Radon concentration and radon effective dose rate in dwellings of some villages in the district of Ajloun, Jordan.

Indoor and soil radon concentrations were measured in the villages of Ayn-Jana, Ishtafena, Samta and Umm-Yanabe' in the district of Ajloun, Jordan. Several factors that are strongly related to the radon concentrations are considered whether in soil such as its type or indoors such as room occupation type, floor level and building materials. In the village of Ayn-Jana, our results showed that the average radon concentration decreases gradually as the floor level increases. The highest concentration was found to be in the ground floor (35.5 ± 5.0 Bqm(-3)) and the lowest was in the second floor (22.9 ± 3.2 Bqm(-3)). Regarding the effect of ventilation rate in the same village, storage rooms revealed the highest concentration (38.8 ± 5.4 Bqm(-3)) while the lowest concentration was in living rooms (33.8 ± 4.4 Bqm(-3)). In the four villages, it was found that the highest radon concentration was in the dwellings made of clay (45.7 ± 6.7 Bqm(-3)) and the lowest was in dwellings made of brick (33.9 ± 6.4 Bqm(-3)). In general, the average indoor radon concentration in these villages was 36.3 ± 2.3 Bqm(-3) and it corresponds to an average effective dose rate of 0.92 ± 0.06 mSvyr(-1). These indoor radon concentrations as well as the annual effective dose are below the action level recommended by ICRP. The average radon concentration in soil of these villages was about 2.55 ± 0.20 kBqm(-3), and it ranges from 2.08 ± 0.12 kBqm(-3) in the village of Ayn-Jana to 3.62 ± 0.13 kBqm(-3) in the village of Ishtafena.

Root and canal morphology of mandibular first and second molar teeth in a Jordanian population.

AIM: To examine the root and canal morphology of mandibular permanent first and second molar teeth in a Jordanian population. METHODOLOGY: A total of 685 extracted mandibular first and second permanent molar teeth were collected from dental clinics within north Jordan. The teeth were examined visually and the root number and morphology were recorded. After that, access cavities were prepared, pulp tissue dissolved by sodium hypochlorite and the root canals injected with Indian ink. Stained teeth were decalcified with 10% nitric acid, dehydrated with ascending concentrations of alcohol and rendered clear by immersion in methyl salicylate. The following observations were evaluated: (i) number of canals per root; (ii) number of root canals per tooth; (iii) canal configuration in each root; (iv) number and location of lateral canals and (v) presence of intercanal communications. RESULTS: Of 330 mandibular first molars, the majority had three (48%) or four (46%) canals, whilst 4% had a third disto-lingual root. Of 355 mandibular second molars, 58% had three canals, 19% two and 17% had four canals, whilst 10% had C-shaped roots. The most prevalent canal configuration in the mesial root of both first (53%) and second (40%) molars was type IV, and in distal roots was type I (54% in first and 79% in second molars). CONCLUSIONS: Jordanian mandibular first and second molar teeth exhibit features close to the average Caucasian root and canal morphology.

Root form and canal morphology of mandibular premolars in a Jordanian population.

AIM: To investigate the root canal anatomy of mandibular premolars in a Jordanian population. METHODOLOGY: Nine hundred extracted mandibular premolars were examined. After the length of the teeth was measured, the presence of developmental grooves and furcated roots was noted. Following the preparation of access cavities, pulp tissue was removed and the canal systems were stained. The teeth were then rendered clear by demineralization and immersion in methyl salicylate. Cleared teeth were examined and the following features were evaluated: (i) type of root canals; (ii) presence and location of lateral canals; transverse anastomosis; (iii) location of apical foramina; and (iv) frequency of apical deltas. RESULTS: The mean lengths of first and second mandibular premolars were 22.6 mm (18-27.5 mm) and 22.2 mm (16-26.5 mm), respectively. Although the majority of the specimens corresponded to Vertucci's classification scheme, analysis of this large data set revealed four additional root canal morphologies. Variable root canal morphologies were found in the mandibular first premolars; two separate apical foramina were found in 33% of the teeth with two canals, compared to 6.2% with one apical foramen. Teeth with three separate apical foramina were scarce (2.2%). The majority of the mandibular second premolars had a single canal; 72% of teeth possessed type I canal systems, whilst 22.8% of the roots had two canals with two separate apical foramina. CONCLUSIONS: The prevalence of multiple canals in the investigated Jordanian mandibular premolars was high, especially for the second mandibular premolar, in comparison with previous studies performed on populations of different racial origin.

