Sudden pediatric death unveiling pulmonary arteriovenous malformations.

Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular connections between pulmonary arteries and veins, often associated with hereditary hemorrhagic telangiectasia (HHT). Most PAVMs are asymptomatic, but life-threatening complications like pulmonary hemorrhage, brain abscesses, and paradoxical emboli can emerge, so prompt diagnosis and treatment are crucial. We report a case of sudden pediatric death in a two-year-old female with no past medical history. Initial vomiting and fast deterioration resulted in a sudden cardiac arrest. The postmortem examination found histological evidence of consistent, extensive lung damage. The absence of the characteristic symptoms made for some challenges when it came to diagnosis, showing precisely that in early life, you could well have many difficulties in catching PAVMs. This case highlights the need to take PAVMs into account as a potential cause of sudden death, particularly when there are no conspicuous symptoms. Awareness among forensic pathologists and consideration of genetic analysis for HHT in such cases is crucial for accurate diagnosis and management.

Simultaneous determination of tramadol in earwax and urine samples: effects of age, duration time and sex.

Background: This study aims to determine the concentrations of tramadol in earwax (µg/g) and urine (µg/ml) samples taken from postoperative patients, to evaluate the sensitivity of earwax (cerumen) as an alternative analyte and compare it with the findings in urine samples. Results: The results indicated that tramadol concentrations in earwax samples were averaged 45.08 µg/g (range: 13.5-107.7 µg/g), whereas tramadol concentrations in urine samples were averaged 4.97 µg/ml (range: 1.57-10.11 µg/ml). There were significant differences when comparing age groups, duration and sex between earwax and urine samples (p < 0.05). Conclusion: Despite the significant differences between earwax and urine samples, earwax can be used as a bioindicator of tramadol detection.

Sudden pediatric death unveiling pulmonary arteriovenous malformations

ABSTRACT Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular connections between pulmonary arteries and veins, often associated with hereditary hemorrhagic telangiectasia (HHT). Most PAVMs are asymptomatic, but life-threatening complications like pulmonary hemorrhage, brain abscesses, and paradoxical emboli can emerge, so prompt diagnosis and treatment are crucial. We report a case of sudden pediatric death in a two-year-old female with no past medical history. Initial vomiting and fast deterioration resulted in a sudden cardiac arrest. The postmortem examination found histological evidence of consistent, extensive lung damage. The absence of the characteristic symptoms made for some challenges when it came to diagnosis, showing precisely that in early life, you could well have many difficulties in catching PAVMs. This case highlights the need to take PAVMs into account as a potential cause of sudden death, particularly when there are no conspicuous symptoms. Awareness among forensic pathologists and consideration of genetic analysis for HHT in such cases is crucial for accurate diagnosis and management.

Epidemiological Analysis of Drowning Deaths Among Different Groups in Jordan - a Retrospective Study (2015-2019).

Background: According to the World Health Organization (WHO), drowning is globally considered as one of the leading causes of injury related deaths. Defined as the process of experiencing respiratory impairment from submersion in a liquid medium. Drowning is a public health concern in Jordan. This study aimed to investigate drowning incident data from the Forensic Medicine Teaching Centre in the North of Jordan for the purpose of defining high risk groups and circumstances around drowning fatalities which suffered an attention deficit. Objective: The study aims to describe the rate of fatal drowning in North of Jordan and to properly understand the risk factors associated with it. Methods: The present study is retrospective, based on investigating 2808 autopsy reports and selecting only 85 drowning related death reports conducted through a 5 year period (2015-2019) in the Forensic Medicine Teaching Centre which serves Northern Jordan including Irbid, Jarash, Ajloun, and Al-Mafraq. The statistical analysis of fatal drowning cases included the following risk variables: Age, gender, month, year, nationality, address, alcohol and drug consumption. Results: 15 variables were consistent and analyzed across the database of this study. The high risk groups and patterns were identified and the majority of fatal drowning cases were related to males (80.4%). Age group from (2 to 27 years of age were included in the high-risk groups with (88.2%) of all cases. Specifically, the age 2 had the highest occurring frequency. While (17.6%) of drowning fatalities occurred in August. Alcohol and drugs had no significant impact on increasing drowning rates. The dominant manner of death among all cases was accidental (95.3%). Fatal drowning rates were decreasing throughout the years of (2015-2019). Conclusion: Defining drowning high risk groups and its epidemiology helps to overcome this preventable cause of death. The current study highlights the necessity for the need of further interventions to be actively fixed into policies and educational programs and emphasize safety precautions during water activities and to improve the dataset collection for better planning of prevention strategies.

