Unveiling the Dark Side of Datura in Pediatric Poisoning With Insights From Jordanian Experience : A Retrospective Clinical Study.

OBJECTIVES: Datura stramonium , jimsonweed, is a toxic plant with hallucinogenic properties. Although there are many studies on Datura poisoning, none reported cases in Jordan. This study offers a comprehensive review on D. stramonium ingestion, covering its epidemiology, clinical presentation, and treatment. We aimed to provide better understanding of the factors for Datura ingestion, identify prevention and management strategies, and address research challenges. METHODS: This study adopted a retrospective review design to evaluate the cases of Datura poisoning in Al Karak, province of Jordan during the spring of 2022. Data collected from medical records, toxicology databases, and consultation records were analyzed using descriptive statistics. RESULTS: The common symptoms of Datura poisoning included agitation, mydriasis, and tachycardia. The management approaches comprised supportive care, administration of Diazepam for agitation, and, in some cases, neostigmine to counteract anticholinergic effects. CONCLUSIONS: Understanding the risks associated with D. stramonium poisoning and implementing effective prevention and management strategies are crucial. This study highlights the importance of recognizing Datura poisoning as a potential diagnosis in children presenting with unexplained anticholinergic symptoms or agitation to the emergency room.

Autism services in low-resource areas.

OBJECTIVES: To explore access to intervention services for children with autism spectrum disorder (ASD) in Jordan. METHODS: We used prospective cross sectional design and survey methodology to collect information from the parents of a convenient sample of children with ASD aged 2.5-17 years and who attended pediatric neurology clinics in 3 different university affiliated hospitals in 3 geographic areas in Jordan from February to December 2018. RESULTS: We interviewed parents of 274 children with ASD. One hundred ninety-six (71.5%) received rehabilitation services. The average age at first session was 3.9 years. The most common services received were behavioral therapy (182; 66.4%). The average weekly hours were highest for speech and behavioral therapy; 6.25 and 6.64 respectively. Private centers for developmental disabilities were the most commonly used followed by private centers for ASD. The most common barriers were costs (138; 58%) and transportation (88; 37.5%). Most parents (198; 72.3%) prefer to receive rehabilitation in a specialized center for autism, and most did not want to receive training to train their child themselves. CONCLUSION: Most children with ASD in Jordan have limited access to recommended autism services. The development of future interventions must consider the needs of those living in limited resource regions.

Type and etiology of pediatric epilepsy in Jordan. A multi-center study.

OBJECTIVE: To study types and etiologies of epilepsy in Jordanian pediatric epileptic patients maintained on antiepileptic drugs using customized classification scheme of International League Against Epilepsy (ILAE) (2010) report. METHODS: This is a cross-sectional, multi-centre study on pediatric epileptic patients on antiepileptic drugs, who were managed in the pediatric neurology clinics at 6 teaching public hospitals in Jordan. RESULTS: Out of the 663 patients included in the study, (90.2%) had one seizure type, (53%) of this type were focal seizures followed by generalized seizures (41.5%) and spasms (5.5%). Distinctive constellations were found in 11/663 (1.7%) patients. Benign epilepsies with centrotemporal spikes were the most common electro clinical syndromes 60/221 (27.1%). Epilepsies attributed to structural-metabolic causes were documented in 278/663 (41.9%) patients, unknown causes 268/663(40.4%) and genetic causes in 117/663(17.7%). Most common causes of structural-metabolic group were due to perinatal insults (32%) and most common causes of the genetic group were the presumed genetic electro clinical syndromes (93.1%). CONCLUSION: Our study is on pediatric epilepsy, using customized classification scheme from the ILAE 2010 report which showed interesting results about type and etiology of epileptic seizures from developing country with potential impact on the international level.

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.

Genetic evaluation of children with autism spectrum disorders in developing and low-resource areas.

LAY ABSTRACT: Autism is the most common neurodevelopmental disorder in children worldwide. Genetic factors play an important role in the risk of developing autism. Determining the genetic cause of autism is key to understanding the biological processes that lead to the clinical manifestations of autism, and can inform the management and even prevention of this condition. Establishing genetic causes of autism requires collection of genetic data on a global scale. Limited research on genetic testing for individuals with autism is available from developing countries in low-resource regions. In this study, we explored the types of investigations ordered for Jordanian children with autism by their physicians. A representative sample of parents of children with autism in Jordan was questioned about the studies that their children received. We found that the recommended genetic testing was only performed in a small number of children with autism. In contrast, most children in the sample received non-genetic testing, which is not routinely recommended. We also explored the sociocultural factors that may influence the decision to perform genetic testing in this population. We discuss our findings in light of the data available from other developing and developed countries.

Differences in identification of attention deficit hyperactivity disorder in children between teachers and parents.

BACKGROUND: The worldwide prevalence estimates for attention deficit hyperactive disorder (ADHD) are extremely heterogeneous. Diagnosis in children demands symptoms be present in at least 2 different settings, mainly school and home. The proportion of children estimated to have ADHD can vary based on whether the symptoms are evaluated by parents or teachers. AIMS: This study determined whether ADHD and its subtypes are better recognized by parents or teachers. METHODS: Our study included 1326 schoolchildren (boys = 712, girls = 614; age range: 6-12 years). We prepared 2 questionnaires for each student enrolled in the study; one was completed by the student's parents and the other by the teacher. We included students who attended 3 selected schools in the cities of Amman and Karak in Jordan during the first term of 2017. The Arabic version of the Diagnostic and statistical manual of mental disorders, 4th edition, was used for the diagnosis and classification of ADHD. RESULTS: Of the 1326 students included in this study, 254 (19.2%) were considered to have ADHD by the teachers and 172 (13.0%) by the parents. The Wilcoxon signed-ranks test showed that teachers gave statistically higher scores on the questionnaire than parents. However, overall agreement between parents and teachers, as measured by the κ-value, reached 77.2%. CONCLUSIONS: Although both teachers and parents recognized ADHD symptoms, they were generally more recognized by teachers than by parents.

