Micronutrient status in Jordan: 2002 and 2010.

BACKGROUND/OBJECTIVES: Two national surveys were conducted in Jordan in 2002 and 2010 to investigate the micronutrient status in women and children. To determine the prevalence of anemia, iron and folate deficiency among women and children in 2010 and compare with the prevalence of anemia and iron deficiency in 2002. SUBJECTS/METHODS: A nationally representative survey was conducted in 2002 (1023 women, 15-49 years of age; 1059 children, 12-59 months of age) and a second survey in 2010 (2035 women; 940 children). Venous blood samples were used to measure hemoglobin, ferritin and red blood cell folate (the latter on a subsample of 393 women). RESULTS: Among women in 2010, the prevalence of folate deficiency and insufficiency was 13.6% and 82.9%, respectively. Geometric mean serum ferritin was higher in 2010 compared with 2002 (21.3 ng/ml vs 18.3, P=0.01); there was no significant change in the prevalence of iron deficiency (35.1% vs 38.7%, P=0.17), iron deficiency anemia (19.1% vs 20.0%, P=0.61) or anemia (29.2% vs 29.3%, P=0.96). Among children, a significantly lower prevalence was observed in 2010 compared with 2002 for iron deficiency (13.7% vs 26.2% P<0.001) and iron deficiency anemia (4.8% vs 10.1%, P<0.001); a nonsignificant lower prevalence was observed for anemia (16.6% vs 20.2%, P=0.09). CONCLUSIONS: In 2010, approximately one of seven women was folate deficient and six out of seven were folate insufficient for the prevention of neural tube defects. Between 2002 and 2010, significant improvement was observed in the prevalence of iron deficiency in children, but not in women.

Promoting new approaches for cancer care in the Middle East.

Cancer is now the fastest growing killing disease in the Middle East. Accordingly, there is an urgent need to train local health professionals: oncologists, palliative care experts, oncology nurses, psychologists, along with social workers, physiotherapists and spiritual counselors on strategies for early detection, curative therapies and palliation. Professionals in the region, along with the public, need to convince medical administrators, regulators and policymakers about investing in education and training of YOUNG professionals, as well as those with already proven experience in cancer care. Training is the basis for any future cancer care program, which aims at the integration of palliative care practices into standard oncology care across the trajectory of the illness.

Cancer incidence in Jordan, 1996-2005.

Cancer causes 14% of all deaths in Jordan. This paper presents the incidence of cancer in Jordan from 1996 to 2005. Over the 10-year period there were 33 661 cases of cancer. The average crude incidence rate was 66.2 per 100 000 for males and 70.0 per 100 000 for females (age-standardized rates: 119 per 100 000 adult males and 116 per 100 000 adult females). The 5 most frequently reported cancers among adult males were: lung (10.6%), colorectal (9.8%), leukaemia (9.3%), urinary and bladder (8.6%) and prostate (7.4%). For adult females these were: breast (32.0%), colorectal (9.0%), leukaemia (6.7%), thyroid (4.9%) and corpus uteri (4.6%). Cancer rates have changed little since 1996.

Frequency of t(14;18) in follicular lymphoma patients: geographical or technical variation.

The t(14;18) translocation is the most distinguishing molecular finding in follicular lymphoma (FL). However, the reported frequencies of t(14;18) in FL show significant variation, which is often attributed to geographical and/or methodological factors. The methods used to detect t(14;18) include Southern blotting, conventional cytogenetics, fluorescent in situ hybridization, and polymerized chain reaction (PCR). Because of its practicality and superior sensitivity, PCR is becoming the more commonly used method in clinical laboratories. The identification of the main breakpoint regions on chromosome 18, including the major breakpoint region (MBR), the minor cluster region (mcr), and the newly defined intermediate cluster region (icr), increased the detection frequency of PCR. In our study, using a highly sensitive nested PCR strategy with primers for MBR, mcr and icr regions, we were able to detect t(14;18) in 95% of FL patients, which is one of the highest reported frequencies using PCR. We screened 58 FL patient samples collected retrospectively from different hospitals in Jordan. DNA was extracted from archival paraffin-embedded samples, some of which were >10 years old. The respective breakpoint distributions were, 47 for MBR (81%), two for mcr (3.5%) and six for icr (10.3%). In this report, we analyze this high frequency of t(14;18) detection in a general review of the recent literature, in an attempt to assess the geographical vs. methodological influences on the reported frequencies.

The spectrum of glomerulopathy in jordan.