Long-term effect of botulinum toxin (A) in the management of calf spasticity in children with diplegic cerebral palsy.

AIM: The aim of this study was to determine possible long-term effects of multi-injections of botulinum toxin A (BT-A) on muscle tone and functional abilities in children with cerebral palsy. METHODS: A randomized, single blind study was carried out. Sixty patients with spastic diplegia were enrolled; 40 received 3 successive doses of BT-A to the calf muscle bilaterally at intervals of 3 to 4 months; 20 received no injections and were considered the control group. Evaluation included measurement of muscle tone, passive ankle dorsiflexion range of motion, and gross motor function. The children in the study group were assessed at entry into the study, at 3 months, and at 18 months after the last injection. An identical assessment protocol was applied to the control group, with measurements taken at entry into the study, at 12 to 15 months, and then at 27 to 30 months, roughly corresponding to the time periods set for the study group. RESULTS: Muscle tone and passive ankle dorsiflexion range showed clinically and statistically significant improvement following BT-A injection at 3 months (P=0.000, P=0.04, respectively) and at 18 months (P=0.005, P=0.007, respectively) compared to the control group, but gross motor function showed significant improvement only at 18 months (P=0.02). Comparison between the first and second evaluations after the last injection in the study group showed a significant improvement in gross motor function and ankle dorsiflexion range (P=0.000 for both parameters); however, muscle tone was significantly increased (P=0.002). CONCLUSION: This study gives support to a possible prolonged effect of intramuscular BT-A as an adjunct to conventional physiotherapy to reduce spasticity and improve functional mobility in children with spastic diplegic cerebral palsy.

Effect of composite shade, increment thickness and curing light on temperature rise during photocuring.

OBJECTIVES: To examine the effect of composite shade, increment thickness and curing light characteristics on the temperature rise associated with composite photocuring. METHODS: Four shades (C2, A4, B1 and B3), four sample thicknesses (2, 3, 4 and 5 mm) of a hybrid resin composite and two curing units, one with two modes of curing, were investigated. The composite samples were packed in polytetrafluoroethylene (PTFE) moulds and cured for 40 s. Samples cured with the ramp curing mode were irradiated for only 20 s. Temperature rises on the undersurface of the curing resin composite were measured using an infrared scanning system. RESULTS: Shade C2 produced the highest maximum temperature of all shades (56.7 degrees C). Thinner samples produced greater temperature rises (2mm induced 60.9 degrees C, 5 mm induced 45.7 degrees C). Samples cured with Optilux 501 unit produced greater temperature rises (60.9 degrees C) than those cured with Dentsply unit (56.2 degrees C). CONCLUSIONS: There was a quantifiable amount of heat generated during visible light curing of resin composite. The amount of heat generated was influenced by shade selected, thickness of material and characteristics of the light curing unit.

Functional outcome of botulinum toxin injection of gastrocnemius and adductors in spastic hemiplegic cerebral palsied children.

AIM: The aim of this paper was to compare between the various effects of botulinum toxin type A (BT-A) when it is injected at gastrocnemius or adductors or at both sites in ambulant spastic hemiplegic cerebral palsy (CP) children. METHODS: Sixty ambulant CP children with spastic hemiplegia were chosen. They were divided into 4 equal homogenous groups. Study groups (A, B, and C) received 3 successive injections of BT-A at 3 to 4 months interval. The injection sites were as follows: gastrocnemius for group A; adductors for group B; gastrocnemius and adductors for group C. Group D received no injections and was considered as a control group. Muscle tone and gait evaluation were conducted for every child in the BT-A groups at his entry and 6 months after the last injection dose. Also, the same evaluation protocol was conducted for every child in the control group at his entry and after 6 month's period. RESULTS: When BT-A groups were compared to the control group, results showed significant improvement in muscle tone following injection in all BT-A groups. A statistically significant increase of the unaffected step length and decrease of step width and foot angle was noted in gastrocnemius group (P=0.04, P=0.003, P=0.002) respectively, as well as in gastrocnemius/adductors group (P=0.006, P=0.002, P=0.003), respectively. However, the cadence and speed of walking showed significant increase in the gastrocnemius/adductors group; only P=0.03, P=0.004 respectively. Comparing between BT-A groups, there was significant improvement in all parameters between adductors and gastrocnemius/adductors groups in favor of the last group. Moreover, there was significant improvement in muscle tone (P=0, cadence P=0.04), and speed of walking P=0.01 between gastrocnemius and gastrocnemius/adductors groups in favor of the last group; however, there was no significant difference between these 2 groups in respect to the step width P=0.96 and the foot angle P=0.92. CONCLUSIONS: Our findings indicate that, in spastic hemiplegic CP, botulinum toxin has a better effect on tone reduction and improvement of gait parameters when it is given at the gastrocnemius and adductors muscles collectively.