Parental use of conventional and complementary therapy for autism in Jordan.

OBJECTIVE: We investigated parental use of conventional therapies and complementary and alternative medicine (CAM) for children with autism in Jordan. METHOD: This prospective cross-sectional study was conducted from February 2018 through December 2018 at the paediatric neurology clinics of three tertiary referral hospitals in Jordan. The accompanying parent was interviewed to complete a structured questionnaire. RESULTS: 274 parents were interviewed. The most common medications used were those to treat hyperactivity (150; 54.7 %), anticonvulsants (60; 21.9 %), and sleep aids (6; 2.1 %). CAM was used by 129 parents (47.0 %). A casein-free diet was the most commonly used dietary modification (24; 8.7 %), while fish oil (Omega-3) was the most common supplement used (96; 35.0 %). Hyperbaric oxygen, chelation therapy, and antifungal treatment were also occasionally used. Higher parental education levels and access to rehabilitation services correlated with higher CAM use (p < 0.05).

Two cases of variant late infantile ceroid lipofuscinosis in Jordan.

BACKGROUND: Late infantile ceroid lipofuscinosis is a rare neurodegenerative disorder that appears between the ages of 2 and 4 years and is difficult to diagnose. In this report we present two sisters with this condition, and the clinical course consisted of delayed developmental skills initially and later regression of previously acquired skills. The cases were initially considered as childhood disintegrative disorder (CDD); however, when whole exome sequencing (WES) genetic testing was done, they proved to be variant late infantile ceroid lipofuscinosis. This is the first report from Jordan. CASE SUMMARY: Clinical presentation included developmental delay and initially speech delay, followed by lose of sphincter control. Motor development was normal until 4 years of age, then they developed ataxia (fear of going downstairs) and weakness while walking. Atonic and myoclonic seizures become intractable, and this was followed by inability to stand or sit and loss of expressive language. In addition to complete blood count test, liver function test, kidney function test, serum electrolyte test, and blood sugar test, serum amino acid profile, B12 level test, thyroid function test, and a brain computed tomography scan were also normal. An electroencephalogram showed a generalized spike and wave pattern, and magnetic resonance imaging showed little to no abnormalities. After dealing with the cases as CDD, WES testing proved a final diagnosis of variant late infantile ceroid lipofuscinosis. Current treatment is anti-epileptic drugs and supportive care at home, and they are now in vegetative state. CONCLUSION: This report highlights the importance of WES for the identification of genetic diseases, especially neurodegenerative disorders.

Epidemiological evaluation of Mediterranean spotted fever in children of the Karak province in south Jordan.

INTRODUCTION: The aim of this study was to describe the epidemiological patterns of Mediterranean spotted fever (MSF) as well as its treatment and outcomes in children in south Jordan. METHODOLOGY: A retrospective observational study was conducted from June 2013 to December 2015. Data regarding demographics, clinical presentation, laboratory findings, treatment, and outcomes were collected. RESULTS: In total, 35 male and 20 female patients (mean age: 6 years ± 3.6) were included. The incidence of MSF was 7.9 cases/100,000 inhabitants/year; MSF affected 89% of individuals in the summer, 74.5% of those living in a rural area with tent housing, and 100% of those who had contact with animals. All cases presented with fever, and 94.5% had a skin rash. Serological tests were positive in 87.2% of cases, and Rickettsia conorii (the Moroccan strain) was present in all positive cases. All cases had thrombocytopenia, but none had leukocytosis. Hyponatremia was present in 71% of cases, and 49%, 61.8%, and 72.7% had increased urea, alanine transaminase, and aspartate aminotransferase levels, respectively. Doxycycline was administered to all patients, with a cure rate of 96.4% and mortality rate of 3.6%. CONCLUSIONS: MSF caused by R. conorii (the Moroccan strain) is prevalent in Jordan, and contact with animals is the route of transmission. The patients' responses to doxycycline were excellent. A high index of suspicion, early diagnosis, and specific treatment considerably decrease mortality. MSF should be considered as a possible cause of febrile disease in those with a rash and in those living in rural areas.

Parental knowledge and attitudes towards epilepsy -A study from Jordan.

PURPOSE: To explore the knowledge, attitudes and behaviors of parents whose children were diagnosed with epilepsy. METHODS: Cross-sectional questionnaire based study of parents who accompanied their children with epilepsy to the child neurology clinics at three university hospitals in Jordan. RESULTS: Most parents (427, 90.3%) knew that epilepsy is not related to a psychiatric disease. Approximately half of the parents (245, 51.8%) used the internet as their source of knowledge, and most used Arabic websites. Searching the word epilepsy was rarely used (51, 10.8%). Most of the parents (428,90.5%) were not restricting their children from watching TV or from using the computer (358,75.5%).However, many parents (280,59.2%) were restricting them from participating in sports. Parents had negative attitudes towards epilepsy; 189 (40.0%)thought that epileptic children can have normal intelligence, and 292 (61.7%) thought that they can continue into higher education. Greater parental knowledge of epilepsy was found to be correlated with the parental education level (p<0.05).Positive attitudes and behaviors towards epilepsy were found to be correlated with a higher parental education level, control of epilepsy,an absence of associated co morbidities, a higher income and internet use (p<0.05). CONCLUSION: This study sheds an important light on the current knowledge status and attitudes of parents of children with epilepsy, and is an invaluable tool for tailoring the delivery of information and support resources for families in our region.