In this study, we reviewed the records and the histological findings of a total of 350 adequate native kidney biopsies at both the Jordan University Hospital (260 biopsies in the period 1986-1989) and the Jordan Hospital (90 biopsies in the period 1997-1999). There were 187 males (53.4%) and 163 females (46.6%). Their ages ranged between 12-77 years. The nephrotic syndrome was the presenting feature in 194 (55.4%) patients, acute renal failure in 55 (15.7%), hematuria and/or non-nephrotic proteinuria in 45 (12.9%), chronic renal failure in 32 (9.1%) and hematuria alone 24 (6.9%). In the patients with the nephrotic syndrome, 140 (72.2%) had primary nephrotic syndrome. In this group membranoproliferative glomerulonephritis (MPGN) was the most common pathology and was detected in 49 patients (35%) followed by focal segmental glomerulosclerosis (FSGS) in 38 (27.1%). Amyloidosis and systemic lupus erythematosus were the commonest findings among the 54 patients with secondary nephrotic syndrome (40.7% and 38.8% respectively). Rapidly progressive glomerulonephritis was seen in 34.5% of those patients presenting with acute renal failure, while FSGS was seen in 25% of those with chronic renal failure. Finally IgA nephropathy was the major finding among both the 45 patients with hematuria-proteinuria and the 24 patients with isolated hematuria (26.2% and 66.6% respectively).

Nebulized glyceryl trinitrate exerts acute bronchodilator effects in patients with acute bronchial asthma.

Glyceryl trinitrate (GTN) is a potent smooth muscle relaxant and vasodilator. There are conflicting reports regarding its efficacy as a bronchodilator. The aim of this study was to examine whether nebulized GTN has bronchodilating effects in patients with acute bronchial asthma. We studied 18 patients (five female, 13 male) who were admitted to the hospital with acute severe asthma on two occasions, administering either 6 mg nebulized GTN or placebo (saline) in a double-blind, randomized, crossover fashion. Bronchial response was assessed by measurement of peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). A systematic effect of this dose of GTN was demonstrated by a mean increase in heart rate of 38.1% (SEM=7.6%) after GTN administration from supine to erect posture, compared with 10.2% (SEM=1.8%) after placebo (P<0.005). Systolic blood pressure decreased by 8.7% (SEM=1.1%) after GTN, compared with 4.0% (SEM=2.1%) after placebo (P<0.05). Diastolic blood pressure did not change significantly. Baseline PEF, FEV1 and FVC did not differ on the two experimental days; however, acute bronchodilating effects were seen: PEF (l/min); 368 (21) pre-GTN, 411 (22) post-GTN and 384 (23) post-placebo (P<0.001). FEV1 (l); 2.12 (0.13) pre-GTN, 2.46 (0.15) post-GTN and 2.25 (0.16) post-placebo (P<0.001). FVC (l); 3.31 (0.17) pre-GTN, 3.75 (0.2) post-GTN and 3.54 (0.2) post-placebo (P<0.001). In conclusions, nebulized GTN has bronchodilating effects in patients with acute bronchial asthma. The exact mechanism of bronchodilation is not known, but it may be due to local effect on bronchial smooth muscles through nitric oxide or by systemic vasodilatation which leads to a decrease in pulmonary artery pressure and pulmonary vascular resistance, or an increase in systemic catecholamine release.

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.

Primary gastrointestinal lymphomas in Jordan are similar to those in Western countries.

It has been a common practice to divide gastrointestinal (GI) lymphomas into Western and Middle Eastern types; the former predominantly involves the stomach, whereas the latter are mostly intestinal. Recent studies suggested that these lymphomas are biologically different from their nodal counterpart and hence should be classified separately. In this retrospective study, we examined all of the primary GI lymphomas seen at Jordan University Hospital, Amman, Jordan, between 1983 and 1992 in an attempt to reclassify and immunophenotype these cases. We studied 53 cases of primary GI lymphomas for which available material was found. Lymphomas were morphologically reclassified according to current classification schemes. Immunoperoxidase stains were performed using the streptavidin biotin method using antibodies against leukocyte common antigen, B, and T-cells. The stomach was the most common site of involvement, accounting for 62% of the cases. The male-to-female ratio was 2.8:1. The three most common histologic types were, in order, diffuse large cell lymphoma, Burkitt's lymphoma, and lymphoma of mucosa-associated lymphoid tissue. Immunoproliferative small intestinal disease was seen in only one patient. The B-cell phenotype predominated in our cases; it was seen in 85% of the gastric and 100% of the intestinal cases. Unlike other series from the region, the stomach was the most commonly involved site by GI lymphoma. Immunoproliferative small intestinal disease seems to be a rare entity in Jordan, and the majority of intestinal and gastric lymphomas were diffuse large cell lymphomas. Histopathologic evidence of mucosa-associated lymphoid tissue origin was seen in at least 18% of the gastric cases. B-cell lymphomas were by far the most common type seen, and T-cell lymphomas were rare.

Pattern of colonic disease in lower gastrointestinal bleeding in Jordanian patients: a prospective colonoscopic study.

