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Summary We set out to compare the outcome of the second born twin with that of the first twin to determine if any differences could be improved. We reviewed retrospectively twin deliveries from 15 April 1994 to 14 April 1996. We excluded from analysis twins weighing 500 g, where either twin had lethal malformation, and where either twin was dead before the onset of labour. After these exclusions 246 twin pairs remained in the study. We compared perinatal mortality, and 5 minutes Apgar scores for both twins. Perinatal mortality was similar for both twins as was the 5 minutes Apgar scores. Twins 1500 g appear at special risk. The mode of delivery has no influence on the perinatal outcome of both twins. It is concluded that the second born twin may not be at increased risk of complications compared with the first born twin. Caesarean delivery will not improve this outcome. [ABSTRACT FROM AUTHOR]

Presents a study which evaluated delivery on perinatal results of singleton fetuses with breech presentation weighing more than or equal to 1500 grams. Materials and methodology used in the study; Discussion on the results of the study.

Background: Providing care for people with dementia incorporates a level of burden which can affect quality of life for both the caregiver and the recipient of care. This study measures the level of burden experienced by Jordanian caregivers for people with dementia and explore related predictors., Methods: Through a cross-sectional survey, participants were invited through convenience sampling to participate in a structured interview., Results: A total of 406 participants completed the survey. According to Zarit Burden Interview, the mean burden score of the sample was 26.2 (SD = 16.2). This score falls under the mild to moderate burden level. Older age of the patient, severe dementia, lower number of caregivers, if the caregiving negatively affected family relations, and if the caregiving negatively affected jobs, were significant predictors of burden., Conclusion: Caregivers in the current study reported no burden to a minimum burden. This result does not mean that these caregivers have no or minimal stress or that they do not have psychological needs; on the contrary, these results call for more attention to providing extra psychological and emotional support to caregivers of patients with dementia in order to decrease the burden level and maintain their efforts in caregiving. Future studies are required to discern the shape and context of unmet caregiver needs, assessment, and support., (© 2024 Japanese Psychogeriatric Society.)