Root canal morphology of mandibular incisors in a Jordanian population.

AIM: To investigate the root canal morphology of mandibular incisors in a Jordanian population using a canal staining and tooth-clearing technique. METHODOLOGY: Four hundred and fifty extracted mandibular incisors were collected from dental clinics within north Jordan. Following pulp tissue removal and staining of the canal systems, the teeth were decalcified with 5% nitric acid, dehydrated with ascending concentrations of alcohol and rendered clear by immersion in methyl salicylate. Cleared teeth were examined by eye and the following features were evaluated: (i) number and type of root canals; (ii) presence and location of lateral canals and intercanal communications; (iii) location of apical foramina; and (iv) frequency of apical deltas. RESULTS: The majority of mandibular incisors had a single canal (73.8% of teeth possessed a Type I canal system). Although 26.2% of the roots possessed two canals, only 8.7% had two separate apical foramina. CONCLUSIONS: The prevalence of two canals in this group of mandibular incisors was 26.2% and is within the range of previous studies performed on populations of different racial origin.

Thermographic investigation of contemporary resin-containing dental materials.

OBJECTIVES: To measure the temperature rise induced during visible light curing of modern resin-containing dental materials and the effect of dentine sections in reducing this temperature rise. METHODS: A variety of newly introduced resin-containing materials were investigated, including flowable, packable and conventional hybrid composites, as well as a compomer and a resin modified glass ionomer material. The resin was packed into polytetrafluoroethylene (PTFE) moulds and cured for 40s. Temperature rises on the undersurface of the curing resin were measured using the Thermovision 900 infra-red scanning system. In the second part of the study, extracted, caries free teeth were sectioned into dentine disks of three thicknesses (0.7, 1.4 and 1.9 mm). Composite samples were overlaid by the disks and the insulating effect of dentine measured. RESULTS: The maximum temperature increases were: 43.1 degrees C (flowable composite), 32.8 degrees C (conventional composite), 32.8 degrees C (RMGI), 23.3 degrees C (compomer) and 22.4 degrees C (packable composite). CONCLUSIONS: There was a quantifiable amount of heat generated in resin-containing material during light curing. Dentine sections were good thermal insulators that significantly reduced temperature rises associated with resin composite photocuring.

Electrocorticography in the management of surgically treated epileptic patients.

OBJECTIVE: To report our experience on 8 patients with mean age of onset of seizures of 8 years, who had intra-operative electrocorticography monitoring during the surgical treatment of their medically intractable partial epilepsy. METHODS: Post-resection electrocorticography grades were according to Jay et al and seizure outcome was a according to Kobayashi et al grades. RESULTS: Five patients had temporal lobe surgery and 3 patients had extra temporal surgery. Four patients had post-resection electrocorticography grade A (no residual epileptic activity), two of them had seizure outcome grade 1 (free of seizures) and the other 2 had grade 11 (free of seizures on medication). The other 4 patients had post-resection electrocorticography grade B (minimal residual epileptic activity) and all had seizure outcome grade 11 except one patient who had grade 111 (more than 50% reduction in seizure frequency). CONCLUSION: Despite the small size of our study, our results suggest that intra-operative electrocorticography may be an important tool in the surgical management of medically intractable epilepsy.

Diagnostic value of short duration outpatient video electroencephalographic monitoring.

