Search

Mahmoud H Ayesh Haj Yousef,1 Ziad Audat,2 Duha M Al-Shorafat,3 Sohaib Al-Khatib,4 Ammar K Daoud1 1Department of Internal Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Special Surgery, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Neurology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Pathology and Microbiology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Mahmoud H Ayesh Haj Yousef, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Email ayeshmahmoud@hotmail.comBackground: Primary diffuse large B-cell lymphoma of the bone (PB-DLBCL) is a rare type of extra-nodal lymphoma. This study aimed to examine the clinical characteristics, outcomes, treatment modalities and risk of central nervous system relapse (CNSR) among adult Jordanian patients with PB-DLBCL.Methods: This retrospective study included patients aged > 16 years who were diagnosed with PB-DLBCL and treated at our hospital between 2002 and 2021. Clinical characteristics, treatment modalities, outcomes and CNSR events were extracted from the hospital’s data system and analysed. Patients were categorised into unifocal (UF) and multifocal (MF) PB-DLBCL groups according to the number of bone sites involved. The involvement of only one site was defined as UF, whereas the involvement of two or more sites was defined as MF.Results: In total, 12 patients were diagnosed with PB-DLBCL. Their median age was 47.5 years (range, 17– 80 years). The male:female ratio was 1:1. There were eight patients in the UF PB-DLBCL group and four in the MF PB-DLBCL group. All patients received treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. In the UF PB-DLBCL group, the male:female ratio was 5:3, the median age was 41 years, and the follow-up duration was 9– 135 (mean, 83.3) months. In the MF PB-DLBCL group, the male:female ratio was 1:3, the median age was 51.5 years, and the survival time was 3– 11 (mean, 7) months. Three patients with vertebral UF PB-DLBCL underwent early vertebroplasty without complications. The most common site involved was the vertebral column. Most patients with UF PB-DLBCL achieved complete remission (CR), whereas no patients with MF PB-DLBCL achieved CR.Conclusion: PB-DLBCL is rare in adult Jordanian patients. UF PB-DLBCL is more common than MF PB-DLBCL. Patients with UF PB-DLBCL had a good prognosis. Patients with MF PB-DLBCL had a high international prognostic index score, risk of CNSR and short survival time.Keywords: primary diffuse large B-cell lymphoma of the bone, WHO classification of primary bone lymphoma, unifocal, multifocal

The adoption of the Voice over Internet Protocol (VoIP) system is growing due to several factors, including its meagre rate and the numerous contours that can be joined with VoIP systems. However, the wasteful utilisation of the computer network is an inevitable problem that limits the rapid growth of VoIP systems. The essential explanation behind this wasteful utilisation of the computer network bandwidth (BW) is the considerable preamble length of the VoIP packet. In this study, we invent a technique that addresses the considerable preamble length of the VoIP packet. The designed technique is known as the manikin voice frame (MVF). The primary idea of the MVF technique is to utilise the VoIP packet preamble tuples that are not essential to the voice calls, particularly client-to-client calls (voice calls between only two users). Specifically, these tuples will be utilised for reserving the data of the VoIP packet. In certain instances, this will make the VoIP packet data manikin or even make it empty. The performance assessment of the introduced MVF technique demonstrated that the utilisation of the computer network BW has enhanced by 33%. Along these lines, the MVF technique indicates potential progress in resolving the inefficient usage of the computer network BW.

The use of Voice over Internet Protocol (VoIP) innovation is rising due to its various merits. Nevertheless, the ineffective use of bandwidth is a key dilemma that restricts the fast-rising use of VoIP innovation. The main factor behind this ineffective use of the bandwidth is the sizable VoIP packet preamble. This research creates a technique to address this dilemma of packet preamble. The created technique is known as payload elimination (PldE). The fundamental concept of the PldE technique is to exploit the information (elements) of the VoIP packet preamble that is superfluous for point-to-point calls. In general, these elements are utilized to transport the payload of VoIP packets. Consequently, the payload size of VoIP packet will be lowered or removed, preserving the available bandwidth. The performance test of the PldE technique indicated an improvement of up to 41.6% in the exploitation of IP network bandwidth. So, the PldE technique is showing signs that it could help solve the problem of the IP network's inefficient use of bandwidth.

