Respiratory syncytial virus in pediatric patients admitted to a tertiary center in Amman: clinical characteristics, and age-related patterns.

BACKGROUND: Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections, particularly in infants and young children during winter. We aimed to study the demographics and clinical characteristics of RSV infections and age-related patterns. METHODS: This retrospective study evaluated pediatric respiratory syncytial virus (RSV) infections conducted in Jordan from September 2021 to March 2022. Patients under the age of five who had viral polymerase chain reaction results showing RSV infection from nasopharyngeal aspiration were included. In addition, demographic information, medical history, and clinical data were gathered. These included comorbidities, outcomes, length of stay, ICU hospitalization, use of antibiotics, and oxygen supplementation. RESULTS: A total of 199 patients were included. Most patients were males (56.8%) and less than one year (43.7%). Children aged between 1 and 2 years presented with more shortness of breath (90.1%) than infants and children more than two years (66.7% and 87%, respectively) (p < 0.001). Older children (> 2 years) were significantly more likely to use antibiotics and have ICU admission than younger children ≤ 2 years (p = 0.045 and 0.018, respectively). There was no relationship between age groups, recurrent hospitalization, previous RSV infection, oxygen therapy, coinfection, and hospitalization duration. The respiratory rate was higher among patients with co-infection (p = 0.031). CONCLUSION: The current study provides information on the demographics and clinical characteristics of RSV infections. These findings contribute to a nuanced understanding of RSV infections in the specified population, emphasizing age-specific variations and clinical implications for better management strategies.

Congenital Diaphragmatic Hernia at a Non-ECMO Center in Jordan.

OBJECTIVES: We studied the clinical characteristics and outcomes of neonates with congenital diaphragmatic hernia (CDH) admitted to a non-extracorporeal membrane oxygenation (ECMO) center. METHODS: A retrospective chart review of neonates with CDH admitted to a University Hospital, in Amman, Jordan, between 2005 and 2019. Demographic characteristics and their management details were extracted and factors associated with survival were analyzed. RESULTS: A total of 28 neonates born with CDH were included; their survival rate was 39.3%. Onset of respiratory distress, pre-operative ventilation, and length of hospitalization were significantly associated with mortality. Survival after surgery was significantly associated with a higher gestational age and a longer hospital stay. CONCLUSION: Our study showed a high mortality rate for CDH patients. Decreasing the health inequity and improved clinical interventions could improve outcomes.

Correlation of vitamin D receptor genotypes, specific IgE levels and other variables with asthma control in children.

INTRODUCTION: Asthma is a common condition affecting millions of children globally. The main goal of this study is to assess factors related to asthma management, particularly atopy level and the impact of genetic variants of the vitamin D receptor (VDR) gene. METHODS: Asthmatic children were enrolled in an outpatient respiratory clinic. Information on patients' medication adherence, medical and medication factors, and sociodemographic were gathered. Spirometry FEV1% and FVC% measurements, and the asthma control test were used to evaluate the severity of asthma, and genotyping of the VDR gene and radioallergosorbent test (RAST) were conducted. Regression analyses were conducted to evaluate variables associated with asthma control and spirometry measures. RESULTS: A total of 313 participants (67.4% males) were recruited in the current study. The mean age was 9.37 (±3.45) years. The mean score for adherence was 4.26 (±2.52), and only 46% of the participants had controlled asthma. Forward conditional stepwise binary regression showed that low and moderate Inhaled corticosteroids (ICS) dose (OR= 0.42 (95% CI 0.20-0.90), p = 0.026; OR = 0.371 (95% CI 0.2-0.72), p = 0.003, respectively) decreased the odds of being in the controlled asthma group, while higher inhaler score (OR = 2.75 (95% CI 2.17-3.49, p < 0.001)) increased the odds of being in the controlled asthma group. However, results found no association between VDR genotype and asthma control, spirometry values or hospitalization due to asthma. CONCLUSIONS: The results indicated that many of the asthma patients had poorly controlled asthma. Factors that were associated with poor asthma control included poor inhaler technique.

Parental knowledge and attitudes toward asthma in Jordanian children with asthma, a multi-center cross-sectional study.