Background: There is paucity of data on the prevalence of novel and traditional cardiovascular risk factors in young women with atherosclerotic cardiovascular disease (ASCVD) in the Middle East. We sought to evaluate clinical profiles and prevalence of novel and traditional risk factors in Middle Eastern young women with ASCVD compared with age-matched controls., Methods: Women 18-50 years of age who have ASCVD were enrolled and each was aged-matched with two women with no ASCVD. Prevalence of novel and traditional risk factors was compared in the two groups. Multivariable analyzes examined the independent association of 16 factors with ASCVD., Results: Of 627 young women enrolled mean age 44.1 ± 5.2 years; 209 had ASCVD and 418 served as controls. Women with ASCVD had significantly higher prevalence of five of the studied traditional risk factors (hypertension, type 2 diabetes [T2D], smoking, low-density lipoprotein cholesterol serum levels, and family history of premature ASCVD [FHx]) than women with no ASCVD. Additionally, of the 11 novel and psychosocial risk factors studied, four showed significantly higher prevalence in young women with ASCVD (preterm delivery, hypertensive disease of pregnancy gestational diabetes, and low level of education). Multivariable analyzes showed hypertension, T2D, smoking, FHx, persistent weight gain after pregnancy and low level of education were independently associated with ASCVD., Conclusions: In this study of young Middle Eastern women; traditional risk factors as well as persistent weight gain after pregnancy were more prevalent in women with ASCVD compared with controls.The study is registered with ClinicalTrials.gov, unique identifier number NCT04975503., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Despite the advantages of vaccination in preventing maternal and fetal problems, there were many concerns in the medical community regarding vaccine safety for pregnant women, and this has put obstetricians in a challenging situation when it comes to advising their pregnant patients on whether to obtain the vaccine., Aim: This study was performed to define the level of acceptance of COVID-19 vaccination and assess the impact of COVID-19 attitudes and knowledge on vaccine acceptance between pregnant and lactating Syrian women who are seeking prenatal care services at the clinics in Azraq refugee camp in Jordan., Method: A quantitative, cross-sectional study utilizing a non-probability convenience sample. A validated and reliable self-administered questionnaire consisting of four sections was used., Results: A total of 412 pregnant/lactating women was recruited The acceptance rate of the COVID-19 vaccine among participants was 86.5%. There was a significant positive moderate association between respondents' attitudes and knowledge around the COVID-19 vaccine and their acceptance of the vaccine (r = .468, p < .001, r = .357, p < .001), respectively., Conclusion: To effectively mitigate the COVID-19 pandemic and achieve collective protection, decision-makers must intensify the efforts in promoting the importance of maternal vaccination, especially in vulnerable communities that suffer the most from pandemic outcomes., Competing Interests: The authors have declared no competing interest., (Copyright: © 2024 Dalky et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Bedside nurses in the intensive care units are exposed to multiple challenges in their regular practice and recently have taken in ventricular assist device care in Lebanon since its introduction as a fairly new practice., Objectives: To explore the experiences of nursing staff who work in Lebanese hospitals with Left Ventricular Assist Devices (LVAD)., Methods: This study employed a qualitative phenomenological research design, where semi-structured interviews were carried out among fifteen LVAD nurses in an acute care hospital., Results: The qualitative data analysis produced six main themes. The first theme prevalent was "LVAD incompetence and shortage" and it reflected the deficit in properly structured training and the number of specialized LVAD nurses. The second theme that resulted from the analysis was titled, "Patient and family knowledge", which indicated the misconceptions that families and patients usually hold about LVAD which usually sugarcoats the situation. This was followed by "Burden of complications", "LVAD patient selection", "Perception of the LVAD team as invulnerable", and "High workload and patient frailty" which reflected the perspectives of LVAD nurses., Conclusion: This study shows that the Lebanese LVAD nurses who participated in this study perceived inadequate competence, yet lacked proper training and induction. The nurses reported multiple challenges relating to care tasks, workload, and patient and family interactions which need to be addressed by coordinators., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Aims: This study evaluates the epidemiology of headache and migraine among adolescents aged 12 to 15., Methods: A school-based cross-sectional study was conducted to collect and analyze data from students in grades 7-10 over the course of one month, using a simple random sampling method. The overall number of participants in this study was 692, with an average age of 13.9 years (SD = 1.3). Descriptive measures and Fisher's exact test were computed. Multivariate regression was calculated to assess the predictors of headache and migraine. Findings . Approximately one-half of the students reported having headaches: tension-type headaches (10.3%), migraines (4.8%), and other headache types (31.5%). Moreover, girl students in the age group of 14-15 reported more headaches and migraines., Conclusion: The prevalence of headache and migraine in Jordan is high and increasing as students grow older. Health education programs led by school nurses and other healthcare practitioners are urgently needed., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Mohammed Albashtawy et al.)

Background: In Palestine, there is a lack of studies that examined self-care behaviors among patients with coronary artery disease in outpatient clinics. Objective: This study purposed to evaluate self-care behaviors, examine the relationship between self-care behaviors and selected sociodemographic and psychosocial factors (e.g. depression, anxiety, stress, and social support), and self-efficacy, and determine predictors of self-care behaviors among patients with coronary artery disease in outpatient clinics in the West Bank/Palestine. Design: A cross-sectional study was conducted. Methods: A total of 430 Palestinian adult patients suffering from coronary artery disease attended outpatient clinics were recruited. A self-reported questionnaire consisting of the following tools: Depression, Anxiety, Stress Scale 21, Sullivian's Self-efficacy scale, and Multidimensional Social Support Scale was used to collect data during the period from the beginning of April to the beginning of July 2022. Descriptive and inferential statistics (Pearson's and Point-biserial correlation tests and multiple linear regression) were used for analyzing data. Results: The patients reported low self-care behaviors levels and high self-efficacy levels. The psychosocial reactions endorsed by the patients were 86.3% for depression, 76.3% for anxiety, 43.3% for stress, and 98.6% had moderate and normal social support. A positive correlation was found between self-care behaviors and age ( r  = 0.160, p  < 0.01), duration of disease ( r  = 0.095, p  < 0.05), self-efficacy ( r  = 0.443, p  < 0.01), and social support ( r  = 0.266, p  < 0.01). Self-efficacy (B = 0.401, p  < 0.01), social support (B = 0.160, p  < 0.01), and age (B = 0.109, p  < 0.05) were significant predictors of self-care behaviors in those patients. Conclusion: Low self-care behaviors were a significant issue among patients with coronary artery disease in outpatient clinics. This study may help healthcare professionals develop health promotion programs for patients with coronary artery disease to improve self-care behaviors.