Voice over IP (VoIP) is widely utilized by organizations, schools, colleges, and so on. Nevertheless, VoIP numerous challenges that hinder its spread. One of the significant challenges is the poor exploit of the VoIP technology network bandwidth (BW), caused by the huge preamble of the VoIP packet. This paper suggests a novel methodology to manage this huge preamble overhead challenge. The proposed methodology is named runt payload VoIP packet (RPV). The core principle of the RPV methodology is to reemploy and exploit the VoIP packet preamble’s data (fields) that are superfluous by VoIP technology, especially for unicast IP voice calls. Generally, those fields will be used to convey the VoIP packet payload. Consequently, diminish or zero the length of the payload and, therefore, spare the BW. The results of the investigation into the suggested RPV methodology indicated significant enhancement in the BW exploitation of VoIP technology. For instance, the saved BW in the examined environment with the LPC codec came to up to 25.9%.

Old telecommunication systems are gradually being replaced by a new system that works over IP networks, which is known as voice over internet protocol (VoIP). VoIP has several merits (e.g., very cheap call rate), which make it increasingly popular in the telecommunication world. However, VoIP faces numerous impediments that decelerate its promotion. One of the top impediments is the wasted bandwidth caused by VoIP systems. Numerous methods have been proposed to handle this impediment, including packet aggregation methods. This paper proposes a novel aggregation method, called packet aggregation and carrier header (PA-CH), to reduce the amount of the large bandwidth caused by VoIP. As the name suggests, PA-CH saves in bandwidth by aggregating the packets in a header and using the redundant fields in the packet header to carry a portion of the packet voice data. The performance of the introduced PA-CH method was investigated based on three main metrics, namely, link capacity, allocated bandwidth reduction, and voice data shortening. Simulation results indicate that the proposed PA-CH method outperforms the comparison methods in three factors. For instance, the proposed method’s allocated bandwidth reduction ratio reaches 51% when the number of calls running concurrently reaches 100. Therefore, the proposed PA-CH method achieves its goal of reducing the wasted bandwidth caused by VoIP.

The demands on virtual communication have increased noticeably during the COVID-19 pandemic lockdown. As an essential part of virtual communication, VoIP should be promoted to achieve the desired level of performance. One critical area investigated in VoIP is the bandwidth utilization (BWU) of the VoIP over IPv6 networks. Enhancing BWU will impact call capacity and quality; it increases call capacity and boosts call quality. Unfortunately, a considerable amount of bandwidth is wasted when running VoIP over IPv6 networks. This is due to the large size of the IPv6 header and the small size of the speech frame. This paper proposes a new method to handle the inefficient BWU when running VoIP over IPv6 networks. The proposed method combines multiplexing multiple VoIP packets in one IPv6 header and using the superfluous fields to carry a portion of the speech frame. Therefore, the proposed is called packet multiplexing and carrier fields (PMCF). Investigation of the PCMF method has been done using four metrics to measure the promotion in BWU, namely calls capacity, header size, bandwidth saving, and speech frame shortening metrics. With the four metrics, the PMCF method has outperformed the comparable methods. For instance, the call capacity has been promoted by up to 269% compared to the typical IPv6 method in the tested scenarios. Therefore, the PMCF method is a feasible solution to facilitate the BWU of VoIP when running VoIP over IPv6 networks.