OBJECTIVE: We explored Jordanian caregivers' knowledge, attitudes, and practices (KAP) toward asthma in their children. METHODS: This cross-sectional investigation was conducted on caregivers visiting the pediatrics clinic at the Jordan University Hospital and King Abdullah University Hospital between December 2021 and January 2023. KAP were measured using a literature-validated questionnaire. Differences in KAP scores across participants' characteristics were examined using the student-t test and ANOVA. RESULTS: A total of 108 caregivers were included in the final analysis. Caregivers were aged 30 to 40 years (54.6%) and had at least secondary education (90.7%). The majority of participants displayed appropriate knowledge with respect to asthma's clinical course. Furthermore, the greater portion of caregivers were knowledgeable about preventing asthma attacks and treating their children during said attacks. Factors affecting knowledge of asthma included age of mothers (p < .05). On the other hand, attitude scores were affected by occupation, type of medication, and family history of asthma (all p < .05). Moreover, employee mothers, children well controlled on both Asthma Control Test and Global Initiative for Asthma scores, and having no pediatric intensive care unit admissions were associated with higher practice treatment scores (all p < .05). Overall practice score was weakly, yet positively correlated with knowledge scores (r = 0.195, p = .043). Similarly, negative attitudes were weakly correlated with higher knowledge scores (r = 0.199, p = .039). CONCLUSION: While the knowledge and practice scores were satisfactory, the clinical status of children with asthma was unsatisfactory. Future studies should examine factors associated with caregiver insecurity and measure their extent of applying asthma prevention guidelines.

The Characteristics of Respiratory Bocavirus Infection in Acutely Sick Children Admitted to a Tertiary Hospital in Jordan.

OBJECTIVE: The clinical manifestations of human bocavirus infections are diverse, ranging from mild common cold to severe lower respiratory tract infections. Bocaviruses have frequently been codetected with other respiratory viruses. We aimed to estimate the burden of bocavirus and multiple viral infections and to investigate the risk factors associated with these infections. METHODS: This study was a retrospective chart review of admitted patients. The medical records of the included children were searched, and data on demographics, clinical presentation, imaging, laboratory and nasopharyngeal swab results were collected. RESULTS: A total of 157 patients were included. Most of the patients were males (62.1%) and under 6 months of age (52%). The 3 most common symptoms presented in the patients were cough (81.8%), rhinorrhea (58.6%) and fever (55.8%). Bocavirus DNA was detected in 12.66% of the patients, while 22.30% had multiple viruses. Age distribution was significantly different between bocavirus and nonbocavirus groups, with a lower proportion of bocavirus infection in all age groups (P = 0.032). The X-ray patterns significantly differed between the 2 study groups, with a lower number of patients in the bocavirus group having normal X-rays (P = 0.007). Patients infected with multiple viruses had more severe respiratory distress symptoms and diarrhea than those infected with only 1 virus. CONCLUSIONS: The prevalence of multiple viruses and bocavirus respiratory infections is significant. This study can guide physicians toward the clinical presentation and characteristics of children with respiratory bocavirus and multiple viral infections and propose future studies conducted in this regard.

Epidemiology of Streptococcus pneumoniae Serotypes in Jordan Amongst Children Younger than the Age of 5: A National Cross-Sectional Study.

INTRODUCTION: Streptococcus pneumoniae infections are a major cause of mortality and morbidity worldwide. In Jordan, pneumococcal conjugate vaccines (PCVs) are not included in the national vaccination program. Due to the current availability of several PCVs, including PCV-10, PCV-13, and PCV-15, along with PCV-20, currently undergoing pediatric approvals globally, the decision to introduce PCVs and their selection should be based on valid local data on the common serotypes of Streptococcus pneumoniae. METHODS: This cross-sectional study aimed to identify the frequency of serotypes of Streptococcus pneumoniae in children aged below 5 years hospitalized with invasive pneumococcal diseases (IPDs), including pneumonia, septicemia, and meningitis, during the study's duration in representative areas of Jordan. Serotyping for culture-positive cases was based on the capsular reaction test, known as the Quellung reaction. qPCR was conducted on the blood samples of patients with lobar pneumonia identified via X-ray or on cerebrospinal fluid for those with a positive latex agglutination test for Streptococcus pneumoniae. RESULTS: This study was based on the analysis of the serotypes of 1015 Streptococcus pneumoniae cases among children younger than the age of 5: 1006 cases with pneumonia, 6 cases with meningitis, and 3 cases with septicemia. Only 23 culture-positive cases were identified in comparison to 992 lobar pneumonia cases, which were PCR-positive but culture-negative, with a PCR positivity rate of 92%. Serotypes 6B, 6A, 14, and 19F were the most common serotypes identified in this study, with prevalence rates of 16.45%, 13.60%, 12.12%, and 8.18%, respectively. PCV-10, PCV-13, PCV-15, and PCV-20 coverage rates were 45.32%, 61.87%, 64.14%, and 68.47%, respectively. DISCUSSION: To the best of our knowledge, this is the largest prospective study from the Middle East and one of the largest studies worldwide showing the serotypes of Streptococcus pneumoniae. It reveals the urgency for the introduction of a PCV vaccination in Jordan, utilizing recently developed vaccines with a broader serotype coverage.

