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Highlights Rarity of this presentation. Controversies on treatment. Controversies about diagnosis.

Introduction: Intravesical chemotherapy instillation by mitomycin -C (MMC) immediately after transurethral resection of bladder tumor (TURBT), although effective in reducing the incidence of non-muscle invasive bladder cancer (NMIBC) recurrence, can result in non desirable effects like bladder irritation and hematuria . Continuous bladder irrigation with saline post resection has been studied as an alternative. In our study we compare the rates of NMIBC recurrence and progression in patients who were treated with either MMC or CSBI immediately after tumor resection. Methods: We retrospectively reviewed the medical records of patients with NMIBC at our institution in Jordan university hospital in the period between 2015-2019. Postoperative instillation of MMC or CSBI for four hours was recorded. Follow up of the patients for recurrence or progression in the first 2 years after diagnosis was recorded and compared for both groups. Results: One hundred nineteen patients met inclusion criteria. Fifty four patients received MMC and 65 patients received CSBI immediately post TURBT. Kaplan-Meieranalysis for recurrence-free survival and progression-free survival didn't show a significant difference between both groups with P-value 0.88 and 0.14 respectively. Conclusion: Postoperative CSBI for four hours following tumor resection is equivalent to immediate postoperative MMC instillation for NMIBC in terms of recurrence or progression rates with fewer side effects . However further research is needed in this field .

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Objective Nocturnal enuresis (NE) is defined as uncontrollable bed-wetting for at least three consecutive months in children over 5 years. Sleep could be dramatically altered in children with primary nocturnal enuresis (PNE); consequently, this helps to confirm the assumption that PNE appears to modify sleep structure, or it might be the result of an irregular sleep structure itself. Method This study conducted on 180 patients with monosymptomatic nocturnal enuresis. Their age was ranged from 6 to 18 years, and they were still having nocturnal enuresis episodes. We record two main points: first, if the child is a regular sleeper or not. The second point if the child is a regular bed wetter or not. This work fully compliant with the STROCCS criteria (Agha et al., 2019). Result A total of 180 children were included (Male 122, 67.8%, Female 58, 32.2%). The mean age was 8.9 (±2.4). This study showed that children aged 7–10 years are significantly more inclined to be reported as specific time bed-wetter's, whereas those aged between 11 and 13 are significantly less likely to wet their bed at a specific time (p = 0.001). Children who tend to sleep more often near a specific time each night are 6.74 times more prone to bed-wet around a particular time during their sleep (p < 0.001). Conclusion This study can be considered as hypothesis-generating that shed light on the possible correlation between the adherence to sleep at a specific time and its effect on the time of enuresis and the number of bedwetting.

Background Intraoperative awareness is the second most common complication of surgeries, and it negatively affects patients and healthcare professionals. Based on the limited previous studies, there ‎is a wide variation in the incidence intraoperative awareness and in the practices and attitudes of depth of anesthesia (DoA) monitoring among healthcare systems and anesthesiologists. This study aimed to evaluate the Jordanian anesthesiologists’ practice and attitudes toward DoA monitoring and their estimation of the incidence of ‎intraoperative awareness. Methods A descriptive cross-sectional survey of the Jordanian anesthesiologists working in public, private, and university hospitals was utilized using questionnaire ‎developed based on previous studies. Practice and attitude in using DoA monitors were evaluated. Anesthesiologists were asked to best estimate the number of anesthesia procedures and frequency of intraoperative awareness events in the year before. Percentages and 95% Confidence Intervals (95%CI) were reported and compared between groups using chi-square tests.‎ Results A total of 107 physicians participated and completed the survey. About one-third of the participant (34.6%; 95% CI 26.1–44.2) had never used a DoA monitor and only 6.5% (96% CI ) reported using it as a “daily practice”. The use of a DoA monitor was associated with experience and type of health sector. However, 81.3% (95% CI 66.5–83.5) believed that currently available DoA monitors are effective for DoA monitoring, and only 4.7% (95%CI ‎1.9–10.8‎) reported it as being “invalid”. Most participants reported that the main purpose of using the DoA monitor was to prevent awareness (86.0%; 95%CI 77.9–91.4), guide the delivery of anesthetics (63.6%; 95%CI 53.9–72.2), and reduce recovery time (57%; 95%CI 47.4–66.1). The event rate of intraoperative awareness was estimated at 0.4% among participated anesthesiologists. Most of participants’ hospitals lacked policy intended to prevent intraoperative awareness. Conclusions Most anesthesiologists believed in the role of DoA monitors in preventing intraoperative awareness, however, their attitudes and knowledge are inadequate, and few use DoA monitors in routine practices. In Jordan, large efforts are needed to regulate the use of DoA monitoring and reduce the incidence of intraoperative awareness.

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