IP telephony have played an essential role during the COVID 19 pandemic lockdown. One of the issues that lower the service level of the IP telephony solutions is the inefficient bandwidth exploitation. This paper proposes a Smallerize/Zeroize (SmlZr) method to enhance bandwidth exploitation. The SmlZr method is explicitly designed for the P2P IP telephony calls over IPv6 networks. The essence concept of the proposed method is to use the unnecessary fields in the header to keep the voice media of the packet. Doing so leads to smallerize or zeroize the packet payload and, thus, enhance the bandwidth exploitation. The SmlZr method has outperformed the RTP method for all the comparison parameters. For instance, the SmlZr method shrinks the bandwidth by 25% compared to the RTP protocol. Bandwidth saving is helpful for P2P IP telephony calls because it alleviates the traffic load. Thus, improve the call capacity boosts the call clarity.

The congestion problem at the router buffer leads to serious consequences on network performance. Active Queue Management (AQM) has been developed to react to any possible congestion at the router buffer at an early stage. The limitation of the existing fuzzy-based AQM is the utilization of indicators that do not address all the performance criteria and quality of services required. In this paper, a new method for active queue management is proposed based on using the fuzzy logic and multiple performance indicators that are extracted from the network performance metrics. These indicators are queue length, delta queue and expected loss. The simulation of the proposed method show that in high traffic load, the proposed method preserves packet loss, drop packet only when it is necessary and produce a satisfactory delay that outperformed the state-of-the-art AQM methods.

Shaher M Samrah,1 Abdel-Hameed Al-Mistarehi,2 Tariq Kewan,3 Sohaib M Al-Khatib,4 Ali M Ibnian,1 Randa S Samrah,5 Basheer Y Khassawneh1 1Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA; 4Department of Pathology and Laboratory Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 5Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Shaher M SamrahFaculty of Medicine, Jordan University of Science and Technology, P.O.Box: 630001, Irbid, 22110, JordanEmail samrah@just.edu.joAbdel-Hameed Al-MistarehiDepartment of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box: 630001, Irbid, 22110, JordanEmail awalmistarehi18@med.just.edu.joBackground: Coronavirus disease 2019 (COVID-19) viral course and behavior remain unpredictable. This study describes incubation time and viral clearance of COVID-19 hospitalized cases in Northern Jordan.Methods: All COVID-19 confirmed cases hospitalized from March 15 to June 09, 2020, were included. Nasopharyngeal swabs were collected, and COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) was performed every two days in all cases. The viral cure was defined when two negative RT-PCR tests were obtained ≥ 24 hours apart. Viral clearance time (VCT) reflects the time from the first positive nasopharyngeal swab to the first of two consecutive negative tests.Results: In this cohort, a total of 157 patients were included. Most cases resulted from two major outbreaks. The median incubation period was 6 days (IQR, 3– 10) and ranged from 1 to 17 days. The median VCT was 13 days (IQR, 7– 2) and ranged from 1 to 40 days. Symptomatic presentation and abnormal chest radiograph were predictors for a prolonged VCT (p=0.015 and p=0.014, respectively). The median time of resolution of symptoms was 7 days (IQR, 3– 10 days). Most symptomatic cases (91.7%) remained RT-PCR positive for up to 20 days after symptoms resolution, with a median of 13.5 days. VCT significantly correlated with the incubation period (p=0.013).Conclusion: Viral cure lagged for as long as 20 days after resolution of symptoms. Continuing with social-distancing, frequent hand hygiene, and wearing facial mask remains essential and is recommended even after clinical resolution of symptoms.Keywords: viral clearance, viral shedding, incubation period, COVID-19, coronavirus, pandemic, CDC

Voice over IP (VoIP) wastes a valuable amount of bandwidth because of its large packet header size compared to its small packet payload. The main objective of this paper is to reduce the amount of this wasted bandwidth, by proposing a new packets coalescence method, called Payload Shrinking and Packets Coalesce (PS-PC). The proposed PS-PC method reduces the amount of the wasted bandwidth by i) coalesces a group of VoIP packets in one header instead of a separate header to each packet and ii) shrinks the VoIP packet payload to a smaller one based on a certain algorithm. The proposed PS-PC method is deployed at the sender side VoIP gateway that represents an exit point to a myriad number of simultaneous VoIP calls. The performance evaluation showed better bandwidth usage when deploying the proposed PS-PC method with ITTP protocol in comparison to the traditional ITTP protocol without the PS-PC method.

