Cocaine use was also associated with higher rates of the secondary outcomes: cardiac arrest (HR: 1.442; 95% CI: 1.346-1.545, P < 0.001), all-cause mortality (HR: 1.215; 95% CI: 1.187-1.243, P < 0.013), and major adverse cardiovascular events (HR: 1.147; 95% CI: 1.116-1.178, P < 0.001). Cocaine users experience significantly higher rates of new-onset cardiac arrhythmias, cardiac arrest, and major adverse cardiovascular events (MI and stroke) compared to cannabis users. These findings highlight the differing outcomes associated with substance use. Future research should aim to validate our findings through prospective, multicenter studies with standardized diagnostic methods as well as longer-term follow-up to more accurately define the outcomes.

Kaizen events involve multifunctional teams in focused efforts to improve quality, reduce waste, and enhance overall performance, and have been widely applied in healthcare management. This study aims to assess the critical success factors (CSFs) that drive the effectiveness of Kaizen events in hospitals, with a case study of Jordan as a representative low- and middle-income country (LMIC). A descriptive, cross-sectional survey was administered to 815 healthcare professionals across private, government, and military hospitals in Jordan to assess their familiarity with KEs and identify key CSFs. The results showed limited formal knowledge of KEs, while private hospitals demonstrated greater awareness than military and government facilities. The primary CSFs identified were follow-up activities, leadership support, team commitment to change, stakeholder representation, and goal clarity. Successful implementation is hindered by several barriers, including a lack of sponsor support and stakeholder resistance.

Aim Healthcare-associated infections (HCAIs) cause increased morbidity and mortality in intensive care units. The aim of this study is to evaluate the characteristics of resistant, gram-negative infections in a pediatric intensive care unit (PICU) and identify clinical and microbiological risk factors associated with mortality. Comprehending these factors is essential for enhancing patient outcomes and directing treatment interventions in the PICU. Materials and methods Data were collected from pediatric patients admitted to the PICU at Queen Rania Al Abdullah Hospital for Children, Amman, Jordan, between January 2020 and December 2024. Patients with gram-negative multidrug-resistant organism (MDRO) infections receiving antimicrobial treatment were included. Demographic data, antimicrobial drug exposures, and outcomes such as mortality were recorded. Results A mortality rate of 32.3% was observed for the study sample. Gram-negative organisms such as Klebsiella and Escherichia coli showed high resistance to multiple antibiotics. Conclusion Age is a critical factor in predicting survival outcomes in PICUs, highlighting the necessity for customized interventions based on patient demographics and clinical features. The increasing prevalence of multidrug-resistant bacteria in PICUs is a pressing concern that demands immediate attention.

Abstract This study aimed to evaluate whether fibrinogen (FGN) and intercellular adhesion molecule-1 (ICAM-1) mediate the associations between multiple risk factors and the ankle–brachial index (ABI), and to determine whether these associations and mediations differ by sex. We analyzed biomarker data from the Midlife in the United States (MIDUS 3, 2017–2022) study using bias-corrected bootstrapped moderated-mediation models. The analysis assessed the mediating roles of FGN and ICAM-1 in the relationship between seven predictors—body mass index (BMI), low-density lipoprotein (LDL), systolic blood pressure (SBP), age, HbA1c, smoking, and statin use—and ABI. Sex was specified as a moderator, and all continuous covariates were mean-centered. After excluding inapplicable cases, 708 participants were included, with a slight predominance of women (56.6%) and a mean age of 66.2 years (SD = 9.7). In men, FGN fully mediated the association between HbA1c and ABI (coefficient per +5% HbA1c = −0.02; 95% CI: −0.045 to −0.005), partially mediated the negative association between age and ABI (coefficient per +10 years = −0.004; 95% CI: −0.01 to −0.0001), and partially mediated the inverse association between BMI and ABI (coefficient per +10 kg/m2 = −0.01; 95% CI: −0.02 to −0.001), despite a positive total effect of BMI on ABI (coefficient per +10 kg/m2 = 0.05; 95% CI: 0.01 to 0.08). Additionally, FGN mediated (indirect-only mediation) the associations of LDL and smoking history with ABI (coefficient per +30 mg/dL LDL = −0.006; 95% CI: −0.011 to −0.001; coefficient for smoking history = 0.01; 95% CI: 0.001 to 0.02). Among women, only SBP predicted a lower ABI without evidence of mediation (coefficient per +10 mm Hg = −0.01; 95% CI: −0.02 to −0.002). Unexpectedly, higher LDL levels were associated with higher ABI (coefficient per +30 mg/dL = 0.03; 95% CI: 0.01 to 0.04). ICAM-1 showed no significant mediation in either sex. Statin use was not associated with ABI, FGN, or ICAM-1 levels. These findings underscore the importance of investigating sex-specific differences in the pathophysiology and management of peripheral arterial disease (PAD).

This systematic review and meta-analysis evaluated the role of neoadjuvant systemic therapy in enabling partial nephrectomy (PN) for patients with high-complexity or locally advanced non-metastatic renal cell carcinoma (RCC). Thirteen studies, including 359 patients, were analysed, with most investigating vascular endothelial growth factor receptor-targeted tyrosine kinase inhibitors (VEGFR-TKIs), while some assessed immune checkpoint inhibitors (IO) alone or in combination. The pooled results showed that neoadjuvant therapy increased the feasibility of PN, achieving high rates of tumour shrinkage and negative surgical margins. Perioperative outcomes, including blood loss and complications, were comparable to upfront surgery, and severe complications were uncommon. Renal function generally declined following treatment, but nephron-sparing approaches preserved kidney function better than radical surgery. Early survival outcomes, including recurrence-free and overall survival, were favourable across studies. These findings suggest that neoadjuvant therapy may be a safe and effective strategy to expand surgical options in complex renal tumours. However, larger prospective trials are needed to validate these results.

Pulmonary arterial hypertension (PAH) is a severe and potentially life-threatening manifestation of connective tissue diseases, often presenting insidiously and complicating timely diagnosis. We report the case of a 48-year-old Saudi woman with no prior chronic illness who presented with progressive exertional dyspnea and fatigue over six weeks. Examination revealed mild central cyanosis, elevated jugular venous pressure, and a prominent right ventricular heave. Laboratory evaluation showed elevated NT-proBNP and mild hypoxemia, while echocardiography demonstrated right ventricular dilation and an estimated pulmonary artery systolic pressure of 70 mmHg. Right heart catheterization confirmed pre-capillary pulmonary hypertension. Serologic workup revealed high-titer anti-U1 RNP antibodies, ANA positivity, and features consistent with mixed connective tissue disease (MCTD), with no evidence of left heart disease, thromboembolic disease, or significant interstitial lung involvement. Management included combination PAH-targeted therapy with an endothelin receptor antagonist and a phosphodiesterase-5 inhibitor, alongside low-dose corticosteroid immunosuppression. Supportive care comprised oxygen supplementation and close hemodynamic monitoring. Over three months, the patient’s functional status improved from WHO functional class III to II, with reduction in NT-proBNP and increased six-minute walk distance. This case underscores the diagnostic challenge of MCTD presenting primarily with PAH, emphasizing that subtle systemic features may precede cardiovascular compromise. Early recognition, prompt hemodynamic assessment, and a multidisciplinary management strategy are crucial to improve prognosis and prevent irreversible right ventricular dysfunction. Clinicians should maintain a high index of suspicion for PAH in patients with connective tissue disease, even in the absence of overt systemic manifestations.