Assessment of Fraction of Exhaled Nitric Oxide and Soluble Receptor for Advanced Glycation End Products Biomarkers for Jordanian Asthmatic Children.

Purpose: Fraction of exhaled nitric oxide (FeNO) and soluble advanced glycation end-product receptor (sRAGE) are proposed as biomarkers of asthma, therefore we sought to assess their use in asthmatic children of Jordan. Patients and Methods: We conducted a case-control study at The University of Jordan Hospital. A total of 141 asthmatic children followed by respiratory pediatricians and 118 healthy children aged 4-18 years were recruited. FeNO was measured by NObreath device and serum sRAGE by ELISA that detect endogenously soluble isoform (esRAGE) and total soluble RAGE (sRAGE). Results: sRAGE in asthmatic was half of the control (p <0.001). In addition, ratio of esRAGE/sRAGE was two-fold higher in asthmatic (p = <0.001). Neither FeNO nor esRAGE levels were significantly different between groups. FeNO and asthma control test (ACT) score were negatively correlated corrected for age and body mass index (BMI), (r = -0.180, p= 0.034). For the uncontrolled asthma group, esRAGE/sRAGE negatively correlated with ACT score (r = -.329, p = 0.038). Receiver operating curve (ROC) analysis revealed significant predictive value (PV) for sRAGE and esRAGE/sRAGE in asthma detection with area under the curve (AUC) of (0.751 ± 0.031) and (0.711±.033), consequently. However, no biomarker had a significant PV for lack of control. Conclusion: The current study supports utilizing sRAGE as a marker for asthma and present a potential therapeutic target. However, our results indicate that both FeNO and sRAGE have a limited role in the management of asthmatic children or assessment of asthma control.

Knowledge, Attitudes, and Practices of Influenza Vaccination among Parents of Children with Asthma: A Cross-Sectional Study.

Asthma is the most common chronic disease in childhood. Exacerbation is a significant problem for asthmatic patients, and viral infections remain the most frequent triggers of asthma exacerbations. This study explored knowledge, attitudes, and practices (KAP) of parents of asthmatic children towards providing influenza vaccine to their children. This cross-sectional study enrolled parents of asthmatic children who visited the outpatient respiratory clinics of two Jordanian hospitals. The present study enrolled 667 parents of asthmatic children (62.8% female). The median age of the participants' children was 7 years. The results showed that 60.4% of the children with asthma never received a flu vaccine. Most of those who had received the flu vaccine reported that the side effects were mild (62.7%). Asthma duration was positively and significantly associated with increased vaccine hesitancy/rejection (OR = 1.093, 95% CI = (1.004-1.190), p = 0.04; and OR = 1.092, 95% CI = (1.002-1.189), p = 0.044, respectively). As the attitude towards flu vaccine score increases, odds of vaccination hesitancy/rejection decreased (OR = 0.735, 95% CI = (0.676-0.800), p < 0.001; and OR = 0.571, 95% CI = (0.514-0.634), p < 0.001, respectively). The main reasons for vaccination hesitancy/refusal included "I don't think my child needs it" (22.3%) followed by "I forget it" (19.5%). The rate of vaccination among children was low and emphasized the necessity of encouraging parents with asthmatic children to vaccinate their children by conducting health awareness campaigns and also emphasized the role of doctors and other healthcare professionals.

Characteristics of inpatients with atopic asthma in a tertiary center: do age and gender have an influence?