Sohaib M Al-Khatib,1 Nour Abdo,2 Laith N Al-Eitan,3 Abdel-Hameed W Al-Mistarehi,4 Deeb Jamil Zahran,5 Marwan Al Ajlouni,2 Tariq Zuheir Kewan6 1Department of Pathology and Laboratory Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 5Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 6Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USACorrespondence: Sohaib M Al-KhatibDepartment of Pathology and Laboratory Medicine, Jordan University of Science and Technology, P.O.Box 3030, Irbid 22110, JordanTel +962-799-409933Fax +962-2-72006262Introduction: 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).Keywords: glioblastoma multiforme, DNA repair genes, SNP, overall survival, Arab population

Garrett Hazelton,1 Sana M Al-Khatib,2,3 Gregg C Fonarow,4 Kevin L Thomas,3 David Hayes,5 Gillian D Sanders,2,3 Susan M Campbell,6 Clyde Yancy,7 Eric D Peterson,2,3 Samuel Sears8 1Department of Psychiatric Medicine, East Carolina University, Greenville, NC, 2Duke Clinical Research Institute, 3Department of Medicine, Duke University School of Medicine, Durham, NC, 4Division of Cardiology, Geffen School of Medicine at UCLA, Los Angeles, CA, 5Mayo Clinic, Rochester, MN, 6WomenHeart, The National Coalition for Women with Heart Disease, Washington, DC, 7Division of Cardiology, Feinburg School of Medicine, Northwestern University, Chicago, IL, 8Departments of Psychology and Cardiology, East Carolina University, Greenville, NC, USA Background: Conveying contemporary treatment options for those at risk of sudden cardiac arrest (SCA) is challenging. The purpose of the present research was to evaluate the quality and usability of available patient educational tools relevant to SCA and its treatment options, such as implantable cardioverter defibrillators (ICDs). We hypothesized that this review would identify gaps in areas of information for the enhancement of patient education and decision-making materials. Methods: We used a formal instrument to assess specific domains of content, development, and effectiveness of 18 available SCA and ICD educational tools. The multidisciplinary review panel included two electrophysiologists, two general cardiologists, a cardiac psychologist, a health services researcher, and a patient advocate. Results: Of the 18 education tools, four were rated as “good, may need revisions, but sufficient for use”, 12 were rated as “marginal, needs revision prior to use”, and two were rated as “poor, inadequate for use”. None of the tools were rated as being of “very good” or “excellent” quality. Conclusion: There appear to be opportunities to improve the quality and completeness of existing educational tools for patients with SCA and ICD. While many tools have been developed, they fall below current standards for supporting informed medical decision-making. Keywords: decision-making, implantable cardioverter defibrillators, patient-centered outcomes research

