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Mohammad Abu-Ain,1,2 Raed Shatnawi,1,2 Ibrahim Shehadeh,2 Mohammad Irfan Khan3 1Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan; 2Prince Hamzah Hospital, Department of Ophthalmology, Amman, Jordan; 3Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UKCorrespondence: Mohammad Abu-Ain, Department of Special Surgery, Faculty of Medicine, The Hashemite University, P.O.Box 330127, Zarqa, 13133, Jordan, Email abuain@hotmail.co.ukObjective: To evaluate the long-term visual acuity and retinal thickness changes after pars plana vitrectomy (PPV) for idiopathic epiretinal membranes (ERM).Methods: We performed a retrospective analysis of 72 patients who underwent PPV for idiopathic ERM in a tertiary hospital over 5 consecutive years. The main outcome measurement was change in visual acuity and macular thickness as recorded with optical coherence tomography (OCT).Results: Medical records of 239 patients with a diagnosis of ERM who underwent PPV with or without internal limiting membrane (ILM) peeling were reviewed; of these, 72 patients with idiopathic ERM were included in the final analysis. All patients completed at least one year of follow-up, and 23 patients (30%) had 5 or more years of follow-up. The mean preoperative best corrected visual acuity (BCVA) was 20/65, and mean preoperative central macular thickness (CMT) on OCT was 434 microns (μm). Mean postoperative BCVA and CMT at one year were 20/40 and 303 μm, respectively (p< 0.0001). A total of 42 patients (58%) improved by 2 or more lines; BCVA and CMT continued to improve postoperatively for up to 5 years of the follow-up period. There was no significant difference in BCVA or CMT between phakic and pseudophakic patients, and ILM peeling was performed in 67% of patients. Improved BCVA at 1 year was associated with younger age (p< 0.0001) and ILM peeling (p=0.020).Conclusion: PPV is an effective treatment for idiopathic ERM, and ILM peel may be of benefit. BCVA continues to improve up to 2 years and beyond after surgery regardless of the duration of symptoms.Keywords: idiopathic epiretinal membrane, pars plana vitrectomy, optical coherence tomography, central macular thickness

Motasem Al-latayfeh,1 Raed Shatnawi,1 Amjad A Al Shdaifat2 1Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan; 2Department of Medicine and Family Medicine, Faculty of Medicine, The Hashemite University, Zarqa, JordanCorrespondence: Motasem Al-latayfehThe Hashemite University, P.O. Box 1134, Amman, 11947, JordanEmail motasem974@gmail.comPurpose: This study aimed to investigate the attitudes and awareness about the development of retinopathy among the patients suffering from diabetes in Amman, Jordan.Methods: A questionnaire was distributed among patients with diabetes visiting internal medicine and endocrinology clinics in a tertiary hospital, in addition to a primary health care center in Amman. The questionnaire inquired about retinopathy awareness, history of screening for retinopathy, and awareness about retinopathy treatment. The patients were also asked about risk factors and preventive measures for diabetic retinopathy management.Results: A total of 303 patients were recruited in the study. Majority of the patients (77%) had their HbA1c levels tested at least once since diagnosis, and most of them (60%) do it regularly. However, 86% of patients reported an A1c > 6.5%. Two thirds of patients are not aware about retinopathy being a recognized complication of diabetes. Lower level of education, female sex, younger age, and shorter duration of diabetes mellitus were associated with less awareness.Conclusion: The study concluded that majority of patients with diabetes were aware of diabetes management. However, the sample population indicated less awareness of diabetic retinopathy. Hence, more educational efforts are needed to further boost patients’ awareness about diabetic retinopathy.Keywords: awareness, diabetes mellitus, diabetic retinopathy, Jordan