Background: Several studies have demonstrated gender influence on asthma prevalence, being higher among males during early childhood. Little is known about the impact of gender and age on asthma exacerbation characteristics in pediatrics. This study aimed to determine the differences in acute asthma between males and females in three different age groups regarding perinatal characteristics of asthmatic patients, comorbidities, medication adherence, level of blood eosinophils, and pattern of hospitalization. Methods: The medical records of 130 pediatric patients with asthma, who presented to the emergency department at Jordan University hospital with asthma exacerbations, were retrospectively reviewed. Demographic information and clinical characteristics were collected. Results: The mean age of patients was 10.7±4.7 years. The age at diagnosis and gestational age were significantly higher in older children. Furthermore, younger children were significantly more likely to experience winter exacerbations and more emergency presentations. Male patients were considerably younger than their female counterparts and were diagnosed younger. In addition, male patients were more likely to have eosinophil levels higher than 3% than female patients. Conclusion: Gender plays a role in the development and outcome of asthma exacerbations at different ages of pediatrics. A better understanding of gender-based and age-based differences in asthma dictates a personalized approach to treatment.

All-cause mortality in a pediatric intensive care unit at a teaching hospital in Amman, Jordan.

BACKGROUND: The aim of this study was to describe the main causes of admission to a general pediatric intensive care unit (PICU), and examine the main causes of mortality in this patient population. In addition, we describe the percentage of patients who died following a failed cardiopulmonary resuscitation (CPR) versus do not resuscitate (DNR) orders. METHODS: This was a retrospective, cohort study with a chart review of admissions and mortality cases that occurred in the PICU. Mortality rates in pediatric admissions are reported with a description of demographics, diagnosis, length of stay, use of mechanical ventilation, use of vasoactive agents, preexisting comorbidities, the presence of a DNR order, and final cause of mortality. Modes of mortality were described as failed CPR or a DNR order. RESULTS: During the study period there were 1,523 admissions to the PICU. Of those, 102 patients died with an overall mortality rate of 6.7%. Patients who died tended to be younger, and the majority (85%) had a preexisting comorbidity, with neuromuscular disease being the most common. The majority of the patients who died (69%) required invasive ventilation. The most common immediate cause of mortality was respiratory disease and the highest case fatality was among those with cardiac disease. Of those patients who died, 90% had failed CPR and 10% had a DNR order. Care was not withdrawn from any patient. CONCLUSION: This study describes the diagnostic categories of children admitted to the PICU, with respiratory disease being the most common cause of admission and mortality. The majority of children who died had an existing comorbidity and did not have a DNR order at the time of their death.

Alterations of serum and saliva oxidative markers in patients with bronchial asthma.

BACKGROUNDS: The development of asthma is highly affected by exposure to exogenous and endogenous oxidative molecules, but the impact of this exposure on the pathophysiology of asthma has received little attention. OBJECTIVES: Evaluating group of selective oxidative stress markers as a tool in the management of asthma disease. METHODS: In comparison with matched healthy controls, levels of the oxidant and antioxidant markers: lipid peroxidation malondialdehyde (MDA), Total glutathione (tGSH), Uric acid (UA), Glutathione peroxidase (GPx), Catalase (CAT) superoxide dismutase (SOD), and Total antioxidant capacity (TAC) were assessed in serum and saliva of different asthma groups. RESULTS: All oxidative markers in serum and saliva of asthma patients showed significant alterations from normal healthy controls (P < 0.05), except the salivary SOD (P = 0.441). Their levels in serum were significantly correlated with asthma severity (P < 0.05), and the distinguishing between childhood and adult asthma was significantly accomplished by GPx, SOD, TAC markers (P < 0.05). However, in patients with childhood asthma no significant differences were detected between the levels of GPx, CAT, UA, MDA in serum and saliva samples (P > 0.05). CONCLUSION: Determination of the oxidative markers GPx, CAT, UA in serum or saliva can distinguish asthma from healthy states. The serum levels of UA and TAC are highly effective in monitoring asthma severity, while the salivary GPx, CAT, UA, MDA are beneficial in the management of childhood asthma. Discrimination of the age factor between asthma groups can be achieved by testing GPx, SOD, TAC in serum.

The burden of influenza and other respiratory viruses in hospitalized infants and children in a university hospital, Jordan.