Speckle-type POZ (SPOP) is described as an essential tumor suppressor factor in gastric cancer, colorectal cancer, and prostate cancer (PCa). SPOP gene mutations were reported in primary human PCa. Isocitrate dehydrogenase-1 (IDH1) oncogene mutations were detected in gliomas, acute myeloid leukemia, some benign and malignant cartilaginous tumors, and only 1% of PCa. This study aimed to investigate the prevalence of mutations of SPOP and IDH1 genes in PCa in the Jordanian population. One hundred formalin-fixed paraffin-embedded tissue samples were collected from patients diagnosed with prostate adenocarcinoma. The obtained specimens were subjected to genomic DNA extraction, PCR amplification, and direct sequencing of exons 4, 5, 6, and 7 of the SPOP gene and exon 6 of the IDH1 gene. SPOP gene mutations were found in 17% of PCa cases, while no mutation was detected in the screened exon 6 of the IDH1 gene. Clinicopathological data demonstrated a strong correlation between prostate-specific antigen (PSA) levels and both Gleason score (GS) and the International Society of Urological Pathology (ISUP) grade group (GG). There was no significant correlation between PSA levels and age (p = 0.816) nor there were significant associations for SPOP mutational status with age (p = 0.659), PSA levels (p = 0.395), GS (p = 0.259), and ISUP GG (p = 0.424) in the tested population. The study found a strong correlation between PSA levels and both GS and ISUP GG. It also identified a high frequency (17%) of SPOP gene mutations in Jordanian Arab PCa patients, mainly in exon 7. No IDH1 mutations were detected in exon 6., Competing Interests: Declarations. Consent for Publication: Not applicable. Competing interest: The authors declare no competing interests. Ethical Approval and Consent to Participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of King Abdullah University Hospital, Jordan University of Science and Technology (IRB Decision reference number: 68/124/2019. Date: June 27, 2019). Patient consent was waived due to the study design being a retrospective study involving laboratory archives and hospital electronic records, and it did not involve human participants. Human Ethics: Patient consent was waived due to the study design being a retrospective study involving laboratory archives and hospital electronic records, and it did not involve human participants, (© 2024. The Author(s).)

Introduction: Hypertension is the foremost contributor to cardiovascular disease(s) and premature death worldwide. Mental health disorders have a significant impact on global public health, affecting millions of individuals with disorders including anxiety, depression, bipolar disorder, and schizophrenia. Importantly, all of these conditions are distinctly associated with hypertension. Accordingly, this study aimed to investigate the prevalence of undiagnosed hypertension among individuals diagnosed with mental health disorders in Jordan and its associated risk factors., Methods: Data from individuals 18-80 years of age, who attended the psychiatry clinic at Jordan University Hospital (Amman, Jordan), were included. The study included participants without a previous diagnosis of hypertension, diabetes, or cardiovascular disease. Systolic and diastolic blood pressure, as well as heart rate, were assessed; in addition, demographic information from each participant was collected. Assessments were performed at the clinic facilities during 2 distinct appointments scheduled at a one-week interval., Results: In total, data from 484 patients (57.2 % female, 42.8 % male) were analyzed. The prevalence of undiagnosed hypertension among those diagnosed with psychiatric disorders was significantly high (30.8 %), the majority of whom were male. Mean age, body mass index, and a positive family history of cardiovascular disease(s) were significantly higher in patients with undiagnosed hypertension. Moreover, patients undergoing treatment with serotonin and norepinephrine reuptake inhibitors (SNRIs) exhibited a significantly higher prevalence of undiagnosed hypertension than their counterparts., Conclusion: Results of the present study revealed a significant prevalence of undiagnosed hypertension among patients with psychiatric disorders (30.8 %). Factors significantly associated with a higher prevalence of undiagnosed hypertension included male sex, older age, higher BMI, family history of cardiovascular disease(s), and use of SNRIs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

