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Although Jordan has applied lockdown in response to COVID-19 pandemic, many people were not adherent to the quarantine. We aimed to examine the attitudes of the Jordanians and how these attitudes can predict their adherence using the health belief model (HBM). A cross-sectional study of 5057 participants using an internet-based questionnaire was conducted during lockdown. Multivariable ordinal regression analyses were used to estimate predictors of adherence to home quarantine. Overall, 646 (12.8%), 2078 (41.2%), and 2317 (46%) of participants showed poor, intermediate, and strict adherence, respectively. Of the HBM constructs, seriousness (β= 0.116, 95% CI 0.027 to 0.205), benefits (β= 0.056, 95% CI 0.002 to 0.110) and barriers (β= -0.025, 95% CI -0.035 to -0.015) were significant predictors. We identified income insecurity (β= -0.096, 95% CI -0.144 to -0.046), social withdrawal (β= -0.062, 95% CI -0.121 to -0.004), religious concerns (β= -0.149, 95% CI -0.202 to -0.096) and health consequences (β= 0.065, 95% CI 0.011 to 0.11) as barriers. Governmental instructions were the only predictive external cue (β= 0.055, 95% CI 0.004 to 0.014). Our findings suggest that a high number of Jordanians are adherent with the quarantine, demonstrating the ability of governmental policies in tackling potential barriers.

Background. Joint-sparing limb salvage surgery (JSLSS) is an advancement in the techniques and concepts of limb salvage surgery, which makes it possible to save not only the limb affected by malignancy but also the adjacent joint and the epiphyseal plate. In the growing child, this procedure is technically demanding due to the availability of small length of bone for implant purchase. Reconstruction options can be biological reconstruction or endoprosthesis; however, the outcome of endoprosthetic reconstruction after joint-sparing resection is not well described in the literature. Purposes. (1) To determine the prosthesis survival rates when using customized Joint-Sparing Endoprosthesis (JSE) after juxta-articular resection of bone tumors, (2) to investigate the rates of local recurrence, (3) to evaluate the need for revision surgery, and (4) to compare the outcome of customized JSE with that of joint-sacrificing techniques. Methods. In our study, joint sparing is defined as any procedure where a custom-made JSE is used in lieu of sacrificing the adjacent joint whenever the length of the remaining bone segment is not enough to accommodate the stem of a modular implant. Twenty-eight patients received JSE, and 31 joints were spared. Their age ranged from 4 to 55 years with a median age of 13 years. Twenty-one patients received surgery for primary reconstruction and 7 patients for revision of failed bone allograft or modular implant. Twenty-four joints are spared in the lower limbs and 7 in the upper limbs. Osteosarcoma was the most common pathological diagnosis (n = 13). Flat surface HA-coated custom JSE was used to spare 15 joints, and short-stemmed custom JSE was used to spare 16 joints. The length of the remaining bone epiphysis for JSE anchorage from the knee and ankle joints was 25–75 mm, median = 45 mm, and the length of the cortical bone remaining for the proximal femur and distal humerus was 5–70 mm, median = 10 mm. Results. Operative time was 2.5 to 4 hours (avg. 3 hr.) The bone resection surface fitted the prosthesis surface with <2 mm difference. Histological examination of all resected specimens shows clear bone resection margins; 2 patients had positive soft tissue margins. At mean follow-up period of 3 years (6 months–10 years), 6 patients developed local and systemic recurrences, three of them had a pathological fracture at the time of diagnosis (P=0.139), and 4 showed a poor response to chemotherapy (P=0.014); all recurrences occurred in the soft tissue. Implant survival at 5 years was 86.15%, and MSTS score was 90% (83–96%). Conclusions. Whenever this kind of implant is affordable and can be utilized, particularly in younger age groups, JSE may be a good reconstruction option to avoid the use of expandable implants and to avoid the potentially higher revision and complication rates associated with biological reconstruction, as well as the complications of conventional joint-sacrificing implant, mainly dislocations and polyethylene wear and tear.