There is little published on the diagnostic value of short duration outpatient video electroencephalographic (VEEG) monitoring in children. The authors performed a prospective study on 37 patients (mean age = 10.4 years), with daily paroxysmal events who underwent short duration (mean = 3.2 hours) outpatient VEEG monitoring. Events were detected in 23 patients (62.2%), and a change in management as a result of outpatient VEEG monitoring was documented in 25 patients (67.6%). Despite the short duration of the outpatient VEEG in this study, the detection rate was comparable with the previously reported studies with longer duration monitoring. The authors found it convenient for the patient and less costly. The study demonstrated that short duration outpatient VEEG monitoring was able to differentiate between seizures and nonseizures in 11 patients (78.6%) and resulted in changing seizure classification in five patients (62.5%), and in selecting epilepsy surgery candidates in nine patients (60%). Short duration outpatient VEEG is useful as a diagnostic tool in patients with daily paroxysmal events, particularly in identifying nonepileptic events.

Congenital muscular dystrophy in Jordanian children.

This is a consecutive study on 28 patients who have been diagnosed as having congenital muscular dystrophy at Jordan University Hospital in the period from January 1990 to February 1997. Of 75 patients diagnosed as having muscle disease, 55 (73.3%) had muscular dystrophy. Of 55 muscular dystrophy patients, 28 (50.9%) had congenital muscular dystrophy, 11 (20%) had Duchenne muscular dystrophy, 9 (16.4%) had Becker muscular dystrophy, 4 (7.3%) had myotonic dystrophy, 2 (3.6%) had limb-girdle dystrophy, and 1 (1.8%) patient had facioscapulohumeral dystrophy. Age of onset of symptoms of congenital muscular dystrophy (hypotonia and weakness) was documented antenatally or in the first few months in the majority (92.9%) of patients. Parental consanguinity was documented in 21 (75%) of congenital muscular dystrophy cases, and family history of possible similar cases in 15 (53.6%). Congenital muscular dystrophy patients with normal cognitive milestones (n = 16; 57.1%) were slightly more common than patients with cognitive delay. In contrast to previous reports, congenital muscular dystrophy is probably more common in communities with high rates of parental consanguinity than other dystrophies. Our study adds significant support to the most recent literature on this finding.

Screening for congenital hypothyroidism in cognitively delayed children.

During the period January 1994 to December 1997, a total of 560 cognitively delayed children were prospectively screened for congenital hypothyroidism in the paediatric neurology clinic at Jordan University Hospital. Seventeen (3%) children were diagnosed to have congenital hypothyroidism. Mean age at diagnosis was 15 months (range 1.8-72 months). Main presenting symptoms (other than cognitive delay) were seizures, lethargy, poor feeding, constipation and prolonged neonatal jaundice. Thirteen (76.5%) of the 17 extrathyroid-associated anomalies involved the central nervous system (CNS). This finding reflects the study population chosen for the present study. All 17 patients had some degree of cognitive improvement ranging from slight improvement to achieving normal milestones after taking L-thyroxine. Congenital hypothyroidism is common in cognitively delayed children. The presence of major abnormality of the CNS should not be regarded as the only possible cause of cognitive delay and thyroid function should be assessed in such children.

Clinical patterns of neuronal migrational disorders and parental consanguinity.

The role of inheritance in neuronal migrational disorders is under intense investigation. Studies on neuronal migrational disorders (NMDs) from developing countries that have a high rate of parental consanguinity are lacking. The present study included 29 children (aged 15 days-12 years, mean age 1.4 years) who were diagnosed to have NMDs, from a non-selected population with seizures and non-selected population of cognitive developmental delay, in the period January 1994 to April 1997. Seventeen (58.6 per cent) patients had lissencephaly, four (13.8 per cent) patients had pachygyria, three (10.3 per cent) patients had neuronal heterotopia, four (13.8 per cent) patients had schizencephaly, one patient (3.4 per cent) had hemimegalencephaly, and 14 (48.2 per cent) patients with NMDs had other associated conditions. Lissencephalic patients had a high rate of parental consanguinity (88.2 per cent) and family history of possible similar cases (76.4 per cent). In conclusion, lissencephaly is probably the commonest neuronal migrational disorder in communities with a high rate of parental consanguinity, adding significant support to the literature on the genetic aetiology of lissencephaly.

Value of brain CT scan in children with febrile convulsions.

