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IntroductionInterdisciplinary rounds (IDRs) involve collaborative patient care where healthcare professionals from various disciplines meet to discuss and plan patient management. In this project, bedside IDRswere introduced at our hospital to enhance care quality, improve communication among medical teams and increase patient satisfaction.MethodologyAfter educating the staff, bedside IDRs were implemented with a team consisting of hospitalists, medical residents, nurses, nurse leaders, nutritionists, case managers and social workers, who gathered at each patient’s bedside to discuss treatment plans and involve patients and their families in real-time discussions. Patient satisfaction was evaluated using Press Ganey (PG) scores over a 7-month period, comparing them with pre-implementation scores. Additionally, staff feedback on workflow and communication was gathered through pre- and postsurveys.ResultsOver 7 months, bedside IDRs led to significant improvements in patient satisfaction and physician-patient communication, as reflected in PG scores. Patients reported feeling more respected and listened to, with a greater understanding of their disease and treatment plan. Staff surveys showed notable improvements in inter-departmental communication and discharge planning effectiveness.DiscussionBedside IDRs improved key patient care aspects, including communication, respect and understanding of treatment plans. By involving the entire healthcare team in patient discussions, a more collaborative and patient-centred approach was fostered, leading to patients feeling heard and respected. A clearer, unified treatment plan improved patients’ understanding of their care. Despite initial coordination challenges, these were addressed with standardised scheduling. Overall, bedside IDRs resulted in better communication among providers, more comprehensive care plans, timely discharges and increased patient satisfaction, ultimately enhancing healthcare delivery.ConclusionUltimately, bedside IDRs contributed to improved healthcare delivery, with positive outcomes on different aspects. These findings highlight the potential of bedside IDRs to improve the quality of care and patient satisfaction in hospital settings.

Azraq Syrian refugee camp, located in Jordan, is where the challenges of managing the COVID-19 epidemic meet the vulnerabilities of displaced people. This study aimed to investigate the epidemiological characteristics, incidence, risk factors, and outcomes of COVID-19 among Azraq camp residents. COVID-19 data from Azraq camp were collected by International Medical Corps clinics and analyzed retrospectively from August 1, 2020, to August 31, 2022. Data included demographics, risk factors, testing history, contact tracing, and vaccination profiles. We estimated COVID-19 incidence and analyzed risk factors using Poisson and multilevel logistic regression. A total of 2,468 confirmed COVID-19 cases were identified, with a prevalence of 5.6 per 100 residents. The camp's monthly incidence rate was more than 50% lower than the national rate, with a 1.7% monthly decrease. Females had a higher incidence than males (6.4% vs. 4.9%, p < 0.001), while the elderly bore the greatest disease burden. Home-based isolation was the main strategy, except during the second wave. Vaccination coverage reached 31.6%, primarily with Pfizer (49.8%). Symptomatic cases made up 44.0% of confirmed cases, with 10.4% requiring hospitalization. Factors independently associated with hospitalization included age, comorbidity, and vaccination status. The study highlights the need for robust surveillance, targeted healthcare interventions, equitable resource allocation, and vaccination campaigns to manage COVID-19 and future epidemics in refugee camps.

Introduction: Lung cancer is the leading cause of cancer‐related mortality, with non–small cell lung cancer (NSCLC) accounting for 85% of cases. Lung adenocarcinoma, the most common subtype, can mimic benign conditions like pneumonia, lung abscess, and interstitial lung disease due to its varied radiologic presentations and associated inflammation and fibrosis. This similarity can delay diagnosis, emphasizing the need for imaging and histopathological confirmation. Case Presentation: A 58‐year‐old male with a significant smoking history, hypertension, and GERD presented with a 5‐month history of episodic epigastric pain, exacerbated by heavy meals, along with progressive respiratory symptoms, including shortness of breath, dry cough, and a 20‐kg weight loss over 3 months. Upper endoscopy revealed gastric ulcers, a hiatal hernia, esophageal mucosal changes consistent with GERD, and Helicobacter pylori infection on biopsy, which was treated with triple therapy, resolving his gastrointestinal symptoms. However, his respiratory symptoms worsened, with increased dyspnea at rest, pleuritic chest pain, and a persistent cough. Chest CT showed multiple cavitating lung nodules, architectural distortion predominantly in the upper lobes, a large irregular lesion in the right lower lobe, and enlarged paratracheal, subcarinal, and distal paraesophageal lymph nodes. The patient was transferred to our facility for further evaluation. Whole‐body CT revealed widespread bilateral cavitary lesions, lymphadenopathy, and a small hiatal hernia. Bronchoscopy with biopsy confirmed metastatic lung adenocarcinoma, with histopathology showing moderately differentiated adenocarcinoma, positive for TTF‐1 and Napsin A and negative for PAX8. Cytology from bronchoalveolar lavage also confirmed malignancy, and PD‐L1 immunostaining showed weak positivity in 15%–20% of tumor cells. The patient was diagnosed with metastatic lung adenocarcinoma and initiated on carboplatin and pemetrexed chemotherapy. Molecular testing was planned, and he was discharged for follow‐up care. Conclusion: Our case of a 58‐year‐old male with cavitating lung nodules, significant weight loss, and progressive respiratory symptoms, initially misattributed to gastrointestinal disease, highlights the diagnostic complexity of lung adenocarcinoma. The biopsy‐confirmed diagnosis of metastatic adenocarcinoma underscores the need for clinicians to maintain a high index of suspicion for malignancy in patients with atypical or nonspecific presentations. Early tissue diagnosis is crucial for timely treatment and improved outcomes, especially in cases involving cavitary lesions or persistent, unexplained symptoms.

