Attitudes of graduating medical doctors toward using sex selection techniques in Jordan in 2009.

OBJECTIVES: The aim of this study was to describe the attitude of graduating medical doctors toward the use of sex selection techniques in Jordan in 2009. MATERIALS AND METHODS (DESIGN): A self-administered questionnaire was used to assess attitude toward using sex selection. Demographic variables, gender preference of future children, and score on attitude toward using technology scale were used as independent variables. RESULTS: A total of 254 doctors (178 males, 76 females) completed the questionnaire. Forty-one (16.1%) doctors thought that sex selection as PGD should be strictly prohibited and 45 (17.7%) thought it should be allowed freely. More than half (54.7%) of them thought it should only be available for medical reason. Only 59 (23.2%) reported that they may consider the use of sex selection technology to choose their future children. Participants who preferred their firstborn child to be a boy or those who preferred their first born child to be a girl were more likely to use sex selection than those without preference. Christian participants were more likely to use sex selection technology than Muslim participants, 9 (47.4%) versus 50 (21.3%). For each one-point increase in Attitude score, the odds of using sex selection increased by 20%. CONCLUSIONS: The majority of graduating medical doctors believed that sex selection should be restricted and they were not willing to use it.

Clinical and Nutritional Determinants of Extrauterine Growth Restriction Among Very Low Birth Weight Infants.

PURPOSE: To identify the clinical and nutritional factors associated with extrauterine growth restriction (EUGR) among very low birth weight infants (VLBW) in a tertiary hospital in Jordan. PATIENTS AND METHODS: We conducted a retrospective analysis of all VLBW infants admitted at King Abdullah University Hospital between July 2015 and June 2020. Clinical factors, nutritional intake, and growth parameters were collected and analyzed. A multilogistic regression model was applied to identify factors associated with EUGR. RESULTS: Of the 247 VLBW infants included in analysis, 112 (45%) were males, 30 (12%) were below 1000 g, and 72 (29%) were small for gestational age (SGA). EUGR was diagnosed in 198 (80%) at discharge. The rates of EUGR among SGA and non-SGA infants were 97% and 73%, respectively. The EUGR infants had a higher gestational age (30.7 vs 29.8 weeks, p=0.04), a lower birth weight (1209 vs 1300 g, p=0.005), a longer ventilatory support (5.7 vs 2.2 days, p=0.03), a higher incidence of sepsis (23% vs 10%, p=0.05), and a longer hospitalization (46 vs 38 days, p=0.03). With multilogistic regression model, the factors associated with EUGR include small-for-gestational age (AOR 9, 95% C.I. 2, 50), >3-day delay in feeding initiation (AOR 3.8, 95% C.I. 1.2,10), >14-day delay in achieving full feeds (AOR 3.3, 95% C.I. 1.2, 8), <3 g/kg of protein intake on the 8th day (AOR 2.1, 95% C.I. 1.1, 4.1), <100 kcal/kg of total caloric intake on the 15th day (AOR 3.8, 95% C.I. 1.6, 8.9), and occurrence of sepsis (AOR 3, 95% C.I. 1.1, 9). CONCLUSION: The rate of EUGR in our unit is high. In addition to being SGA at birth, sepsis and suboptimal protein and caloric intake in the first two weeks of life were significantly associated with this complication. A more aggressive enteral and parenteral nutritional approach is needed to minimize postnatal growth delay.

Sex preference and interest in preconception sex selection: a survey among pregnant women in the north of Jordan.

