Establishing the cholinesterase levels in jordan: an investigation and monitoring model for pesticides outbreak

Background Aims: To establish and validate the method used to analyze cholinesterase in blood and to establish a baseline level among Jordanians living in a heavy agricultural activity area and as well as among those living in an urban non-agricultural area

Materials and Methods: Modified Ellman procedure was used to analyze 851 and 1033 blood samples from heavy agricultural activity and urban area for cholinesterase activity in erythrocytes and Plasma

Results: sample collected from heavy agricultural activity showed low cholinesterase level average 1037U/L +/- 279 and 23 U/gHb +/- 7.9 compared with urban area average 1616 U/L +/- 662 and 31 U/gHb +/- 13 for plasma and erythrocyte respectively. The levels in workers living in heavy agriculture activity showed 52% inhibition in plasma and 41.1% in erythrocyte when compared to the established normal levels that were observed in urban area

Conclusions: Clinicians using cholinesterase for clinical diagnosis and management should be aware that baseline levels are different according to the residence of their patients

Poisoning in Jordan: analysis of three year data from Jordan national drug and poison information center

This study aims at analyzing the patterns of poisoning cases reported to the Jordan National Drug and Poison Information Center and emphasizes the roles and challenges faced by the center from a practical perspective. A retrospective analysis of a three year period 2006- 2008 was conducted depending on the data collected by the center. Analysis of data shows that a total of 914 inquiries were received by the center during the study period. More than 90% of the enquiries were from health care providers and 3.6% from the public that included victims and victims' relatives. The exposed population age ranged from less than 1 year to 80 years, with the highest incidence in children less or equal to 5 years [34.9%]. The most common reason of poisoning was unintentional [49.39%], followed by suicidal attempts [23.94%]. The highest incidence of poisoning was due to drugs which accounted for more than 42% of all exposures, where acetaminophen products were responsible for most of the cases within this category [13.4%]. The poisoning features in Jordan reflect mostly the incidences of poisoning within Amman- the capital of Jordan- in addition to other major cities in the country. Yet the center seeks more perception from the public, support from healthcare providers and verification from related governmental parties, which will enable the center to fulfill its duties according to international standards

effect of genetically related risk factors on the recurrence rate of acute pulmonary embolism in a tertiary teaching hospital in Jordan

To identify the recurrence rate of Pulmonary Embolism [PE] during the first 6 months of the diagnosis of the patients while they were on anticoagulation therapy in order to study the impact of hereditary risk factors on the recurrence rate in patients with acute pulmonary embolism during the same period. A prospective study was conducted at Jordan University Hospital, from January 2005 to the end of December 2007. A follow up was conducted till July 2008. Ninety [90] patients with acute PE were investigated; only 72 patients were included in the study due to the loss of follow up of other patients. All patients were investigated for the genetically related thrombophilic factors [FVL, FII and MTHFR], plasma level of free protein C, protein S, and antithrombin III. The patients were divided into two groups: first group those who have recurrence of PE and the second group those who have no recurrence. Seven patients [9.7%] out of 72 who met the inclusion criteria, had a recurrent episode of PE within the first 6 months of diagnosis. There was a significant correlation between the recurrence rate of PE and protein C deficiency p value 0.025. There was no significant correlation between the recurrence of PE The results of our study necessitate the need to test patients with unprovoked vein thrombosis for the presence of deficiencies of natural anticoagulants; especially protein C level. Other potential risk factors for the recurrence of Venous Thromboembolism [VTE] have to be individualized. Further studies with a larger number of patients are needed to clarify the significance of these risk factors in the recurrence of PE

First percutaneous balloon pericardiotomy [PBP] or pericardioplasty in Jordan: a case report and review of literature

Patients with large pericardial effusions regardless of their etiology frequently undergo surgical pericardial window to avoid recurrence that occurs in more than 50% if pericardiocentesis alone was done through the percutaneous approach. Some patients are very sick to undergo surgery options. A newly developed old procedure, Percutaneous Balloon Pericardiotomy [PBP], was introduced in 1991 and has been proven to be safe and efficient, with very low rate of recurrence, and little chance of complications. Herein, we describe this procedure done for the first time in Jordan

Thrombophilia-related genetic variations in patients with pulmonary embolism in the main teaching hospital in Jordan

To study the frequency of Factor V Leiden [FVL], prothrombin gene mutation G20210A and methylenetetrahydrofolate reductase C677T in patients with acute pulmonary embolism [PE]; and to investigate whether these factors are more frequent in patients who have no obvious risk factors for venous thrombo-embolism compared to those with obvious risk factors. A case-control study conducted at Jordan University Hospital, Amman, Jordan during the period 2005-2007. Compared 92 patients with acute PE to 99 normal subjects. All subjects were investigated for the 3 genetically related thrombophilic factors. The frequency of these factors in patients were 22/92 [23.9%] FVL, 3/92 [3.3%] Factor II [FII] and 48/92 [52.2%] methylenetetrahydrofolate reductase [MTHFR]. In the control group, FVL was 12/99 [12.1%], FII 0/99 [0%], and 53/99 [53.5%] MTHFR. There was a statistically significant difference between patients and controls for FVL [p=0.03], but no statistical significance for FII [p=0.10] and MTHFR [p=0.85]. In patients with no obvious risk factors, the frequency of these factors were 8/29 [27.6%] FVL, 2/29 [6.9%] FII, and 14/29 [48.3%] for MTHFR compared to patients with obvious risk factors 14/63 [22.2%] for FVL, 1/63 [1.6%] FII, and 33/63 [52.3%] MTHFR. The FVL is statistically more frequent in patients with PE compared to the control group, and the frequency of FVL, FII, and MTHFR is not significantly higher in patients with acute PE who have no obvious risk factors compared to those with obvious risk factors

Acute non-cardiogenic pulmonary edema following acute upper airway obstruction with a piece of meat

A 14- year-old boy developed acute pulmonary edema post upper airway obstruction. This complication of acute upper airway obstruction is not very rare. The cause of obstruction in this case is suffocation by a piece of meat during a barbeque party. The piece of meat was removed from the upper airway; however, he continued to be in respiratory distress, which was relieved only after intubation with mechanical ventilation. In this type of acute pulmonary edema, the leading mechanism is increased negative intrapleural pressure due to the forceful inspiration against the obstructed airways. Treatment modalities include relieving the obstruction, mechanical ventilation with Positive End Expiratory Pressure [PEEP] and diuretic. Knowledge of this complication increases the vigilance of the emergency physicians and helps to identify patients at risk and then start helpful treatment for these patients