We performed a 68 Ga-DOTATOC PET/CT scan on a 25-mo-old female patient who presented with opsoclonus myoclonus ataxia syndrome and had negative initial anatomic imaging. The scan showed a somatostatin receptor-overexpressing cervical tumor in favor of a cervical neuroendocrine tumor, with subsequent histopathologic findings of ganglioneuroblastoma., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Objective: The objective of this study was to investigate the prognostic significance of the depth of cervical stromal invasion (CSI) in women with FIGO stage II uterine endometrioid adenocarcinoma (EC)., Methods: Our database of women with EC was quired for patients with stage II EC. Pathologic slides were retrieved and reviewed by gynecologic pathologists to determine cervical stromal thickness and depth of CSI as a percentage of stromal thickness (%CSI). Kaplan-Meier, univariate, and multivariate analyses were used to compare recurrence-free, disease-specific (DSS), and overall survival (OS) between women who had<50% versus ≥50% CSI. Univariate and multivariate analyses were used to assess other prognostic variables associated with survival endpoints., Results: A total of 117 patients were included in our study who had hysterectomy between 1/1990 and 8/2021. Seventy-nine patients (68%) with <50% and 38 (32w%) with ≥50% CSI. After a median follow-up of 131 months, 5-year DSS was significantly worse for women with ≥50% CSI (78% vs. 91%; P =0.04). However, %CSI was not an independent predictor for any of the studied survival endpoints. Independent predictors of worse 5-year recurrence-free survival and DSS included FIGO grade 3 tumors ( P =0.02) and the presence of lymphovascular space invasion ( P =0.03). Grade 3 tumors were the only independent predictor of worse 5-year OS ( P =0.02)., Conclusions: Our results suggest that deep CSI is not an independent prognostic factor for survival endpoints in women with stage II uterine endometroid adenocarcinoma. The lack of independent prognostic significance of the depth CSI needs to be validated in a multi-institutional analysis., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The association between primary immunodeficiencies and autoinflammatory disorders has been popularized over the past decade. In this report, we illustrated the co-infection of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in a three-year-old Jordanian male patient with an extremely rare variant of the CYBB gene (c.125C>G, p.Thr42Arg) associated with chronic granulomatous disease (CGD) coexisting with familial Mediterranean fever (FMF). CGD and FMF co-existence induced early-onset inflammatory bowel disease mainly resembling Crohn's disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al Zu’bi et al.)

Renal cell carcinoma (RCC) exhibits a propensity for unusual wide metastasis. Cutaneous metastasis from RCC is a rare and poorly recognized clinical entity. We present a case of cutaneous metastasis of poorly differentiated RCC in 49-year-old male patient. In the presented case, the skin lesion was the first sign of widely spread RCC. After the establishment of the diagnosis using radiological and histopathological assessments, the patient was labeled as a terminal case and was referred for pain management. He deceased after 6 months of the initial presentation., Competing Interests: The authors declare no conflict of interest., (© 2023 Published by Elsevier Inc.)

Mature B-cell neoplasms are typically divided into Hodgkin and Non-Hodgkin Lymphomas. Hodgkin Lymphoma is characterized by the neoplastic Reed-Sternberg cells, usually harbored in an inflammatory background, with a frequent clinical presentation of mediastinal lymphadenopathy. Many studies link between autoimmunity and lymphomagenesis, a large proportion of these studies evidently trace the pathogenesis back to the misdirected detection of self-derived nucleic acids by Toll-Like Receptors (TLRs), especially those of the intracellular type. In this study, we analyzed the relationship between a selected SNP in TLR9 (TLR9-1237T>C; rs5743836) and the risk and overall survival of HL patients in a Jordanian Arab population. A total of 374 subjects; 136 cases of Hodgkin lymphoma and 238 matched healthy controls were incorporated in this study. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissues. Genotyping of the genetic polymorphisms was conducted using a sequencing protocol. The results show a statistically significant higher distribution of the rs5743836 (TLR9-1237T>C) allele among the case population, with a p-value of 0.031 (<0.05). This distribution proved significant when studied in the codominant (only significant in the T/C genotype, p-value = 0.030), dominant (p-value = 0.025), and overdominant (p-value = 0.035) models. None of the models showed any statistically significant difference in survival associated with the rs5743836 (TLR9-1237T>C) SNP., Competing Interests: The authors have declared that no competing interests exist.

