Changes in occlusal bite force following placement of preformed metal crowns on primary molars in 4-6 years old children: a 6 months' follow-up pilot study.

AIM: To evaluate the occlusal bite force (OBF) changes 6 months after placement of preformed metal crowns PMCs on primary molars in children. METHOD: Twenty-two subjects (aged 5.08 ± 0.92 years) participated and completed OBF records. Each patient received eight PMCs on their primary molars. OBF was recorded using a battery-operated portable type of OBF gauge at different time intervals: before placement, 1 week-, 1 month-, 2 months-, 3 months-, and 6 months after PMCs placement (T0-T5). A second group consisted of 22 caries-free children matched for age and gender were selected as a control sample and received no dental treatment. OBF was recorded in these subjects at T0 and T5 (6 months after). RESULTS: OBF was reduced the first week after placement of PMCs. However, the OBF was restored and reached its original value at T4. At the 6-month recall visit (T5), maximum occlusal bite force (MOBF) was 148% and 136% of pre-treatment value on right and left sides, respectively. The mean MOBF difference between T5 and T0 was statistically significant (70.83N and 54.67N on the right and left sides respectively, p < 0.000). CONCLUSION: OBF decreased 1 week after placement of PMC restoration and started to increase after 1 month reaching 136-140% of its original value after 6 months.

Multiresidue pesticide analysis of the medicinal plant Origanum syriacum.

Origanum syriacum is a medicinal plant widely used in Jordan both as a folk remedy and in the food and beverage industry. As the plant can be treated with pesticides during commercial production, three different methods for pesticide multiresidue analysis of this plant have been evaluated. One method based on soxhlet extraction followed by acetonitrile/petroleum ether (PE) partitioning was found to be particularly suitable. Extracts were cleaned-up using a Florisil column. Mean recoveries of pesticides from spiked herbal samples were 74-119%, with coefficients of variation between 1.0 and 23.6%. The limits of detection were in the range 0.0008-0.5 mg kg(-1). The method was used for the determination of pesticide residues in O. syriacum samples purchased from the local market. Seven out of eight samples contained detectable levels of dichlorodiphenyltrichloroethane (DDT), folpet, dicofol, hexachlorobenzene (HCB), hecachlorocyclohexane (HCH), quintozene, transchlordane and vinclozolin.

The use of serial measurement of plasma cholinesterase in the management of acute poisoning with organophosphates and carbamates.

OBJECTIVE: To evaluate the benefits of using serial measurements of plasma cholinesterase (butyrylcholinesterase, BuChE) activity in the management of cholinesterase inhibitor insecticidal poisoning. METHOD: After establishing and validating BuChE activity test, and making it available for clinical service in the toxicology laboratory at Jordan University Hospital. Serial measurements of BuChE were performed on samples taken from 10 symptomatic patients presented with the manifestations of poisoning due to acetylcholinesterase inhibitor insecticides during the year 2001. The number of serial repeats of BuChE activity tests ranged from 2 to 4 and from 8 to 11 for patients with carbamates and organophosphates (OPs) poisoning, respectively. The results of serial measurement of BuChE obtained from each patient's samples were used to draw a curve; three different types of curves were obtained from all patients samples. RESULT: The obtained curves were found to follow our three proposed curves, which support our point view regarding the importance of the proposed curves in the differential diagnosis and treatment of cholinesterase inhibitor pesticides poisoning. CONCLUSION: This study pointed out the importance of utilizing serial measurements of BuChE activity in the diagnosis and the management of organophosphates and carbamates poisoning. The BuChE activity results were used to support diagnostic and prognostic criteria that guided patient management and follow up. Applying those curves to large number of patients' samples will enhance its credibility. The study also demonstrated the importance of direct contract between toxicologist and physician in treatment of the pesticides poisoned patients.

Aluminum phosphide fatalities, new local experience.

Aluminum phosphide (AlP) pesticide is a highly toxic, low cost, and easily accessible rodenticidal agent. Its toxicity results from the liberation of phosphine gas upon exposure to moisture, which leads to multisystem involvement, resulting in serious consequences. The highly toxic parathion insecticide was a common cause of mortality in pesticide fatalities, prior to its banning. Its toxicity was familiar to the public as well as to physicians. Recently, ten fatalities due to AlP were encountered within a three-month period during spring, when it was used as a rodenticide in the vicinity of grain stores. The victims' ages ranged from 1-34 years. The circumstances of death were accidental in six cases, suicidal in two and possibly homicidal in two cases. Retrospectively, the clinical manifestations, scene investigation, autopsy, histological and toxicological findings supported the diagnosis of AlP intoxication. Immediate recognition was difficult due to unfamiliarity of the agent to the physicians. The occurrence of these fatalities might suggest changes of pattern in pesticide poisoning. This should raise the attention of the physician to the problem of AlP poisoning and also necessitates the awareness of the public to the hazards of this poison. Education, proper handling, strict observation and abiding by the regulations controlling this material are good protective measures against AlP poisoning.

Carbon monoxide fatalities in medicolegal autopsies.