PURPOSE: This study was developed to document causes of rectal bleeding of Jordanian patients and compare them with results from several parts of the world. METHODS: Diagnostic and therapeutic colonoscopy was used as a first-line investigation on 701 consecutive Jordanian patients presenting with rectal bleeding. When indicated, technetium 99m-labeled red blood counts or selective angiography were used also. RESULTS: Most common causes according to frequency were hemorrhoids, polyps, ulcerative colitis, amebic colitis, neoplasm, diverticulosis, anal fissure, Crohn's disease, and arteriovenous malformations. CONCLUSIONS: This is the first study addressing this problem from this part of the world. Findings were different from many other results published in western and eastern studies in certain disease entities.

Red cell aplasia resembling Diamond-Blackfan anemia in seven children in a family.

PATIENTS AND METHODS: Seven children of the same family with a possible variant of Diamond-Blackfan anemia (DBA) are reported. Five were male siblings, and the other two were their cousins, one male and one female. All were products of consanguineous marriages of healthy parents. All cases occurred within one generation. Anemia was present at birth or shortly after birth. Hepatosplenomegaly was present in all. Four had short stature. Hematological findings included normochromic, normocytic, or macrocytic anemia, marked reticulocytopenia, with initial normal white blood cell and platelet count, and absent or markedly decreased erythroid precursors on bone marrow examination. All were treated initially with prednisolone; in one patient oxymetholone was added. RESULTS: Three children failed to respond to the initial treatment, and also failed to respond to cyclosporin A and pulse doses of methylprednisolone. Myelofibrosis occurred in two siblings, 9 and 11 years from diagnosis. In two children the disease recurred 9 and 12 years after initial diagnosis. CONCLUSIONS: Our cases point to a possible variant of DBA characterized by the presence of normochromic normocytic anemia, hepatosplenomegaly, absent skeletal malformations, and unusual long- term complications.

Spectrum of renal involvement in familial Mediterranean fever.

Kidney biopsies were performed on fifteen patients with a long-standing history of familial Mediterranean fever (FMF) and evidence of renal involvement. On light microscopy, seven patients were found to have amyloidosis, six mesangial proliferative glomerulonephritis (MsPGN) and two patients rapid progressive glomerulonephritis (RPGN). Immunofluorescent studies of the six biopsies with MsPGN were positive for mesangial IgA deposits (IgA nephropathy) in three patients and IgM mesangial deposits in three (IgM nephropathy). We conclude that in patients with FMF and renal involvement, non-amyloid renal lesions (IgA nephropathy, IgM nephropathy and RPGN) should be considered in the differential diagnosis in addition to amyloidosis.

Membranoproliferative glomerulonephritis associated with multicentric angiofollicular lymph node hyperplasia. Case report and review of the literature.

A 14-year-old boy presented with fever, anemia, hepatosplenomegaly, generalized lymphadenopathy and nephrotic syndrome. Lymph node biopsy showed angiofollicular lymph node hyperplasia (generalized Castleman's disease) of the plasma cell type. Kidney biopsy showed membranoproliferative glomerulonephritis type 1. Complete remission was achieved with corticosteroid treatment and repeat kidney biopsy 22 months later showed complete resolution of the renal pathology. The association between membranoproliferative glomerulonephritis and multicentric angiofollicular lymph node hyperplasia, plasma cell type, has not previously been reported.

Congenital malignant melanoma of the eye.

Twenty-three cases of congenital malignant melanoma have previously been reported. Here the authors report the first case of a congenital malignant melanoma arising in the eye. A newborn girl had a large pigmented ocular tumor, hepatomegaly, and multiple pigmented skin and choroidal lesions. The histopathologic diagnosis was of a malignant melanoma with hepatic metastases. The skin and choroidal lesions were considered to be congenital melanocytic nevi. The most plausible pathogenetic link between these two conditions was that the malignancy had arisen as a second-hit mutation within a choroidal congenital melanocytic nevus. Despite widespread metastases the baby, treated by surgery and chemotherapy, survives in good health, aged 2 years, 10 months.

Diagnostic value of cervical lymph node biopsy: a pathological study of 596 cases.

During a 10-year period (1976-1985), a total of 596 cervical lymph node biopsies for diagnostic purposes were performed at our institution. Thirty-five percent of these nodes were involved with malignant lymphoma, and 20.5% showed metastatic deposits. Nondiagnostic reactive hyperplastic changes were noted in 23% of the cases. Several other inflammatory and neoplastic conditions were encountered. Comparison of our data with several series from different countries with review of relevant literature are presented.

Rapid progressive glomerulonephritis in patients with familial Mediterranean fever.

Two patients with a long-standing history of familial Mediterranean fever (FMF) presented with gross hematuria, oliguria, and acute renal failure; both required dialysis support. Kidney biopsies from both patients revealed crescentic rapid progressive glomerulonephritis (RPGN) without amyloidosis. One patient recovered renal function with methylprednisolone pulse therapy and cyclophosamide. The second patient did not improve and required regular hemodialysis. He is asymptomatic on colchicine therapy. To our knowledge, these are the first cases documenting the presence of RPGN in patients with FMF.