Background: Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide in young children and is predominately caused by viral respiratory pathogens. This study aims to identify the viral etiologies of ALRI in hospitalized children in Jordan University Hospital and compare the clinical characteristics of influenza virus infection with other respiratory viruses. Methods: A retrospective viral surveillance study that included 152 children below 15 years of age admitted with ALRI from December 2018 through April 2019 was conducted. We recorded results of real-time reverse transcriptasepolymerase chain reaction (RT-PCR) for common respiratory viruses. Clinical and demographic information of the study population was collected from patients' electronic medical records. Results: 152 patients were identified with a median age of 1 year (mean was 2.1 years). Ninety-five patients (62.5%) were males. One or more viral respiratory pathogens were detected in 145 (95.3%) children. Respiratory syncytial virus was the most detected virus in 68 patients (44.8%). Influenza virus was detected in 25 patients (16.4%). Children with influenza infection had more fever and lower leukocyte count compared to children infected with other viruses. The severity of the ALRI correlated significantly with several factors, including age less than six months and the presence of neuromuscular disease (p<0.05). Conclusion: Viral detection was common among children admitted with ALRI. Viruses, including influenza, are recognized as significant contributors to the morbidity associated with ALRI. More attention is needed on strategies for the prevention and detection of viral ALRI in developing countries.

Impact of COVID-19 lockdown on children with asthma in Jordan: a parental questionnaire.

Objective: To evaluate the impact of a 10-week lockdown on children with asthma aged 4-17 years in terms of presentations to the emergency department (ED), frequency of admissions, compliance with medications and changes in pulmonary function testing results. Design and setting: A questionnaire-based cross-sectional study using Google Forms to collect parents' and caregivers' responses after they consented to participation. Results: A total of 374 parents/caregivers were contacted and 297 (79%) responded. The majority of the children were male (188 or 63%) and 49.8% were aged 7-12 years. More than half of the participants (194 or 65%) reported improved compliance with medications and spacer use. There was a significant reduction in the number of presentations to the ED from 137 to 80 and admissions to hospital from 56 to 24 during the 10-week lockdown period compared with the same time period in the previous year (p≤0.0001). Around 25% of the participants used telemedicine by phone and social media applications for communication with their treating physician and 59 (80%) described it as easy and smooth. Conclusion: The national lockdown in Jordan due to the COVID-19 pandemic was associated with a fall in emergency presentations and hospital admissions for acute asthma exacerbations. Parental responses indicate that fears focused around COVID-19 were associated with enhanced compliance with use preventer medications during the lockdown.

Coronavirus disease 2019 (COVID-19): a brief overview of features and current treatment.

Since the report of the first cases of pneumonia caused by SARS-CoV-2 in December 2019, COVID-19 has become a pandemic and is globally overwhelming healthcare systems. The symptoms of COVID-19 vary from asymptomatic infection to severe complicated pneumonia with acute respiratory distress syndrome (ARDS) and multiple organ failure leading to death. The estimated case-fatality rate among infected patients in Wuhan, the city where the first case appeared, was 1.4%, with 5.1 times increase in the death rate among those aged above 59 years than those aged 30-59 years. In the absence of a proven effective and licensed treatment, many agents that showed activity against previous coronavirus outbreaks such as SARS and MERS have been used to treat SARS-CoV-2 infection. The SARS-CoV-2 is reported to be 80% homologous with SARS-CoV, and some enzymes are almost 90% homologous. Antiviral drugs are urgently required to reduce case fatality-rate and hospitalizations to relieve the burden on healthcare systems worldwide. Randomized controlled trials are ongoing to assess the efficacy and safety of several treatment regimens.

Vitamin D deficiency in children with bronchial asthma in southern Jordan: a cross-sectional study.

OBJECTIVES: To assess serum 25-hydroxycholecalciferol (25-OH vitamin D) levels in Jordanian children with bronchial asthma, and to examine correlations between 25-OH vitamin D levels and asthma severity and control. METHODS: A cross-sectional study was conducted at the Paediatric Chest Clinic, Al-Karak Governmental Hospital, Southern Jordan, between May 2015 and February 2016. Serum 25-hydroxyvitamin D level was determined in children aged 1-14 years diagnosed with bronchial asthma (6-14 years) or recurrent wheezing episodes (<6 years). Asthma severity was determined based on the Global Initiative for Asthma assessment, the Asthma Control Test, and the Childhood Asthma Control Test. Demographic and clinical characteristics were compared between patients with low and normal 25-OH vitamin D levels, and correlations between asthma severity and 25-OH vitamin D level were assessed. RESULTS: Out of 98 included children, 25-OH vitamin D levels were deficient and insufficient in 41 (41.8%) and 34 (34.7%) children, respectively. Only 23 (23.5%) had sufficient 25-OH vitamin D levels. A significant correlation was found between severity of asthma symptoms and 25-OH vitamin D deficiency. CONCLUSION: 25-OH vitamin D deficiency is highly prevalent in Jordanian children with bronchial asthma and correlates significantly with asthma severity.