BACKGROUND: Preconception sex selection for non-medical reasons is a controversial issue in bioethics. Little research has described preferences for preconception sex selection among Arab populations. This study describes the sex preference and interest in employing sex selection techniques among pregnant women in northern Jordan. METHODS: A self-reported questionnaire was administered to 600 pregnant women in Irbid, Jordan. chi(2) test and binary logistic regression were used to examine the factors associated with interest in preconception sex selection. RESULTS: In general, the interest in using sex selection was low. Women who preferred boys were more likely to be interested in sex selection, if paid for by the couple [odds ratio (OR) = 4.40, 95% confidence interval (CI): 1.75-11.11] or by health insurance (OR = 3.42, 95% CI: 1.94-6.06), or, if feasible, administered through oral medication (OR = 8.84, 95% CI: 5.05-15.63). Women with lower education were more likely to be interested in sex selection, if paid by health insurance (OR = 1.96, 95% CI: 1.10-3.45) and were more likely to believe that sex selection is legal (OR = 1.79, 95% CI: 1.06-2.86). Women who had no boys were more likely to be interested in sex selection, if paid by health insurance (OR = 1.94, 95% CI: 1.10-3.42) or, if feasible, through medication (OR = 3.03, 95% CI: 1.82-5.00). CONCLUSIONS: The majority of participants were not in favor of using preconception sex selection. Those with a preference to have boys, with lower education, and those with an imbalanced family were more likely to be interested in using sex selection technology.

Clinical features of neonatal sepsis caused by resistant Gram-negative bacteria.

BACKGROUND: Clinical features and outcomes of neonatal sepsis caused by resistant Gram-negative bacteria are not well described in Jordan. The aim of the present study was therefore to describe microbiology and clinical features, laboratory findings and outcomes of early- and late-onset Gram-negative neonatal sepsis. METHODS: All patients with Gram-negative bacteremia between July 2003 and June 2005 were retrospectively included. Resistance profiles, clinical features and outcomes of early and late-onset neonatal sepsis were compared. RESULTS: A total of 79 patients (after excluding all nine cases of Gram-positive bloodstream infection (BSI) were identified as having Gram-negative BSI (25 had early-onset and 54 had late-onset neonatal sepsis). Respiratory distress, metabolic acidosis and requirement of ventilation were found in 74.7%, 40.5%, and 58.2%, respectively. Hypotension was found in 22.9% of patients. Klebsiella pneumoniae was responsible for 43 cases (54.4.2%). Klebsiella pneumoniae resistance rates to ampicillin and ceftazidime were 100% and 50%, respectively. Mortality rate was 30.9%. Forty-eight percent of deaths occurred within 3 days of sepsis. Meningitis was diagnosed in five cases. Elevated C-reactive protein (CRP) and thrombocytopenia were seen in 28% and 24% of infants with early-onset sepsis, respectively, and in 79.6%, 59.3% of infants with late-onset sepsis respectively. CONCLUSION: Both early- and late-onset neonatal sepsis are caused by highly resistant Gram-negative bacteria. Mortality of sepsis is high. Elevated CRP and thrombocytopenia is seen more commonly in late-onset neonatal sepsis.

Maternal periodontal status and preterm low birth weight delivery: a case-control study.

OBJECTIVES: To assess the association between severity and extent of maternal periodontal disease and preterm birth/low birth weight (PLBW) among women in the north of Jordan. METHODS: A total of 148 woman who gave preterm birth/low birth weight birth and 438 women with uncomplicated full term vaginal delivery were included in this study. Socio-demographic characteristics, antenatal history, medical history, and family medical history were collected through personal interview or abstracted from maternal records. The oral hygiene status, and periodontal and dental parameters were assessed for all women. RESULTS: The average of probing pocket depth (PPD) and average of clinical attachment level (CAL) were significantly higher among women who gave PLBW babies. The mean gingival recession was not significantly different between the two groups. The percentages of sites with PPD > or = 3 mm and CAL > or = 3 mm were significantly higher among women who gave PLBW babies. Number of decayed teeth, number filled teeth, and number of missing teeth showed no significant association with PLBW delivery. CONCLUSION: The extent and severity of periodontal diseases appeared to be associated with increased odds of PLBW delivery. Nevertheless, more and larger intervention trials are needed before it can be fully accepted that periodontal infection is a true risk factor for PLBW.

Effect of methotrexate on the survival of human lymphocyte cultures carrying MTHFR 677 (C>T) and MTHFR 1298 (A>C) mutations.

