BACKGROUNDColorectal 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.OBJECTIVESDescribe the epidemiological features of CRC, predict future trends and compare the results with those from other Arab and Middle Eastern countries and the West.DESIGNRetrospective epidemiologic study.SETTINGTertiary center, teaching hospital.PATIENTS AND METHODSA 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.MAIN OUTCOME MEASURESNumber of cases and accumulated average over time, percentages of demographic variables and results of mathematical forecasting models.SAMPLE SIZE970.RESULTSThe 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).CONCLUSIONCRC 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.LIMITATIONSSingle institution study.

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.

Introduction Nipple-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 results Four 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%. Conclusion Following 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.

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