Motasem Al-Latayfeh,1,2 Mohammad Abdel Rahman,2 Raed Shatnawi1,2 1Department of General and Special Surgery, School of Medicine, The Hashemite University, Zarqa, Jordan; 2Department of Ophthalmology, Prince Hamza Hospital, Amman, JordanCorrespondence: Motasem Al-LatayfehThe Hashemite University, P.O. Box 150495, Zarqa, 13115, JordanTel +962797397711Email motasem974@gmail.comPurpose: To analyze the real-life clinical outcome of a single dexamethasone implant (DEX) injection in the treatment of persistent diabetic macular edema (DME) after anti-vascular endothelial growth factor (anti-VEGF) agents in a sample of the Jordanian population.Methods: An observational case study design that involved a retrospective chart review analysis in a tertiary hospital in Amman, Jordan. Patients who showed persistent DME after receiving at least six doses of anti-VEGF agents for DME treatment were included.Results: The study population consisted of 72 participants (29 females, 43 males) having an average age of 66 years. All patients had best-corrected visual acuity (BCVA) less than 0.7 (6/9) and SD-OCT documented center-involved DME. The study results showed that the average baseline BCVA improved from 0.205± 0.1 before DEX injection to 0.358± 0.1 at 3 months post-injection (p< 0.0001). The central mean thickness (CMT) showed significant improvement also (539.347± 132.402 to 379.041± 99.430, p< 0.0001). There was a mean of 3 mmHg increase in intraocular pressure at 3 months post-injection (p< 0.0001), however, only 4% of patients required medical treatment. Other inflammatory biomarkers in OCT, such as intraretinal hyper-reflective dots (HRD), showed significant improvement also (23.67± 16 to 14.83± 13, p< 0.0001). No other significant safety concerns were noticed.Conclusion: A single DEX injection showed significant clinical and anatomical improvement in DME cases that are persistent after anti-VEGF treatment in our sample, with an excellent safety profile. In case of supply shortage of intravitreal injections, which occurs frequently at our center, a single DEX injection may be utilized as an effective DME therapy. Further research is mandated to identify clinical response in a larger sample and more frequent injections.Keywords: diabetic macular edema, dexamethasone, anti-VEGF, Ozurdex, Jordan

The design patterns from the widely used Gang of Four book provide flexible, reusable designs that can be employed in many disparate application domains. Each of these well-known patterns employs important object-oriented techniques, including encapsulation and inheritance, and polymorphism (both compile time and runtime), as well as object instantiation and deletion. Because these patterns employ the object-oriented techniques in standard ways, they can serve as a good mechanism for comparing different object-oriented languages and for comparing the compilers for these languages. The authors compare different modern object-oriented languages and compilers using the standard Gang of Four design patterns as benchmarks. The languages compared were C++, Java, and the new .NET language, C#. The performances of C++ and Java were examined on both Linux and Microsoft Windows XP, whereas the performance of C# (a Microsoft programming language) was examined only on Microsoft Windows XP. Of particular interest was the performance of C#, as it is the newest language of the three, as well as the performance of all three object-oriented programming languages in a standard PC-based environment, with the commonly used PC operating systems, Linux and Microsoft Windows. Statistical techniques were employed in order to achieve strong language comparisons. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of suicide presents a significant public health challenge globally, affecting diverse populations around the world. This study is motivated by the urgency to tackle suicide as a crucial public health issue on a global level, according to the United Nations Sustainable Development Goals and the General Programme of Work and Mental Health Action by the World Health Organization., Materials and Methods: The research was performed at the Forensic Unit of Hospital Canselor Tuanku Muhriz, spanning a retrospective analysis covering 2012 to 2021. A descriptive analysis was conducted to analyse the patterns of suicide and the sociodemographic characteristics of the cases., Results: The findings show monthly variations and a recent increase in suicide rates, especially during the pandemic of COVID-19. Analysis of suicide methods indicates that hanging is the most common suicide method, which accounts for almost half of the sample population, followed by jumping from a height and burning charcoal. Adult males are primarily implicated in suicidal acts, and the study reveals unique trends among different age groups, genders and employment statuses., Conclusion: This study aims to offer thorough insights and comprehension into suicide within the Malaysian sociodemographic framework. Consequently, it could furnish valuable insights for public health authorities and governmental bodies.