Acupuncture has been introduced as an adjuvant therapy to in vitro fertilization (IVF) cycles in many randomized controlled trials (RCTs). However, there has been a debate among trials regarding the effectiveness and safety of the procedure. To determine how effective and safe acupuncture is as an adjunct to IVF cycles for primary and secondary female infertility. We conducted a literature search for relevant RCTs and ultimately included nine studies. The main selected outcomes included the rates of clinical pregnancy, ongoing pregnancy, miscarriage, live birth, and side effects. Patients receiving acupuncture were grouped together regardless of the acupuncture points used or the protocol for the insertion of needles. We performed a subgroup analysis according to whether studies originated inside and outside China to investigate the results of the different RCTs. We pooled outcomes as a risk ratio (RR) with 95% confidence interval (CI). The analysis revealed that in China, acupuncture led to lower clinical [RR=0.80, 95% CI (0.66, 0.97), p=0.02] and ongoing [RR=0.78, 95% CI (0.63, 0.97), p=0.03] pregnancy rates than placebo. Outside China, acupuncture increased clinical pregnancy rates [RR=1.38, 95% CI (1.11, 1.71), p=0.003] and ongoing [RR=1.73, 95% CI (1.29, 2.31), p<0.001] pregnancy rates. Rates of live birth and miscarriage did not significantly differ between the arms. Regarding side effects, acupuncture groups had a significantly higher rate of puncture site itching compared to control groups [RR=1.51, 95% CI (1.12, 2.04), p=0.007]. Overall analysis does not show a statistically significant increase in clinical pregnancy rates worldwide when using acupuncture as an adjunct therapy to IVF. There were no issues regarding patient safety from any included study. Subgroup results indicated that better rates for clinical pregnancy seem to be occurring more often in RCTs performed outside China than within., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Obstetrics and Gynecology | Turkish Journal of Obstetrics and Gynecology published by Galenos Publishing House.)

Objective: To assess the knowledge and awareness of Jordanian female university students regarding human papillomavirus (HPV) infection and its vaccine., Materials and Methods: A self-administered, anonymous questionnaire was distributed to 450 participants at Jordan University of Science and Technology (JUST) in Jordan. The survey focused on three areas: knowledge and awareness of HPV infection, knowledge of HPV vaccine, and source of information about HPV infection and its vaccine., Results: The survey response rate was 79.8%. Most of the respondents (about 68%) have heard about HPV and knew that the HPV is a virus in the genital area that is sexually transmitted, and 59% of them knew that persistent infection with PV virus can cause precancerous/cancerous diseases in the genital tract. Only 45% of the respondents have ever heard about HPV vaccine and 37.8% of them knew that HPV vaccine is very effective in preventing HPV infection and its related precancerous/cancerous diseases. Majority of the respondents, 78.7 % and 73.5%, who knew about HPV and HPV vaccine, respectively, had heard about it from healthcare providers., Conclusion: The study suggests that more health education and information about the HPV characteristics and HPV vaccine is needed for female university students.