Central nervous system tumors in adolescents and young adults (AYA) are rarely reported in the literature. The association with cancer predisposition syndrome is not established. Programmed death ligand 1 (PD-L1) can predict the potential response of patients to immunotherapy. A link between mismatch repair protein deficiency (MMRP-D) and response to immunotherapy is established. P53 is reported to be positive in MMRD-D cases. We aim to investigate the frequency of MMRP-D in AYA with high-grade glioma and any potential association with PD-L1. A total of 96 cases were tested including 49 (51.0%) cases of glioblastoma. Six cases (6.25%) were MMRP-D, 17 (17.7%) were PD-L1 positive, mostly in grade IV tumors (8.7% in grade III compared to 26% in grade IV, p value = 0.027), and 69 (71.9%) were P3 positive. None of the MMRP-D cases expressed PD-L1. P53-positive cases were mostly MMRP proficient ( n  = 67; 74.4%, p value 0.051). Fourteen cases (28.7%) were positive for both PD-L1 and P53, while p53-positive grade IV tumors were mostly associated with negative PD-L1 ( n  = 29, 58%, p value = 0.043). MMRP deficiency does not appear to be prevalent in high-grade glioma in AYA. Expression of PD-L1 in a quarter of cases might suggest a role for immunotherapy in high-grade glioma.

Colorectal cancer (CRC) is the third most common cancer worldwide. In the West, the incidence has stabilized or decreased. There are only occasional published studies that describe the epidemiology of CRC and its changing trends in Jordan and other Middle Eastern countries. Describe the epidemiological features of CRC, predict future trends and compare the results with those from other Arab and Middle Eastern countries and the West. Retrospective epidemiologic study. Tertiary center, teaching hospital. A retrospective study covering 14 years (2003 to 2016). All cases of CRC were retrieved from the computerized system. Demographic data were recorded and analyzed using Mathematica 11.2 and IBM SPSS version 23 software. Mathematical grey forecasting models were used to predict future trends. Number of cases and accumulated average over time, percentages of demographic variables and results of mathematical forecasting models. 970. The male-to-female ratio was 1.5:1 and 97.4% were adenocarcinomas. The accumulated mean number of diagnosed cases doubled from 44.8 between 2003 and 2007 to 82.9 from 2008 to 2016. The accumulated annual average increased beginning in 2008. The forecasting models predicted a further increase in CRC. The mean age was 60.5 years and the median 62.0. Half of the cases presented at an advanced stage (TNM stage III or IV). CRC is increasing and is expected to increase further. Better health care planning that includes education and screening is needed to reverse these rising trends and to improve early detection. Single institution study. None.