Background: Nurses' job satisfaction is a crucial component of a safe and efficient healthcare environment., Aim: To understand the level of job satisfaction among migrant nurses working in intensive and critical care in Saudi Arabia., Method: This study used a quantitative descriptive design. A total of 421 migrant nurses working in intensive and critical care units in two teaching hospitals in Saudi Arabia completed a questionnaire based on the McCloskey/Mueller Satisfaction Scale., Findings: Participating migrant nurses had moderate levels of job satisfaction overall, except for salary, holiday allowance and maternity leave, which attracted low satisfaction scores, and nursing peers, which attracted a high satisfaction score. There were no statistically significant differences in job satisfaction scores according to demographic variables except marital status, with a significantly higher job satisfaction among married respondents., Conclusion: Promoting job satisfaction among nurses could improve the efficiency and quality of nursing care. There is a range of strategies that can be used to enhance nurses' job satisfaction, including improving working conditions and promoting career development., Competing Interests: None declared, (©2023 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Background: According to the World Health Organization (WHO), drowning is globally considered as one of the leading causes of injury related deaths. Defined as the process of experiencing respiratory impairment from submersion in a liquid medium. Drowning is a public health concern in Jordan. This study aimed to investigate drowning incident data from the Forensic Medicine Teaching Centre in the North of Jordan for the purpose of defining high risk groups and circumstances around drowning fatalities which suffered an attention deficit., Objective: The study aims to describe the rate of fatal drowning in North of Jordan and to properly understand the risk factors associated with it., Methods: The present study is retrospective, based on investigating 2808 autopsy reports and selecting only 85 drowning related death reports conducted through a 5 year period (2015-2019) in the Forensic Medicine Teaching Centre which serves Northern Jordan including Irbid, Jarash, Ajloun, and Al-Mafraq. The statistical analysis of fatal drowning cases included the following risk variables: Age, gender, month, year, nationality, address, alcohol and drug consumption., Results: 15 variables were consistent and analyzed across the database of this study. The high risk groups and patterns were identified and the majority of fatal drowning cases were related to males (80.4%). Age group from (2 to 27 years of age were included in the high-risk groups with (88.2%) of all cases. Specifically, the age 2 had the highest occurring frequency. While (17.6%) of drowning fatalities occurred in August. Alcohol and drugs had no significant impact on increasing drowning rates. The dominant manner of death among all cases was accidental (95.3%). Fatal drowning rates were decreasing throughout the years of (2015-2019)., Conclusion: Defining drowning high risk groups and its epidemiology helps to overcome this preventable cause of death. The current study highlights the necessity for the need of further interventions to be actively fixed into policies and educational programs and emphasize safety precautions during water activities and to improve the dataset collection for better planning of prevention strategies., Competing Interests: The authors declare no conflict of interest., (© 2022 Ali M Shotar, Mahmoud Halalsheh, Rashed Shatnawi, Hadeel Abu-El-Rub, Nahd A. Hussein, Sarah Shoter, Hassan Mahafdhah.)

Purpose: This study was aimed at describing our experience in congenital cataract surgery in a developing Country., Methods: A retrospective study was conducted in Amman, Jordan. The patients who were diagnosed with congenital cataract and underwent the surgery were included in the study. It was decided to use an intraocular lens if the corneal diameter was more than 10 millimeters., Results: The findings revealed that around 13 of the patients did not have any visual axis opacification, indicating that they were aphakic. Visual axis opacification was seen in 8 out of the total sample of participants. Eleven patients with obvious opacification of the visual axis were found to be pseudophakic after at least two procedures and were thus cleared. It was necessary to do a second surgery to rectify the visual axis opacification induced by pseudophakia, which was putting the patient's ability to recuperate at danger. Three of them (or 12 percent) exhibited visual axis opacification, which is a rare occurrence. The intraocular lenses used in the remaining 24 patients were constructed of hydrophilic plastic., Conclusion: Patients are less prone to have visual axis opacification while implanted by hydrophobic intraocular lenses is something they should consider., Competing Interests: No competing or potentially conflicting interests are declared by the authors., (Copyright © 2021 Raed Shatnawi et al.)

Background: Carbon monoxide (CO) poisoning rate has stayed the same around the globe over the last quarter of a decade. However, the number of people who die compared to the number of people who get poisoned, and the mortality rate has declined dramatically., Objective: The aim of this study was to evaluate the severity of the CO poisoning problem in Jordan and compare it to other countries and to search for any related factors that could affect the death rate., Methods: A retrospective study was conducted in the Forensic Medicine Teaching Centre, Irbid, Jordan for a 10-years period (2009 -2018). 5,725 autopsy reports were assessed, and only 71 CO-related death cases were selected and analyzed based on the following risk factors: age, gender, year and month of death, nationality, address, the settings that the cases occurred in, carboxyhemoglobin saturation (COHb%) and the presence of alcohol and drugs in blood., Results: The rate of deaths due to CO poisoning showed a general decline over the reviewed years. Most victims were males (70.4%). And although the death rate showed an increase with age, the age group between 20-year-old and 39-year-old accounted for 38% of all cases. Most cases happened in the winter months, December, January, and February. 87.1% of the cases occurred at home settings. The average COHb% was 68%±13% and ranged from 12%-83%., Conclusion: Although the incidence is decreasing with time, CO is still a threat that must be dealt with. As all cases in our study were accidental cases and good preventive measures, such as good CO detectors and good air flow in the places that hold devices that could generate CO, and proper education to the public, especially in the colder regions of the country, could prove useful in decreasing the incidence of CO deaths further., Competing Interests: The authors declare no conflict of interest., (© 2021 Ali M. Shotar, Rashed Shatnawi, Mahmoud Halalsheh, Hadeel Abu-El-Rub, Nahd A. Hussein, Sara Shoter, M’otaz Obeidat, O’la Abu Al-Asal.)