Introduction: ESBL-producing Enterobacteriaceae can cause severe infections, but they are also isolated from the stool of asymptomatic subjects. Faecal carriage of such organism is poorly understood., Methods: First phase of the study was cross-sectional with prevalence and epidemiology of ESBL faecal carriage in two nursing homes in Beirut: 57 residents in the first (NH1) and 151 residents in the second (NH2). In second phase, faecal swabs from cohort of NH1 residents were examined for carriage at six-week intervals over three-month period. Residents' charts were reviewed to assess carriage risk factors., Results: Over 3 consecutive samplings at NH1, 81% of residents were at least one-time carriers with 50% at the first round, 60.4% at the second, and 74.5% at the last one. At NH2, 68.2% of residents were carriers. Constipation (in NH1) and antibiotic intake (in NH2) were significantly associated with higher ESBL faecal carriage while the length of stay at the nursing home (in NH2) was associated with less carriage., Conclusion: Faecal carriage of ESBL-producing Enterobacteriaceae is high among nursing home patients in Beirut. The rate of carriage changes rapidly and significantly over time either with multiple factors playing a possible role like outbreak spreading, antibiotic, and health care system exposure.

Background: The paradigm shift towards the nonsurgical management of dental caries relies on the early detection of the disease. Detection of caries at an early stage is of unequivocal importance for early preventive intervention., Objective: The aim of this in vitro study is to evaluate the performance of a visual examination using the International Caries Detection and Assessment System (ICDAS) criteria, two quantitative light-induced fluorescence (QLF) systems--Inspektor™ Pro and QLF-D Biluminator™ 2 (Inspektor Research Systems B.V., Amsterdam, The Netherlands)--and a photothermal radiometry and modulated luminescence, The Canary System® (Quantum Dental Technologies, Toronto, Ont., Canada) on the detection of primary occlusal caries on permanent teeth., Methods: A total of 60 teeth with occlusal surface sites ranging from sound to noncavitated lesions (ICDAS 0-4) were assessed with each detection method twice in a random order. Histological validation was used to compare methods for sensitivity, specificity, percent correct, and the area under the receiver operating characteristic curve (AUC), at standard and optimum sound thresholds. Interexaminer agreement and intraexaminer repeatability were measured using intraclass correlation coefficients., Results: Interexaminer agreement ranged between 0.48 (The Canary System®) and 0.96 (QLF-D Biluminator™ 2). Intraexaminer repeatability ranges were 0.33-0.63 (The Canary System®) and 0.96-0.99 (QLF-D Biluminator™ 2). The sensitivity range was 0.75-0.96 while that of specificity was 0.43-0.89. The AUC were 0.79 (The Canary System®), 0.87 (ICDAS), 0.90 (Inspektor™ Pro), and 0.94 (QLF-D Biluminator™ 2)., Conclusion: ICDAS had the best combination of sensitivity and specificity followed by QLF-D Biluminator™ 2 at optimum threshold., (© 2015 S. Karger AG, Basel.)

Objective: To evaluate and compare the current approach to the management of ectopic pregnancy between the main two civil hospitals in the north of Jordan., Design: A retrospective study., Material and Methods: A retrospective review was made of the records of all patients with confirmed ectopic pregnancy admitted to Princess Badea Teaching Hospital (PBTH), and King Abdullah University Hospital (KAUH) between January 1, 2005 and December 31, 2005. The total number of deliveries for the same period was obtained from the labor ward records of hospitals. Information regarding demographic data, presenting symptoms, methods of diagnosis and treatment were extracted from individual patient records., Results: There were 50 cases of confirmed ectopic pregnancy in PBTH compared with 20 cases in KAUH. The total number of deliveries at PBTH was 9,000 (1 ectopic/180 deliveries) while at KAUH, the number of deliveries was 3,000 so the ratio was 1: 150. The majority of patients (82%) had ruptured ectopic pregnancy at presentation. All cases at PBTH were managed by laparotomy. Of the 20 cases at KAUH, five cases were managed laparoscopically and three received medical treatment for their ectopics. There was no maternal mortality from ectopic pregnancy or its management at either hospital., Conclusion: The management of ectopic pregnancy in our community is still suboptimal. We recommend the development of clinical protocols for early diagnosis and referral, training in transvaginal scanning and an increase in the use of laparoscopy for the management of ectopic pregnancy.