Risk factors for postoperative pulmonary complications in children with severely compromised pulmonary function secondary to severe scoliosis.

OBJECTIVES: After corrective surgery for scoliosis, postoperative pulmonary complications lead to increases in morbidity, length of hospital stay (LOS) and mortality. This study aimed to identify associations with such respiratory complications, and to assess the utility of noninvasive ventilation (NIV) in children with severe scoliosis METHODS: This retrospective cohort study included all children aged ≤17 years who underwent spinal surgery for scoliosis between January 2009 and January 2012 at a quaternary pediatric hospital. Data were collated regarding polysomnography (PSG) and NIV use, before and after corrective surgery. Factors associated with severely compromised pulmonary function (SCPF) were established and correlations with the occurrence of postoperative pulmonary complications and LOS were identified. RESULTS: Altogether, 133 children had corrective surgery for scoliosis, aged 12.7 (range: 2-17) years at operation. Scoliosis causes were identified as: idiopathic (39.8%), neuromuscular disease (32.2%), syndrome (15.7%), and congenital (12%). Correlates with SCPF (forced vital capacity [FVC] <40% predicted, n = 10) included markers of sleep hypoventilation, including serum bicarbonate ≥29 mmol/L, morning pCO2 > 50mm Hg (P = .003), and overnight, episodic CO2 retention of >7 mm Hg. Using these parameters an additional eight children with SCPF were identified making a total of 18 out of 133 (13.5%) of the patients. Postoperative pulmonary complications were seen in 24 children (18%) and their occurrence correlated with higher Cobb angle (>90°), lower pulmonary function (FVC), higher serum bicarbonate and underlying neuromuscular disease. Amongst the 18 children with SCPF, regular use of NIV preoperatively was associated with reduced rate of postoperative pulmonary complications (P = .02) and reduced LOS by 6.4 days (P = .01). CONCLUSION: Nocturnal hypoventilation on PSG identifies children with SCPF. Use of NIV in children with SCPF was linked to fewer postoperative pulmonary complications and reduced duration of hospital stay.

Correction to: Asthma Control and Its Predictive Factors in Adult Asthma Patients.

[This corrects the article DOI: 10.14740/jocmr4021.].

Asthma Control and Its Predictive Factors in Adult Asthma Patients.

BACKGROUND: Asthma is a highly prevalent condition that remains difficult to control, as its associated factors remain poorly understood. Thus, the primary aim of the present investigation was to determine the prevalence of uncontrolled asthma in hospital units in south Jordan and to evaluate the risk factors that may contribute to uncontrolled asthma. METHODS: This was a cross-sectional study involving 93 patients aged 40.5 ± 13.6 years that met the criteria of the Global Initiative for Asthma (GINA). Relevant patient data were collected via a questionnaire and through a review of medical records. The questionnaire comprised of sections pertaining to sociodemographic and clinical characteristics, as well as pharmacological asthma treatment, asthma severity and asthma control. Asthma severity was determined in line with the GINA guidelines, whereby the patients were classified into four groups (intermittent, mild persistent, moderate persistent or severe persistent). Moreover, based on the findings yielded by the asthma control questionnaire (ACQ), patients were divided into three levels, whereby those diagnosed with partly controlled and uncontrolled asthma were combined into one group, denoted as "poorly controlled asthma", with "uncontrolled asthma" and "controlled asthma" as the remaining two groups. Atopy was defined as one or more positive reactions (A/H ratio > 1) on a skin prick test. RESULTS: Asthma control was achieved in 45.2% of the sample. Moreover, older age, severe asthma according to the GINA guidelines, longer duration of asthma, atopy, being on treatment for asthma and history of allergic rhinitis were identified as the main risk factors contributing to poorly controlled asthma. Multivariate analyses, however, revealed that only atopy to two or more allergens and having severe asthmatic attacks were statistically significantly associated with poorly controlled asthma, for which the odds ratio Mantel-Haenszel (ORMH) of 17.2 and 2.2 was obtained, respectively. CONCLUSION: Our findings indicate that severe asthma and atopy to two or more allergens are the main risk factors for uncontrolled asthma. However, further studies with larger sample sizes are needed to confirm these results.