The correlations between the presence of MTHFR 677 (C>T) and MTHFR 1298 (A>C) mutations in human lymphocytes and the sensitivity of lymphocytes to methotrexate (MTX) were examined in cultures derived from 82 unrelated women, genotyped for these mutations by polymerase chain reaction-restriction fragment length polymorphism. Lymphocytes heterozygous for the mutant allele, MTHFR 677T, were significantly more sensitive to methotrexate than those carrying the homozygous wild-type allele, MTHFR677C, and those carrying either the mutant or the wild-type alleles in the polymorphic MTHFR 1298 site. In addition, the lymphocyte cultures carrying the mutant MTHFR 1298C allele were not different in their sensitivity to MTX from those cultures carrying the wild-type allele, MTHFR 1298A. This demonstrated that the polymorphic site MTHFR C677, but not MTHFR1298, could be considered as a useful pharmacogenetic determinant in planning and designing the effective personal MTX chemotherapeutic doses and regimes.

Neonatal mortality in Jordan: secondary analysis of Jordan Population and Family Health Survey (JPFHS) data.

OBJECTIVE: This study aimed to analyze the 2009 Jordan Population and Family Health Survey (JPFHS) data to determine the level, trend, and distribution of neonatal mortality (NNM) in Jordan and determine its associated factors. METHODS: Nationally representative data on NNM were extracted from the JPFHS data. Using multivariate analyses, the strength of associations between 12 clinical/sociodemographic variables and neonatal mortality were quantified after controlling for potential confounders. RESULTS: The weighted NNM rate for 2005-2009 period was 16 deaths per 1000 live births, with the early NNM rate and late NNM rates were 10 deaths per 1000 live births and six deaths per 1000 live births, respectively. Fluctuations of NNM according to year of birth and geographic variations were noted. Risk of NNM increased among male newborns, as mother's education level decreased, in mothers 40-49 years old, in multiple gestations-low birth weight neonates, and as birth interval was <3 years. CONCLUSIONS: The NNR rate for 2005-2009 period of 16 deaths per 1000 live births indicates that there are opportunities to decrease it. Risk factors of neonatal mortality with respect to predictors of death during first days of life and variables related to geographic variations require particular focus to improve the quality of obstetric and neonatal health services and to decrease neonatal mortality.

Prevalence and outcome of acute kidney injury, as defined by the new Kidney Disease Improving Global Outcomes guideline, in very low birth weight infants.

AIM: To evaluate the prevalence, risk factors and outcome of acute kidney injury (AKI) in very low birth weight (VLBW) infants. METHODS: In this retrospective study of VLBW infants, we analyzed the prevalence of AKI, as defined by changes in serum creatinine and urine output, associated risk factors and outcomes. RESULTS: A total of 293 VLBW infants (mean gestational age 28.7 wk) were included, of whom 109 weighed less than 1000 g at birth. The overall prevalence of AKI was 11.6% (22% in infants with a birth weight under 1000 g and 5.4% those heavier). A total of 19 (55%) affected infants died, with a mortality rate of 58% in infant less than 1000 g and 50% in those heavier. After adjusting for confounding variables, only necrotizing enterocolitis (NEC) remained associated with AKI, with odds ratio of 4.9 (95%CI: 1.9-18.6). Blood pressure and glomerular filtration rate (GFR) were not different between affected infants and the others upon discharge from hospital. A normal GFR was documented in all affected infants at one year of age. CONCLUSION: Using Kidney Disease Improving Global Outcomes definition of AKI, it occurred in over 10% of VLBW infants, more commonly in infants with lower birth weight. NEC was an independent associated risk factor. Renal function, as defined by GFR, was normal in all surviving affected infants 10 to 12 mo later.

Severe Hypotension After Amlodipine Use for Hypertension in a Newborn on Beta Blocker Therapy for Thyrotoxicosis.

A 35-year-old woman with a 9-year history of Grave's disease delivered a male infant weighing 2,210 g at 32 weeks of gestation by caesarean section. The neonate developed thyrotoxicosis and, at the age of 24 h, was treated with oral carbimazole (500 µg every 8 h) and propranolol (2 mg/kg/day in two divided doses). He subsequently developed hypertension on day 4, which required therapy with amlodipine (0.1 mg once daily). Severe hypotension developed within 24 h and required discontinuation of amlodipine, with initiation of intravenous inotropic support with dopamine and dobutamine (at a rate of 20 µg/kg/min). The blood pressure rapidly normalized, and both dopamine and dobutamine infusions were stopped within 36 h. A Naranjo assessment score of 6 was calculated, indicating that the severe hypotension was a probable adverse drug reaction caused by the combination of amlodipine and propranolol therapy.