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Introduction: Misconceptions surrounding the discipline of plastic surgery are widespread among not only the public, but medical students and professionals, as well. The purpose of this study was to explore how the inclusion of plastic surgery rotation into the medical curriculum affects medical students’ knowledge, attitudes and preferences regarding plastic surgery specialization and referral.  Design and Methods: A descriptive-correlational design was utilized to collect data from 200 medical students in the final two years of education from two separate six-year medical programs in Jordan. Data was collected using self-reported questionnaires regarding knowledge of surgical procedures allocation, attitude towards plastic surgery, preference of specialization, and benefits of plastic surgery to physicians and patients.Results: Analysis showed that medical students of plastic surgery integrate rotation (program A) had a higher average score of correct procedure-allocation (M = 12.57, SD = 3.14), compared to non-integrated plastic survey rotation program (program B) (M = 8.29, SD = 3.05) 8.29. About 83% of students in program A had their knowledge on plastic surgery from direct exposure to a plastic surgeon, compared to 43% of program B, and 24% of students in program A reported that their perception of plastic surgery influenced by media compared to 62% of those in program B.Conclusions: medical students who have been exposed to plastic surgery education are more confident about procedures of plastic surgery specialty and had more reliable sources of knowledge about plastic surgery than those who were not exposed to plastic surgery rotation.

Background Patellofemoral pain is a common condition. The Kujala score is a well-established scoring system to assess anterior knee pain and has been translated into many languages including Arabic. The purpose of this cross-sectional study is to culturally adapt the Arabic version of the Kujala score and determine its validity. Methods The Kujala score is composed of 13 multiple-choice questions. We modified two questions in the score; running and squatting, and were replaced with questions related to walking on different terrain and prostration, each with the same number of answer choices as the original questions so as not to affect the final score. These modifications were written in Arabic by the same group who translated and validated the original score into Arabic. The original and modified Kujala scores was printed and given to patients complaining of patellofemoral pain to be filled during their visit to the orthopedic outpatient clinics. Final scores for the original and modified questionnaires were calculated. Data was analyzed using SPSS statistics version 21.0 measuring Cronbach’s alpha, intraclass correlation coefficient, and Pearson correlation. Results Ninety-four patients were included in the study, 28 (29.8%) men and 66 (70.2%) women. The mean age for the included patients was 43.67 (± 14.46) years. The mean score for the modified initial questionnaire was 63.91 (± 16.32), and the mean score for the modified re-test questionnaire was 66.52 (± 17.50). There was a statistically significant difference between the mean scores (p = 0.041), with a mean difference of 1.97 (95% CI 0.08 to 3.856). We found a significant strong correlation between the score before and after changing the questions with a p value of < 0.001. Conclusions The culturally modified Arabic Kujala questionnaire is shown to be a valid, well-designed tool and an appropriate method of measuring patellofemoral pain.

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Objective: To explore (a) the risk factors associated with a deficiency of vitamin B12, and (b) the baseline (cutoff) serum level of vitamin B12 for a clinically-symptomatic deficiency in the Jordanian adult population. Background: Compared to the data available for developed countries, there is a marked scarcity of information on the levels and symptomology of vitamin B12 deficiency in developing countries, particularly in the Middle Eastern region. Methods: A total of 485 subjects were included in this study. Blood samples were drawn for biochemical analysis and data regarding socio-demographics, general health, anthropometric measures, and past medical, surgical, and medication history were collected. To explore the cut-off point, we compared all parameters included in a standard complete blood count as well as main symptoms reported to be associated with B12 deficiency between groups of different B12 cut-off values, consisting of those above and below 200, 175, 150 and 125 pg/ml. Results: Dietary habits, age, recurrent headaches, heart burn and peptic ulcer disease were found to be significantly associated with lower vitamin B12 levels. Surprisingly, daily smoking was associated with significantly higher B12 levels. The results revealed that none of the included potential indicators of B12 deficiency could be considered an indicative feature of deficiency. There were no significant differences neither in the symptoms nor in the CBC parameters between any of the tested study groups. Conclusion: Low dietary intake, older ages, recurrent headaches, heartburn and peptic ulcer disease, all could be considered as a risk factors of having low vitamin B12 levels within the Jordanians. Also, they tend to have lower levels of vitamin B12 levels, in comparison to countries in the West, without necessarily having deficiency symptoms. Cut-off value to diagnose functional B12 deficiency could be less than 125 pg/ml for the Jordanians. More local studies are needed to establish an accurate vitamin B12 cut-off value for the population in Jordan.