Screening of mutations in the GCK gene in Jordanian maturity-onset diabetes of the young type 2 (MODY2) patients.

Maturity-onset diabetes of the young type 2 (MODY2) is a genetic form of diabetes mellitus caused by mutations in the glucokinase gene (GCK). We assessed the frequency of GCK gene mutations in Jordanian suspected MODY2 patients. We screened exons 7, 8 and 9, which are specific for pancreatic glucokinase, for mutations at positions 682A>G, p.T228A; 895G>C, p.G299R, and 1148C>A, p.S383X, respectively, in 250 subjects (100 patients suspected to have MODY2 and 150 healthy controls without family history of diabetes mellitus). We did not find any association of these mutations in Jordanian suspected MODY2 patients or in healthy controls, different from data on Caucasian Italian patients screened for the same mutations.

Hymen care for unmarried Muslim females: role of the forensic consultant in gynaecology interventions.

This case series illustrates the role of the forensic consultant in hymen care for unmarried Muslim females exposed to gynaecology interventions. The age range of the 12 females attending University of Jordan Hospital in Amman was 35 days to 28 years. Gynaecology interventions included the use of a vaginoscope, circular resection of the hymen in cases of congenital imperforate hymen, evacuation of perineal abscess and evaluation of a torn hymen. The forensic consultant provides a valuable role in reassuring patients and parents about procedures used to avoid rupturing the hymen, and in protecting the gynaecologist's and patients' rights by providing reports of the status of the hymen before and after intervention in cases where damage is unavoidable.

Hymen care for unmarried Muslim females: role of the forensic consultant in gynaecology interventions

This case series illustrates the role of the forensic consultant in hymen care for unmarried Muslim females exposed to gynaecology interventions. The age range of the 12 females attending University of Jordan Hospital in Amman was 35 days to 28 years. Gynaecology interventions included the use of a vaginoscope, circular resection of the hymen in cases of congenital imperforate hymen, evacuation of perineal abscess and evaluation of a torn hymen. The forensic consultant provides a valuable role in reassuring patients and parents about procedures used to avoid rupturing the hymen, and in protecting the gynaecologist's and patients' rights by providing reports of the status of the hymen before and after intervention in cases where damage is unavoidable

Doppler ultrasound-guided brachiocephalic central line insertion in cardiac surgery: an overlooked approach revisited

The insertion of central venous lines is sometimeschallenging for both the physician andthe patient. In a previous work from our institute,Badran et al. described brachiocephaliccentral line insertion as an overlookedapproach and recommended its use in clinicalpractice. The aim of this study is to evaluateultrasound-guided brachiocephalic centralline insertion in patients undergoing cardiacsurgery. Twenty-six low-risk patients undergoingcoronary bypass surgery consented toparticipate in the study (14 male, 12 female).Ultrasound-guided brachiocephalic centralline insertion was performed, and the mainoutcomes measured were the success rate andthe ease of cannulation. The procedure wassuccessful in 24 patients (92.3%), while itfailed in two (7.7%). The single-puncture successrate was 79.3% (19 out of 24), with noacute or late complications. Using Dopplerultrasound guidance, the brachiocephalic veinis a suitable site for central venous catheterinsertion in cardiac surgery (AU)

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8-Hydroxy-2'-deoxyguanosine (8-OHdG) as a short-term predictor of regional and occupational health problems.

Exposure to a large number of environmental toxins can induce damage to DNA and may play an important role in the pathophysiological processes of atherosclerosis. To examine the effect of some specific environmental conditions that predispose to sudden coronary atherosclerotic death on the level of 8-OHdG, urine samples were collected from cases of certain occupations and polluted regions that showed a high prevalence of premature deaths. The samples were then analyzed for 8-OHdG. Analysis of 108 cases and 45 controls showed a significant high level of 8-OHdG in relation to occupations, habits, residency and work shift. The mean +/- standard deviation (M +/- SD) for the control group was 4.5 +/- 2.3 ng 8-OHdG/mg creatinine (n = 45), compared to 9.1 +/- 3.1 ng/mg in taxi drivers (n = 9), 10 +/- 5.5 ng/mg in chemical factory workers (n = 16), 12.0 +/- 8.9 ng/mg in paint workers (n = 9), 14.6 +/- 11.1 ng/mg in gasoline station workers (n = 15), 15 +/- 6.1 ng/mg in cement factory workers (n = 12), 16.4 +/- 3.2 ng/mg in city center inhabitants (n = 18) and 18.6 +/- 3.2 ng/mg in smokers (n = 15). These conditions at least in the pilot study done by the author, showed some form of precipitation of sudden atherosclerotic coronary death. This work proved that the recently used 8-OHdG DNA damage biomarker may be an important marker of environmental conditions that are expected to have a serious long-term impact on the cardiovascular system.

Brachiocephalic veins: an overlooked approach for central venous catheterization.

Central venous access is important in both assessment and treatment of the patient. In modern clinical practice, a percutaneous approach is preferred. The well-established subclavian and internal jugular vein catheterization techniques, however, still carry the risk of major acute complications. In this article we describe a trial study of a percutaneous brachiocephalic vein catheterization technique conducted on a total of 74 cadavers undergoing autopsy. Relying on constant and easily recognizable anatomical landmarks, we performed a total of 128 catheterizations of the right and left brachiocephalic veins. The success of catheterization was ascertained by regional dissection. Our results show very high reproducibility with a success rate of about 97% on the first attempt of catheterization on both right and left sides. Equally important, collateral injury of neighboring structures was consistently absent. We propose the introduction of this rather overlooked approach into clinical practice.

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.

Effect of aluminum phosphide on blood glucose level.

Aluminum phosphide (AlP), a poison extensively used as a grain fumigant and rodenticide, can cause an increase or decrease in blood glucose levels Both hypo- and hyper-glycemic effects of AlP can be attributed to the wide variety of changes in magnesium, calcium, phosphate, citrate and cortisol levels. These biochemical changes can act as active stimulatory or inhibitory modulators to enzymes and hormones that catalyze and regulate glucose metabolism. According to the type of biochemical changes, AlP can cause either elevation, decrease or no change in blood glucose levels. A case of AlP-caused death is reported.

Killing tools in mechanical asphyxia.

In homicidal deaths, many countries, including Jordan, used to differentiate between an intention to kill some person and whether or not this intention is preceded by premeditation or planning in advance. A retrospective review of 42 homicidal mechanical asphyxial deaths was carried out with special regard to the types of tools used and their impact on the intention and premeditation to kill. Two major causes of homicidal asphyxia-hand and ligature-accounted for 95% of the deaths (35.7% and 59.3%, respectively). Many of the victims of homicidal asphyxia were women (40.5%) and infants under the age of one year (26%). Most of the women were killed by their in-laws (24%). A sexual motive or unlawful sexual relationship outside the bonds of marriage was proven in 14 out of 17 adult female victims. This suggests how difficult it can be to support a criminal charge in cases of mechanical asphyxial deaths.

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.