Purpose: To analyse the prognostic factors for eye salvage for eyes with intra-ocular retinoblastoma (RB) that is resistant to systemic chemotherapy and focal therapy by external beam radiation therapy (EBRT)., Methods: A retrospective analysis of 28 eyes with intra-ocular RB that was resistant for systemic chemotherapy and focal consolidation therapy and received EBRT. Outcome measures included tumor stage at diagnosis, stage migration, type of tumor seeds, treatment modalities, eye globe salvage, metastasis, and survival., Results: Most of the patients (83%) had bilateral RB, and 42% were females. All eyes were treated initially by combination of systemic chemotherapy and focal consolidation therapy. The dose of EBRT was 45 Gy. The mean follow-up was 6.5 years, and the overall eye globe salvage rate post EBRT was 46%: 67% (2/3) for group B, 71% (5/7) for group C, and 33% (6/18) for group D. Patient's gender, tumor site, laterality, and tumor stage at diagnosis were not significant prognostic factors (p> 0.05) for final outcome. The significant poor prognostic factors were tumor stage migration during systemic chemotherapy (p= 0.03) and presence of vitreous seeds at time of EBRT (p=0.001). Post EBRT complication rate was 68% (19/28) including; retinal detachment (3), vitreous hemorrhage (4), neovascular glaucoma (1), cataract (16), radiation retinopathy (2), and second malignancy (2)., Conclusion: EBRT is an alternative for enucleation when RB is resistant to combined chemoreduction/focal consolidation therapy in absence in vitreous seeds. The known risks for EBRT are not justified for patients with unilateral RB and for those who have functional vision in the other eye., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Oman Ophthalmic Society.)

Purpose : To study the role of external beam radiation therapy (EBRT) for the treatment of retinoblastoma eyes that were not cured by combined systemic chemotherapy and focal consolidation therapy. Methods and Materials : A retrospective case series of 28 eyes for 24 retinoblastoma patients treated by EBRT after the failure of tumor controlled by chemotherapy and focal therapy. The main outcome measures included: international intraocular retinoblastoma classification stage (IIRC) and Reese Ellsworth (RE) stage, tumor seeding, treatment modalities, eye salvage, and survival. Results : The median age at diagnosis was 11 months. There were 14 (58%) males and 20 (83%) bilateral cases. All eyes were treated initially by systemic chemotherapy (range; 6-8 cycles). The dose of radiation used for all eyes was 45 Gray (Gy).The mean follow-up was 75months, and the overall eye salvage rate after EBRT was 13 (46%) eyes: 67% (2/3) for IIRC group B, 71% (5/7) for group C, and 33% (6/18) for group D eyes. Vitreous seeds and tumor stage migration during management by chemotherapy were the most important significant predictive factors for tumor control ( p = .001 and 0.033, respectively). Conclusion : Eyes with retinoblastoma that failed chemotherapy followed by focal therapy were controlled with EBRT. However, the presence of vitreous seeds, stage migration during the course of chemotherapy, as well as good vision in the other eye may not justify the known risks of EBRT.

Retinoblastoma is the most common intraocular malignancy of infancy which frequently manifests with a white pupillary reflex. We report a case of delayed presentation of a child with retinoblastoma in his left eye because parents thought the change in iris colour in this eye was due to the innocent heterochromia irides that was previously diagnosed in his elder sibling. This late presentation necessitated enucleation of the affected eye followed by chemotherapy., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The purpose of this report is to characterize the clinical and electrophysiological effects of extraocular muscle surgery in 15 patients with oculo-cutaneous albinism (OCA) and infantile nystagmus syndrome (INS). Our hypothesis is that surgery on the extraocular muscles of patients with OCA and INS changes their nystagmus and their visual function., Design: Interventional, prospective, cohort, noncomparative case series., Methods: All 15 patients had surgery on all four virgin horizontal recti; three for strabismus alone, three for nystagmus alone, five for an eccentric gaze null zone alone, and four for an eccentric gaze null zone plus strabismus. All patients have been followed for at least six months. All 15 patients had the subjective outcome measure of pre- and postoperative binocular best optically corrected acuity (BBOCA). Objective outcome measures included anomalous head posture (AHP) in nine patients, eye movement recording measures of expanded nystagmus acuity function (NAFX) in 10 patients, null zone position (NUZP) and null zone width (NUZW) in 10 patients, and foveation time (FOV) in nine patients., Results: The results are summarized as follows; BBOCA increased 0.1 LogMar or greater in 14 of 15 patients. In those operated on for an AHP with or without associated strabismus the AHP improved significantly (P < .01 for all). The NAFX, NUZP, NUZW, and FOV measured from eye movement recordings showed persistent, significant increases in all patients (P < .01 for all)., Conclusions: This report adds to the evidence that surgery on the extraocular muscles in patients with INS has independent neurologic and visual results.