Studies specifically dealing with the value of brain CT scans in different types of febrile convulsion are lacking when compared to the large amount of studies on other favorable convulsive disorders. This study is correlation study between children who presented with febrile convulsions (n = 38) and the results of their brain CT scans. Twenty four patients had risk factors for subsequent epilepsy (group A), 3 of them had abnormal CT scans in the form of mild diffuse brain atrophy, and all 3 patients were found to have prior neurodevelopmental deficits. The other 14 patients did not have such risk factors (group B) and had normal brain CT scans. Despite the small size of the study, the results are unequivocal, and it can be concluded that brain CT scan is not indicated in the management of simple or complex febrile convulsions. Brain CT may be justifiable, but may not be clinically useful in the management of febrile convulsion patients with prior neurodevelopmental deficits.

Immunoglobulins in the treatment of Guillain-Barré syndrome in early childhood.

This is a prospective study on the use of immunoglobulins in the treatment of Guillain-Barré syndrome in four children, three of whom were younger than 3 years of age. All of them were unable to walk and were still deteriorating when the treatment was started. Three patients started recovering within 24 hours, and all the patients were fully mobile within 6 weeks after receiving first dose of immunoglobulins. This report shows the efficacy of intravenous immunoglobulins in the treatment of young children presenting with acute Guillain-Barré syndrome.

Etiology of intellectual impairment in Duchenne muscular dystrophy.

The precise etiology of intellectual impairment in Duchenne muscular dystrophy (DMD) is unknown. Histopathologic and computed tomographic studies have revealed structural brain changes; however, to our knowledge, no cranial magnetic resonance imaging (MRI) studies have been performed on DMD patients to further delineate these structural changes. We prospectively studied 4 DMD patients by cranial MRI, DNA deletion analysis, clinical evaluation, and intelligence testing. There was no significant correlation between verbal intelligence scores and MRI findings, DNA deletion, or the clinical severity of the disease. These first MRI studies of DMD did not reveal any significant anatomic brain alteration, other than mild atrophy in 2 patients. We believe these results must be considered when investigating the etiology of intellectual impairment in DMD in future studies with larger patient samples.

Neonatal Guillain-Barré syndrome.

A term female infant had the clinical manifestations and accompanying electrophysiologic studies to fulfill the criteria of Guillain-Barré syndrome. At birth, she presented with generalized hypotonia, paucity of lower limb movements, and diminished muscle stretch reflexes. At 3 weeks of age, motor nerve conduction studies demonstrated evidence of demyelination and axonal involvement. Progressive clinical improvement was observed beginning at the age of 2 weeks with subsequent normalization of clinical examinations and nerve conduction studies. To our knowledge, this patient is the youngest reported with Guillain-Barré syndrome.

Reactions of extracts of Reiter treponeme with syphilitic and non-syphilitic human sera in the single radial haemolysis technique.

A single radial haemolysis (SRH) technique, using Reiter protein or Reiter lysate as the coating antigen, was investigated. Results obtained with syphilitic and presumed non-syphilitic human sera were compared with results obtained in the absorbed fluorescent treponemal antibody test (FTA-ABS), the Reiter protein complement fixation test ( RPCFT ), the Venereal Diseases Research Laboratory Slide test (VDRL) and the Cardiolipin Wasserman reaction ( CWR ). The SRH reaction, with either Reiter antigen, was more sensitive than any of the screening tests ( RPCFT , VDRL and CWR ) for detecting positive syphilitic antibodies. Although the SRH test used almost the same materials as the RPCFT , it was appreciably more sensitive for the detection of the group-specific antibodies in syphilitic human serum.

A proposed life cycle for the Reiter treponeme.

Direct microscopical observations of single developing cysts in sealed slide microcultures prepared from 5-days-old tube cultures of the Reiter treponeme revealed two distinct phases in the life cycle. In one phase transverse fission was the main method of multiplication while in a second phase, occurring when conditions in the medium became unfavourable for propagation, cysts developed. These could release large numbers of actively motile treponemes when returned to optimum growth conditions. These observations, together with results of the dilution method for the calculation of the Most Probable Number and the absence of a response in treponemes killed by high temperature (45 degrees C) or abnormal pH (10), showed that the cysts were viable and a mode of propagation for the Reiter treponeme.