Sensitization to inhaled allergens in asthmatic children in southern Jordan: a cross-sectional study.

BACKGROUND: Sensitization to inhaled allergens in children with bronchial asthma significantly affects asthma pathogenesis, severity and persistence into late childhood and adulthood. The present study determined the prevalence of sensitization to inhaled allergens in children with bronchial asthma and wheezing episodes in order to investigate the effect of positive sensitization on the severity and control of asthma symptoms and to screen for other associated allergic conditions. METHODS: A cross-sectional study was conducted, including children between 6 months and 14 years of age attending the chest clinic of Al-Karak, south of Jordan, between November 2013 and February 2016. Skin prick tests (SPTs) using 11 standardized allergen extracts were conducted in 277 children. The severity of asthma was determined based on the Global Initiative for Asthma (GINA) assessment and the Childhood Asthma Control Test (C-ACT) in addition to the history of use of systemic steroids and hospital admissions within the past 12 months. RESULTS: Sixty-seven percent of children with bronchial asthma reported sensitization to one or more of the inhaled allergens. The most common allergens were olive pollens (18%), cat fur (13.5%), and Dermatophagoides pteronyssinus (11.9%). There was a significant increase in allergen sensitization with age (p < 0.001). The most common concomitant allergic condition among children was allergic rhinitis (71.5%); however, allergic conjunctivitis was the only allergic condition that correlated with the skin test reactivity (p = 0.01). A family history of bronchial asthma was confirmed in 40.4% of children. Children with positive SPTs had lower ACT scores and reported more frequent use of systemic steroids and admissions to hospital within the past 12 months; however, this effect was not statistically significant (p > 0.05). CONCLUSIONS: Sensitization to inhaled allergens is highly prevalent in children with asthma and wheezing episodes in southern Jordan and may be correlated with the severity of the disease. Therefore, appropriate measures to recognize and avoid these allergens are highly recommended. Most children in our study suffered from concomitant allergic rhinitis, indicating that an appropriate diagnosis and treatment of allergic rhinitis could significantly improve asthma control and thus the quality of life of these children. TRIAL REGISTRATION: This study is not a clinical trial.

Methicillin-resistant Staphylococcus aureus nasal carriage among primary school-aged children from Jordan: prevalence, antibiotic resistance and molecular characteristics.

BACKGROUND AND AIM: Colonization with methicillin-resistant Staphylococcus aureus (MRSA) increases the risk for subsequent infections with an increased mortality and morbidity. Children were suggested to be a major asymptomatic reservoir for community-associated (CA) MRSA with an ability to quickly spread the MRSA within community. Therefore, the availability of epidemiological and antibiotic susceptibility data of CA-MRSA will be useful for the infection control and management policies. This study aimed to assess the nasal carriage, molecular characteristics and antibiotic susceptibility of MRSA in primary school-aged children from Jordan. PATIENTS AND METHODS: A total of 210 nasal swabs were collected from children aged 6-11 years. Isolated MRSA and its SCCmec typing, Spa type and PVL (Panton-Valentine Leukociden) toxin were identified following culture, biochemical and PCR. Antibiogram was determined by the disc diffusion method. RESULTS: The prevalence of CA-MRSA was 7.1%. Allergic rhinitis and recent antibiotic exposure were the only significant risk factors for MRSA nasal carriage among children. Resistance to erythromycin, trimethoprim-sulfamethoxazole and tetracycline was 33.4, 20 and 13.4%, respectively. All isolates were susceptible to the remaining non-ß-lactam antibiotics used in this study, in particular linezolid and mupirocin. All MRSA isolates were SCCmec type IV and PVL toxin negative and the majority were Spa type t223. CONCLUSION AND RECOMMENDATIONS: This is the first study to assess the MRSA prevalence among children aged 6-11 years in Jordan. The prevalence in community children is within the range compared with other studies in other countries. The antibiogram, SCCmec and Spa types of the isolated MRSA are much similar to what was found previously in Jordan. However, all isolates were PVL toxin negative. The study recommends increasing the public awareness of MRSA and the proper antibiotics dispensing. Future studies to follow-up on the changing epidemiology of the CA-MRSA in Jordan are also recommended.