Endogenous nitric oxide modulates responses of tissue and airway resistance to vagal stimulation in piglets.

The role of endogenous nitric oxide (NO) in modulating the excitatory response of distal airways to vagal stimulation is unknown. In decerebrate, ventilated, open-chest piglets aged 3-10 days, lung resistance (RL) was partitioned into tissue resistance (Rti) and airway resistance (Raw) by using alveolar capsules. Changes in RL, Rti, and Raw were evaluated during vagal stimulation at increasing frequency before and after NO synthase blockade with N(omega)-nitro-L-arginine methyl ester (L-NAME). Vagal stimulation increased RL by elevating both Rti and Raw. NO synthase blockade significantly increased baseline Rti, but not Raw, and significantly augmented the effects of vagal stimulation on both Rti and Raw. Vagal stimulation also resulted in a significant increase in cGMP levels in lung tissue before, but not after, L-NAME infusion. In seven additional piglets after RL was elevated by histamine infusion in the presence of cholinergic blockade with atropine, vagal stimulation failed to elicit any change in RL, Rti, or Raw. Therefore, endogenous NO not only plays a role in modulating baseline Rti, but it opposes the excitatory cholinergic effects on both the tissue and airway components of RL. We speculate that activation of the NO/cGMP pathway during cholinergic stimulation plays an important role in modulating peripheral as well as central contractile elements in the developing lung.

Pitfalls in measuring cerebrospinal fluid glycine levels in infants with encephalopathy.

In encephalopathic infants, cerebrospinal fluid hyperglycinemia and elevated cerebrospinal fluid to plasma glycine ratio are considered pathognomonic of nonketotic hyperglycinemia. To evaluate the significance of cerebrospinal fluid hyperglycinemia and elevated cerebrospinal fluid to plasma glycine ratio in acutely encephalopathic infants, a retrospective chart review of all cases of isolated elevation of cerebrospinal fluid glycine levels at Arkansas Children's Hospital from January 1995 to December 2000 was performed. Twenty-two patients (14 males) were included. The most common diagnosis was hypoxic ischemic encephalopathy (n = 8). Nine patients had elevated cerebrospinal fluid to plasma glycine ratio, which was transient in 7 patients. This study shows that elevated cerebrospinal fluid to plasma glycine ratio can be encountered in a variety of clinical conditions. The significance of this observation in light of the poor prognosis of nonketotic hyperglycinemia and the possible role of glycine in the mechanism of ischemic neuronal injury is addressed.

Methylenetetrahydrofolate reductase polymorphisms C677T and A1298C as maternal risk factors for Down syndrome in Jordan.

BACKGROUND: The activity of the methylenetetrahydrofolate reductase (MTHFR) enzyme is regulated by the two polymorphisms C677T and A1298C, which reduce enzyme activity and result in hypomethylation of chromosomes that increase the risk of nondisjunction. These polymorphisms are suggested to be risk factors for Down syndrome (DS) in some populations. AIM: The aim of this study was to test if C677T and A1298C polymorphisms are correlated to maternal risk of DS in Jordan. METHODS: The proportions of C677T and A1298C polymorphisms were examined in 53 case mothers who delivered DS children and 29 controls. The median age of case mothers was 35 years when delivering their affected children. Polymerase chain reaction-restriction fragment length polymorphism was used for genotyping. RESULTS: The frequency of MTHFR C677T allele in all DS mothers was 3.2-fold higher than in the controls (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 1.303-7.677). Also, the proportion of 677T in the older case mothers was different from the controls, but was significantly higher in younger case mothers than in the controls (OR = 4.2, 95% CI: 1.61-10.97, p = 0.003). The proportions of 677CT and 677TT genotypes in younger cases are, respectively, 10- and 9-fold higher than in the controls. The proportions of MTHFR A1298C are significantly different among all case groups and the controls (χ(2) = 4.27, p = 0.127), but there was a significant difference between young case mothers and both older case mothers group and the controls (OR = 1.25, 95% CI: 0.405-3.85, p = 0.698). CONCLUSIONS: There is strong association between MTHFRC677T and maternal risk of DS in Jordanian mothers younger than 35 years old and the MTHFR1298C allele has a lesser but additive risk effect in MTHFR677T/1298C compound heterozygotes.

