Although penetrative sex is the most common route of HPV infection, there is strong evidence of non-sexual modes of transmission. As the first of its kind, this study aimed to investigate the knowledge and awareness of Jordanian physicians on such routes. A questionnaire was conducted among a national Jordanian sample of physicians from Jordanian health sectors. The survey included questions assessing participants’ knowledge on HPV, non-sexual routes of infection and HPV vaccines. Physicians’ attitudes towards HPV screening and vaccination were covered. Statistical analysis was carried out using SAS 9.4, ANOVA, post-hoc Tukey-Honest test and Kruskal-Wallis test. All significant differences were set at α = 0.05. A total of 412 participants completed the survey. Physicians showed a huge deficit in knowledge on nonsexual routes of HPV transmission. They agreed that the most and least common routes of non-sexual transmission are skin to mucosa (64%) and contaminated water (15%), respectively. Females showed significantly better knowledge in all aspects of HPV transmission and vaccination (p<0.0001) and more positive attitudes towards HPV screening and vaccination compared to males (p = 0.03). Age group ≤ 25 and academic physicians demonstrated higher knowledge on HPV vaccines compared to their counterparts in non-academic places (p = 0.002). Specialty and experience seemed to have no impact on knowledge or attitudes of participants. Higher knowledge physicians had more positive attitude towards vaccination and screening compared to lower knowledge fellows (p<0.001). The noteworthy findings of this study is the extremely low level of knowledge on non-sexual routes of HPV infection among Jordanian physicians. Increasing the level of awareness of physicians and healthcare workers on these routes and their association with cervical and other cancers through university curricula and other reliable sources is strongly recommended.

The long-term immunoglobulin responses of COVID-19 vaccinations is important to determine the efficacy of these vaccinations. This study aimed to investigate and compare the long-term immunoglobulin response of COVID-19 vaccination recipients, using anti-S IgG, anti-N IgG, and IgM titer levels. This study included 267 participants, comprising individuals who tested positive for COVID-19 through PCR testing (n = 125), and those who received the Pfizer (n = 133), Sinopharm (n = 112), AstraZeneca (n = 20), or Sputnik (n = 2) vaccines. Female participants comprised the largest share of this study (n = 147, 55.1%). This study found that most participants had positive IgG antibodies, with 96.3% having anti-S IgG and 75.7% having anti-N IgG. Most participants (90.3%) tested negative for anti-N IgM antibodies. Sinopharm-vaccinated individuals exhibited a notably lower rate of positive anti-S IgG (93.8%) and a significantly higher rate of positive anti-N IgG antibodies (91%). Anti-N IgG levels were significantly correlated with the number of prior COVID-19 infections (p = 0.015). Specifically, individuals with a history of four COVID-19 infections had higher anti-N IgG titers (14.1 ± 1.4) than those with only one experience of COVID-19 infection (9.4 ± 7.2). Individuals who were infected with COVID-19 after receiving the vaccine demonstrated higher levels of anti-N IgG, exhibiting a 25% increase in mean titer levels compared to those who were infected prior to vaccination. There was a statistically significant association between anti-N IgG positivity with age (p = 0.034), and smoking status (p = 0.006) of participants. Participants younger than 20 and older than 60 showed the highest positivity rate of anti-N (>90%). Smokers had a low positivity rate of anti-N (68.8%) compared to nonsmokers (83.6%). In conclusion, this study demonstrated that most COVID-19 vaccination recipients had positive IgG antibodies, with differences in the long-term immunoglobulin response depending on the type of vaccine administered and occurrence of COVID-19 infection.

Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with cardiomyopathy (CM), associated with worse cardiovascular outcomes. This study aims to provide a comprehensive, national-level analysis of AF and CM-related mortality in the United States. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was utilized, using death certificates from 1999 to 2024. The study included patients aged ≥15 years with CM and AF. Statistical analyses were conducted to calculate age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent changes with 95% confidence intervals (CIs). Between 1999 and 2024, CM with concomitant AF accounted for 134,470 deaths among individuals aged 15 years or older. The overall AAMR rose from 1.5 per 100,000 in 1999 to 2.3 in 2024. From 1999 to 2016, the AAMR rose modestly (1.5–1.8), followed by a pronounced rise from 2016 to 2022 (1.8–2.5), and a relative decline by 2024 (2.5–2.3). Compared with 2019, mortality in 2020 demonstrated a 15% relative increase (incidence rate ratio = 1.15; 95% CI: 1.11–1.19). Males had disproportionately higher AAMRs compared to females. By race, the highest AAMRs were observed in non-Hispanic (NH) Black and White populations (1.8 each). Regionally, the West and Midwest exhibited the highest AAMRs (1.9 each). Urban–rural stratification revealed higher AAMRs among rural areas (2.2) when compared with urban (1.8) areas. Targeted public-health interventions and resource allocation to address this growing cardiovascular mortality burden, particularly in high-risk demographic groups, are needed.

Amiodarone-induced thyrotoxicosis (AIT) can complicate the management of atrial tachyarrhythmias, particularly when endocrine and rhythm responses diverge. A man in his early 70s with persistent atrial fibrillation and flutter, prior catheter ablations, and previously recovered tachycardia-induced cardiomyopathy presented with atrial flutter with rapid ventricular response after prolonged amiodarone exposure. Evaluation demonstrated severe thyrotoxicosis and a newly reduced left ventricular ejection fraction. Thyrotoxicosis persisted despite methimazole, prednisone, cholestyramine, and beta-blockade; plasma exchange followed by total thyroidectomy achieved biochemical control. Atrial flutter nevertheless persisted and sinus rhythm was maintained only after amiodarone was reintroduced. Recurrent sinus pauses with syncope subsequently required dual-chamber pacemaker implantation. At follow-up, device interrogation showed no recurrent atrial fibrillation or flutter, and left ventricular ejection fraction had recovered to 50-55%. This case illustrates that definitive treatment of AIT may not by itself resolve a coexisting atrial arrhythmia and that endocrine and rhythm-control strategies may need to proceed independently.