Objective: To evaluate the function of the hypothalamic-pituitary-gonadal axis in adolescent female patients with beta-thalassemia major., Materials and Methods: A prospective study of the function of the hypothalamic-pituitary-gonadal axis function of 31 beta-thalassemia major females aged between 13 and 22 years and in 12 control females aged between 12 and 22 years. All were treated at Princess Rahma Teaching Hospital, Irbid, Northern Jordan between April 2001 and April 2003., Results: Of the 31 beta-thalassemia major females, 13 (41.9%) had delayed puberty. Hypothalamic-pituitary-ovarian axis dysfunction was found in 15 patients (48.4%). Twelve patients (38.7%) had hypogonadotropic hypogonadism and 5 (16.1%) had ovarian failure. High levels of serum ferritin were significantly higher in patients with delayed puberty., Conclusion: Pituitary and ovarian dysfunction are common problems in beta-thalassemia major patients. The main possible cause is iron overload. This stresses the need for intensive and regular use of chelation therapy to prevent damage to the hypothalamic-pituitary-ovarian axis.

Objective: To describe the maternal and perinatal outcome of pregnancies in women aged 45 years or more at the time of delivery and to compare them with pregnancies in women aged between 20 and 29 years., Methods: A retrospective review of hospital deliveries after 28 weeks gestation was performed at the Princess Badeea Teaching Hospital in North Jordan for patients delivered between 1st April 1994 and 31st December 1997. We compared the maternal and perinatal outcome of pregnancies in women aged of 45 years or more (study group, n = 114) with women aged between 20-29 years (control group, n = 121) delivered at the same hospital during the same period., Results: The incidence of pregnant women aged 45 years or more was 3.3 per 1,000 births. The median maternal age was 45 years. The majority of women (81.6%) were 45 to 46 years old. Gravidity and parity was significantly higher in the study group (p < 0.0001), also antenatal and medical complications as pre-eclampsia and diabetes mellitus were higher in the study group. Caesarean section rate, incidences of placental abruption and placenta previa were more common in older patients compared with young patients (32.4 vs 10.7%, 6.1 vs 0.8% and 4.4 vs 1.6%, respectively). There were no differences in the incidences of neonatal deaths, lethal malformations and fetal weight between the 2 groups., Conclusion: Women aged 45 years or more at delivery may expect a good pregnancy outcome but should expect a higher incidences of placental abruption, placenta previa, preeclampsia and caesarean delivery.

This retrospective review of the case records was designed to determine the relationship between previous caesarean section and subsequent development of placenta praevia and placenta praevia with accreta. All women delivered with the diagnosis of placenta praevia at Princess Badeea Teaching Hospital from 1 January 1995 to 31 December 1996 were analysed. There were 18 651 deliveries in the study period. Sixty-five had placenta praevia, 21 of whom had a history of previous caesarean. The incidence of placenta praevia was significantly increased in those with a previous caesarean section (1.87%) compared with those with an unscarred uterus (0.25%) (P<0.0001). The risk increased as the number of previous caesarean sections increased. We also conclude that there is a high association between anterior placenta praevia, placenta accreta and previous caesarean section. This was enhanced with the increasing number of previous caesarean sections.

Objective: To compare the outcome of the second-born twin with that of the first twin and to find out whether there were any differences and the reason for such differences, if any, and how to improve those differences., Method: We retrospectively reviewed twin deliveries from the 15th of April, 1994 to the 14th of April, 1996. Excluded were twins weighing < 500 gm, either twin with a lethal malformation, and either twin who died before the onset of labour. After this exclusion 246 twin pairs remained in the study. We compared perinatal mortality and 5-minute Apgar scores for both twins., Results: Perinatal mortality was similar for both twins as well as 5-minute Apgar scores. The twins < 1500 gm appeared at special risk. The mode of delivery had no influence on the perinatal outcome of either twin., Conclusions: The second-born twin may not be at increased risk of complications compared with the first-born twin and caesarean delivery may not improve this outcome.