Kikuchi-Fujimoto disease (KFD) is a rare benign and self-limiting syndrome. We aim to review cases of KFD at our institution as a rare illness in the Arab ethnic descent and to analyse reports from most countries in the East Mediterranean zone. This is a retrospective study in which the histopathology database was searched for the diagnosis of KFD. A full review of KFD patients' medical records was done. Data regarding demographic features, clinical presentation, laboratory findings, comorbidities, and management protocols were obtained. Published KFD cases from east Mediterranean countries were discussed and compared to other parts of the world. Out of 1968 lymph node biopsies studied, 11 (0.6%) cases of KFD were identified. The mean age of patients with KFD was 32 years (4-59). 73% (8/11) were females. The disease was self-limiting in 5 patients (45%); corticosteroid therapy was needed in 4 patients (34%). One patient was treated with methotrexate and one with antibiotics. One patient died as a consequence of lymphoma. Jordanians and Mediterranean populations, especially those of Arab ethnic background, seem to have low rates of KFD. The genetic susceptibility theory may help to explain the significantly higher disease prevalence among East Asians. Early diagnosis of KFD-although challenging-is essential to reduce the morbidity related to this illness., (© 2022. The Author(s).)

Background: The COVID-19 pandemic had many implications on healthcare services, including cellular pathology. The pandemic-related lockdown was applied in Jordan from March to May 2020. King Abdullah University Hospital (KAUH) was chosen to provide care for COVID-19 patients during that period. Since there was no experience in dealing with COVID-19 patients, the hospital maintained some essential services but canceled elective surgeries and procedures. The rationale was to prioritize care for COVID-19 patients and to provide better adherence to infection control policies and protect non-infected patients and healthcare workers. The purpose of the present study is to investigate the impact of COVID-19 pandemic restrictions on cellular pathology practice patterns at KAUH., Methods: This is a retrospective observational study conducted at KAUH. All cellular pathology reports during the 2020 national lockdown were retrieved. The total numbers of specimens including types and procedures were recorded. Data were compared with the corresponding data in 2019 when there was no pandemic and when hospital and laboratory services were run in full capacity., Results: 2020 lockdown period showed a 57.9% reduction in the total number of specimens received at the cellular pathology laboratory as compared to the corresponding period of 2019 (1400 versus 3322). Emergency procedures have represented 99.1% of the service during the lockdown with a remarkable diversity shift., Conclusion: There was a significant drop in the number of specimens dealt with at KAUH cellular pathology laboratory during the COVID-19 pandemic-related national lockdown. We learned from this pandemic how to adapt to such circumstances by adjusting our way of working to reach the best level of staff safety while maintaining highly productive work. Implementing digital pathology platforms, working from home strategies and alternative training methodologies have emerged as an essential need., Competing Interests: All authors declare that they have no conflicts of interest., (© 2021 The Authors.)

Background: Gangliogliomas are neoplasms containing both astrocytic and neuronal components. We present a case of gangliogliomas of the optic chiasm, which are extremely rare pathologies., Case Description: A 16-year-old female patient referred to our clinic with gradual deterioration of vision for the age of 1 year mostly in the right eye. Ophthalmic examination confirmed reduced visual acuity with only perception of light in the left eye. Brain magnetic resonance imaging showed a solid mass lesion involving the hypothalamus and the optic chiasm, which was hypointense on T1-weighted images, hyperintense on T2-WI, and marked homogenous contrast enhancement. The patient was operated and bulging of the optic chiasm and the site of lamina terminalis was seen. Subtotal resection of the tumor was achieved. Histopathological examination revealed ganglioglioma (WHO Grade I). Follow-up of the patient was for 3 years and 8 months with stable neurologic and radiologic findings., Conclusion: To the best of our knowledge, 20 cases, including ours, have been reported in the literature and a presurgical diagnosis of ganglioglioma is very infrequent with confused radiologically with low-grade pilocytic astrocytomas., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Surgical Neurology International.)