Factors affecting intention to breastfeed among Syrian and Jordanian mothers: a comparative cross-sectional study.

BACKGROUND: Breastfeeding is considered the ideal method of infant feeding for at least the first six months of life. This study aimed to compare breastfeeding intention between Syrian and Jordanian women and determine factors associated with breastfeeding intention among pregnant women in these two countries. METHODS: A cross-sectional design was used to collect data from1200 pregnant women aged 18 years and above (600 participants from each country). A self- administered questionnaire was used to collect data on socio-demographic characteristics and breastfeeding intention. RESULTS: Intention to breastfeed was reported by 77.2% of Syrian and 76.2% of Jordanian pregnant women. There was no significant difference in intention to breastfeed between Syrian women and Jordanian women. In both countries, women with a more positive attitude to breastfeeding, women with previous breastfeeding experience and women with supportive partners were more likely to intend to breastfeed. Syrian women with a monthly family income of more than US$200, younger than 25 and primiparous or having one child were more likely to report an intention to breastfeed their infants. Jordanian women with an education level of less than high school and not living with their family-in-law were more likely to intend to breastfeed. CONCLUSIONS: In Syria and Jordan, a more positive attitude to breastfeeding, previous breastfeeding experience and presence of supportive husbands are associated with intention to breastfeed. These factors should be considered when planning programs designed to promote breastfeeding in these two countries.

Renal impairment and hydronephrosis in a premature infant following morphine infusion: case report.

This is a case report of an association between morphine administration and occurrence of hydronephrosis with acute renal failure. This premature female infant born at 27 weeks of gestation had moderate hydronephrosis with acute renal impairment while receiving morphine infusion for pain management after chest-tube insertion. All these findings were reversed after stopping morphine and urinary catheterization. Follow-up renal ultrasound and voiding cystourethrogram showed resolution of hydronephrosis with no evidence of vesicoureteral reflux. Morphine is associated with reversible hydronephrosis and renal impairment in premature infants.

Knowledge, attitude and practice of breastfeeding in the north of Jordan: a cross-sectional study.

BACKGROUND: In Jordan, as in neighboring countries in the Middle East, higher education and higher employment rates in recent years among women have had an impact on traditionally based infant feeding. The objective of this study was to evaluate practice, knowledge and attitude to breastfeeding and to assess factors associated with breastfeeding among women in the north of Jordan. METHODS: A cross sectional study was carried out between 15 July 2003 and 15 August 2003. A total of 344 women with children aged between 6 months and 3 years from five different villages in the north of Jordan were randomly selected and interviewed. Information regarding participants' demographics, infant feeding in first six months of life, knowledge and attitude towards breastfeeding was collected. RESULTS: Full breastfeeding was reported by 58.3%, mixed feeding was reported by 30.3% and infant formula feeding was reported by 11.4%. Almost one third of the full breastfeeding group did so for 6-12 months, and almost two thirds did continue breastfeeding for more than one year. Employed women were more likely not to practice full breastfeeding compared to unemployed women (odds ratio 3.34, 95% CI 1.60, .98), and women who had cesarian delivery were more likely not to practice full breastfeeding compared to those who had vaginal delivery (odds ratio 2.36, 95% CI 1.17, 4.78). Jordanian women had a positive attitude but work place and short maternity leaves had a negative impact on breastfeeding. CONCLUSION: This study showed that a high proportion of Jordanian women did breastfeed for more than one year. However, working women and those who deliver by caesarean section were less likely to breastfeed. It is speculated that adopting facilitatory measures at hospitals and work place could increase the rate of full breastfeeding.