IntroductionNipple-sparing mastectomy (NSM), a procedure involving careful dissection of the breast tissue whilst keeping the nipple-areola complex (NAC) intact, is now increasingly practiced amongst surgeons in the treatment of certain situations of breast cancer. Given the importance of breasts to the female body image, this type of conservative breast surgery takes into account patient satisfaction and overall cosmesis, whilst ensuring appropriate oncological safety.Methods and resultsFour nipple-sparing mastectomy procedures were performed in our tertiary care centre, Princess Basma Teaching Hospital, in Jordan between June and September 2019. Indications for these procedures included invasive ductal carcinoma, malignant phyllodes, and high-grade ductal carcinoma in-situ. Patients were carefully assessed prior to surgical intervention using radiological imaging, ensuring a distance from NAC of >2 cm in all cases. Procedures were performed successfully with minimal intraoperative and no post-operative complications. Follow-up was carried out at 24 months, with no cases of local or distant post-operative recurrence, and patient satisfaction was qualitatively measured with the use of a BREAST-Q questionnaire. The questionnaire demonstrated improved overall physical well-being and satisfaction with an average overall post-operative physical well-being of 97%.ConclusionFollowing nipple-sparing mastectomy and immediate submuscular reconstruction with silicone implants,patients demonstrated high levels of satisfaction and quality of life (QoL) as measured by BREAST-Q survey. Two years of follow-up confirmed high patient satisfaction with increased scores from the preoperative baseline level.

Penile calciphylaxis is a rare presentation of calcific uremic arteriolopathy and can be a life-threatening condition usually seen in patients with end-stage renal failure with hemodialysis. The clear etiopathogenesis of calciphylaxis is not fully understood, but it is postulated to be characterized by the accumulation of calcium in the microvessels of adipose tissue and skin, which leads to ischemia and necrosis, causing painful ulcerations, and could potentially be complicated by sepsis and mortality. End-stage renal disease (ESRD) is one of the major risk factors for penile calciphylaxis. In this report, we describe a case of a 53-year-old Hispanic male patient with ESRD and diabetes on hemodialysis, who presented with a five-day history of acute, severe, burning, non-radiating pain to the head of his penis associated with black discoloration. He was diagnosed with penile calciphylaxis and received a combination of conservative and surgical interventions, resulting in a highly positive outcome marked by complete healing of the scar without any reported complications.

Portal vein thrombophlebitis is a rare complication that can occur in various hypercoagulable states, including COVID-19. We are presenting a 74-year-old female with a history of hypertension, diabetes, and lymphoma who contracted the COVID-19 infection and presented with persistent fever, leukocytosis, and mild epigastric tenderness. She developed hypotension, acute hypoxic respiratory failure, and worsening leukocytosis with bandemia and was diagnosed with portal vein thrombosis (PVT) and superior mesenteric vein thrombosis. The patient received broad-spectrum IV antibiotics and full anticoagulation therapy with heparin and was discharged on oral Warfarin after completing 14-day antibiotic therapy. She presented again with recurrent watery diarrhea, fever, abdominal pain, and fatigue and was diagnosed with pylephlebitis and multiple small liver abscesses. The patient was treated with antibiotics for six weeks and was discharged on warfarin, furosemide, and spironolactone with close outpatient follow-up. Prolonged fever in COVID-19 patients can indicate extensive thrombosis at unusual sites, which can lead to major morbidity and mortality in patients.

Pulmonary embolism (PE) is a life-threatening condition requiring early and accurate diagnosis. The Wells and Geneva scores, along with D-dimer testing, are key tools in assessment. However, the standard D-dimer cut-off of 0.5 mg/mL, while highly sensitive, has low specificity, leading to excessive imaging. This study examines whether modifying the D-dimer threshold can improve diagnostic efficiency and reduce unnecessary testing. This retrospective study analyzed 878 patients who underwent computed tomography pulmonary angiography (CTPA) at Monmouth Medical Center from January 2022 to December 2023. Statistical analysis, including ROC curve assessment, was conducted using IBM SPSS, with significance set at p < 0.05. The study cohort had a mean age of 57.2 years (±18.3), with 61.4 % female patients. PE was diagnosed in 7.7 % (n = 68) via CTPA, while 92.3 % had negative results. Dyspnea (59 %) and chest pain (33.9 %) were the most common symptoms. Patients with PE had significantly higher mean D-dimer levels (4.77 mg/mL) than those without PE (1.45 mg/mL, p < 0.001). Raising the D-dimer cut-off from 0.5 mg/mL to 0.65 mg/mL improved specificity from 12 % to 37 % while maintaining 100 % sensitivity. This study highlights the potential to improve the diagnosis of pulmonary embolism (PE) by adjusting the D-dimer cut-off. By increasing the cut-off, we were able to enhance specificity while maintaining sensitivity, leading to fewer unnecessary imaging tests. These results suggest that refining diagnostic thresholds can improve the accuracy of PE detection, reduce patient exposure to unnecessary procedures, and better allocate healthcare resources.