One of the main challenges of delivering high quality of care to cancer patients in developing countries is the lack of well-trained radiation oncologists. This is a direct cause for the lack of residency programs coupled with lack of resources. This article describes and details establishments of a successful and sustainable radiation-oncology residency program in our country. The program has been in operation for 14 years and has trained and graduated radiation oncologists who are now working in various countries. The curriculum of the 4-year residency program, fashioned according to American College of Radiologists (ACR) recommendations, includes site-specific clinical rotations and didactic lectures in clinical oncology, radiobiology, medical physics, statistics, and epidemiology. It also includes a component of advanced clinical experience in the form of 3-month externship at one of collaborating centers outside the country. Evaluation of the residents is conducted annually via written exams and 360° feedback. Residents also sit for the formal certification exam in radiation oncology from the national Medical Council. The exam consists of 2 written exams and one oral. As a form of benchmarking residents' knowledge, they are required to sit for the ACR examinations held annually and conducted in Amman in tandem. The program has successfully trained and graduated 28 residents, who now work as consultant radiation oncologists locally and abroad. Each resident has gone through a structured training that includes exposure to a Western-style patient-management culture, enhancing the breadth and width of their clinical experience. The residency program, initiated in a developing country, underwent many challenges, yet it overcome all obstacles and resulted in a successful training of competent radiation oncologists serving the region.

Introduction: Diabetes mellitus (DM) and smoking are highly prevalent among Middle Eastern patients admitted with acute coronary syndrome (ACS) or who undergo percutaneous coronary intervention (PCI)., Methods: This study used the analysis of the data from the first Jordanian PCI registry (JoPCR1) to determine the impact of coexistence of smoking and diabetes mellitus on the coronary artery severity and outcome following percutaneous coronary intervention in Middle Eastern patients., Results: Of 2426 patients enrolled, 1300 (53.6%) and 1055 (43.5%) were diabetics and smokers, respectively. The patients' age was 59.0 ± 10.1 and ranged between 24 and 95 years. Males comprised 79.4% of all patients. The patients were divided into four groups: nondiabetic-nonsmokers (22.2%), diabetic-nonsmokers (34.3%), nondiabetic-smokers (24.2%), and diabetic-smokers (19.2%). Compared with the other three groups, patients in the diabetic-nonsmoker group were older, more likely to be females, and having a higher prevalence of hypertension, dyslipidemia, chronic renal disease, and history of CVD and revascularization. Consequently, the diabetic-nonsmoker patients (but not the diabetic-smokers) had a higher prevalence of multivessel CAD and PCI than the other three groups, highlighting the importance of other risk factors (age, gender, metabolic syndrome, and comorbidities) and not only smoking in predisposing for CAD. Furthermore, those patients had a higher incidence of ACS as an indication for PCI than the stable coronary disease (73% vs 27%) and the highest CRUSADE bleeding risk score (63.9%) among other groups. The in-hospital events including in-stent thrombosis and emergency CABG events did not significantly differ among groups ( p = 0.5 and 0.22). Heart failure and major bleeding events occurred significantly higher among diabetic-nonsmokers compared to other groups. In-hospital deaths occurred significantly more among diabetic-nonsmokers. Moreover, the one-month and one-year follow-up outcome events (the mortality rate, in-stent thrombosis, readmission for ACS, coronary revascularization, and major bleedings) occurred more frequently in the diabetic-nonsmoker group. However, the difference was statistically significant only for major bleeding incidences., Conclusions: In this analysis of a completed prospective Middle Eastern PCI registry, the majority of the diabetic-nonsmoker (and not the diabetic-smokers) patients (73%) presented with ACS. This group was the highest at risk for in-hospital PCI complications as well as the worst in outcomes after one year of follow-up. Those patients were more likely to be older, female, and have the worst cardiovascular baseline features, highlighting the importance of other risk factors (age, gender, metabolic syndrome, and comorbidities) and not only smoking in predisposing for CAD. Thus, more sufficient education about controlling CVD risk factors should be implemented in the Middle Eastern region., Competing Interests: No potential conflict of interest was reported by the authors., (Copyright © 2020 Mohamad I. Jarrah et al.)