All post-mortem medicolegal reports issued by Jordan University Hospital (JUH) during the period 1978-96 were reviewed. Carbon monoxide (CO) as a silent killer was responsible for 31.5% (n = 110) of poisoning fatalities. These were due to unintentional exposure to CO sources in confined spaces (bedrooms (24.6%), worker lodgings (23.6%) and bathrooms (16.4%), and without the victims being aware of CO hazards. Sixty-five per cent of CO fatalities occurred during December to February and 30% of the cases involved the age group 20-29 years, followed by the age group 30-39 years (20%). Non-Jordanians constituted 50% of CO fatalities and Egyptian workers accounted for 78%. Being unaccustomed to cold climates, and on low incomes, they had been using simple and unsafe heating devices. Many of these deaths could have been prevented. Safety educational campaigns to increase awareness of the general population of CO sources, their hazards and how to avoid them should be held continuously during the cold months of the year. All health and safety sectors are advised to be involved.

Reliability of clinical decisions regarding alcohol influence.

In Jordan, pursuing legal procedures related to alcohol intake usually depends on the physicians' clinical judgment. A study was carried out on 825 medico-legal cases over a 2 year period to evaluate the extent of physicians' clinical decisions on patients suspected to be under the influence of alcohol. A significant number of cases (12.6%, n = 104) were found to be positive for alcohol. The study showed that the clinical examination failed to diagnose a large number of cases (78.9%, n = 82). Also, the majority of diagnosed cases (50%, n = 11) had a blood alcohol concentration (BAC) range of 50-100 mg/dl. 32% (n = 33) of the cases with positive BAC were admitted to hospital. A high admission rate was observed when BAC was <50 mg/dl and >150 mg/dl, which constituted 39.3% (n = 13) and 48.5% (n = 16) of the admitted cases respectively. A large number of the admitted cases had either simple or no trauma (48.4%, n = 16) as compared with the control group of cases (21.8%, n = 10). The admission rate of positive BAC cases in traffic accidents was double that of control group. These findings may reflect the unreliability of the clinical decision in positive BAC. Implementing a certain BAC level locally for both clinical and a jurisdiction purposes is strongly recommended.

Stability of trihexyphenidyl in stored blood and urine specimens.

Trihexyphenidyl (THP) is an anticholinergic agent with forensic toxicological interest. The stability of THP was studied in postmortem blood and urine samples at a concentration of 0.25 microgram/ml under different storage temperatures. After solid phase extraction (SFE), THP was measured by gas chromatography. On day zero and at intervals over a 6 months period, there was no significant loss of THP at the storage temperatures -20 degrees C and 4 degrees C in the spiked and authentic samples. Blood and urine samples stored at 25 degrees C showed a maximum recovery loss (about 14%) of THP after 3 months of storage. This loss was considered a significant change and corresponded to a P value < 0.046. The study demonstrates that the analysis of blood and urine samples containing THP would produce consistent results when they are stored for 6 months at -20 or 4 degrees C and for 3 months at 25 degrees C.

Alcohol in medicolegal cases seen at Jordan University Hospital.

The magnitude of alcohol-associated incidents in relation to medicolegal cases, including road traffic accidents and acts of violence, has not been evaluated in Jordan. Between 1993 and 1995, 825 such cases received at Jordan University Hospital were screened for the presence of alcohol. Blood alcohol was positive in 9.1% of vehicle passengers, 9.6% of pedestrians, 12.4% of cases involving violence, 13.6% of drivers, 65% of cases brought by police and in 12.5% of other cases. Blood alcohol concentrations (BAC) ranged from 10-350 mg/dL. BAC of more than 50mg/dL was found in 65% and 55% of driver and violence cases respectively, and in 33% to 69% of the other categories. Alcohol may have contributed to some of these incidents. In cases with positive BAC, prior alcohol intake was frequently denied. There was no association between cases with positive BAC and a particular time, date or occasion.

Comparative pharmacokinetics of two nifedipine products in capsule form following single oral administration in healthy volunteers.

The pharmacokinetic parameters (AUC, Cmax, Tmax, and t1/2) of nifedipine following single oral administration of a 10 mg capsule of test product were compared to those of the same amount of a reference product. The two products in capsule form were administered according to a randomized two-way crossover design in 22 healthy male volunteers. Nifedipine plasma concentrations were determined using a rapid, sensitive and precise high performance liquid chromatography (HPLC) method with ultraviolet (UV) detection at 235 nm. The parametric 90% confidence intervals of the mean value of the ratio [Myogard (test product) /Adalat (reference product)] for pharmacokinetic parameters were 0.90-1.08, 0.80-1.07, and 0.93-1.12 for AUC0-->infinity, Cmax and t1/2, respectively. In each case, values were within the acceptable bioequivalence range of 0.8-1.25. Distribution free point estimate for the difference in expected medians of Tmax of the two products (Myogard-Adalat) was 0.00 h with a 90% confidence interval of 0.00-0.13 which is greater than the accepted bioequivalence of +/- 0.12. The kinetic parameters were comparable to those reported for nifedipine, and no statistically significant differences were found in any of them when comparing the two products by analysis of variance (ANOVA) on log-transformed data. Thus, the two products could be considered bioequivalent regarding absorption rate (Cmax and Tmax), extent of absorption (Cmax and AUC) and elimination (t1/2).