Epidemiological Study of Carbon Monoxide Deaths in North Jordan 2009-2018.

BACKGROUND: Carbon monoxide (CO) poisoning rate has stayed the same around the globe over the last quarter of a decade. However, the number of people who die compared to the number of people who get poisoned, and the mortality rate has declined dramatically. OBJECTIVE: The aim of this study was to evaluate the severity of the CO poisoning problem in Jordan and compare it to other countries and to search for any related factors that could affect the death rate. METHODS: A retrospective study was conducted in the Forensic Medicine Teaching Centre, Irbid, Jordan for a 10-years period (2009 -2018). 5,725 autopsy reports were assessed, and only 71 CO-related death cases were selected and analyzed based on the following risk factors: age, gender, year and month of death, nationality, address, the settings that the cases occurred in, carboxyhemoglobin saturation (COHb%) and the presence of alcohol and drugs in blood. RESULTS: The rate of deaths due to CO poisoning showed a general decline over the reviewed years. Most victims were males (70.4%). And although the death rate showed an increase with age, the age group between 20-year-old and 39-year-old accounted for 38% of all cases. Most cases happened in the winter months, December, January, and February. 87.1% of the cases occurred at home settings. The average COHb% was 68%±13% and ranged from 12%-83%. CONCLUSION: Although the incidence is decreasing with time, CO is still a threat that must be dealt with. As all cases in our study were accidental cases and good preventive measures, such as good CO detectors and good air flow in the places that hold devices that could generate CO, and proper education to the public, especially in the colder regions of the country, could prove useful in decreasing the incidence of CO deaths further.

Antioxidant activity of simvastatin prevents ifosfamide-induced nephrotoxicity.

Ifosfamide is an anticancer agent used largely in treatment of solid tumors. The mainstay dose-limiting toxicity of ifosfamide is nephrotoxicity. This is largely believde to be a result of ifosfamide-induced oxidative stress. In this study, we investigated the antioxidant activity of simvastatin and the possible protective role of simvastatin against ifosfamide induced nephrotoxicity. Thirty Sprague-Dawely rats were divided into five groups and given orally different drug combinations. Group I and II were regarded as control groups and received 0.1% DMSO and normal saline, respectively. Group III received ifosfamide at 50 mg/kg, group IV received simvastatin at 0.3 mg/kg and group V received both ifosfamide and simvastatin. All animals were decapitated 2 days after the last ifosfamide administration. Findings revealed that ifosfamide induced nephrotoxicity as indicated by a significant increase in plasma creatinine and lipid per oxidation. This increase was significantly inhibited in animals pretreated with simvastatin. Histopathological observations were in correlation with the biochemical parameters in that simvastatin minimized ifosfamide-induced renal tubular damage. The above results promote a future use of simvastatin in combination with ifosfamide in treatment of cancer patients to indicate that simvastatin protectics against ifosfamide-induced nephrotoxicity in terms of oxidative stress and might be given in combination.

Validation of the Waterpipe Tolerance Questionnaire Among Jordanian School-Going Adolescent Waterpipe Users.

INTRODUCTION: Waterpipe use among adolescents has been increasing progressively. Yet no studies were reported to assess the validity and reliability of nicotine dependence scale. The current study aims to assess the validity and reliability of an Arabic version of the modified Waterpipe Tolerance Questionnaire WTQ among school-going adolescent waterpipe users. METHODS: In a cross-sectional study conducted in Jordan, information on waterpipe use among 333 school-going adolescents aged 11-18 years was obtained using the Arabic version of the WTQ. An exploratory factor analysis and correlation matrices were conducted to assess validity and reliability of the WTQ. RESULTS: The WTQ had a 0.73 alpha of internal consistency indicating moderate level of reliability. The scale showed multidimensionality with items loading on two factors, namely waterpipe consumption and morning smoking. CONCLUSION: This study report nicotine dependence level among school-going adolescents who identify themselves as waterpipe users using the WTQ.

Sexual Offenses Among Children in the North of Jordan: An Exploratory Study.

Sexual offenses are an important global health problem threatening people of all age groups. There are no reported studies regarding sexual violence among children in Jordan. Therefore, this study aimed to examine the problem of sexual violence among children in the Northern region of Jordan. A retrospective design was adopted to review all reports from the Forensic Medicine Teaching Center of North of Jordan clinic on cases of sexual-related assaults that occurred between 2003 and 2007. Reports were reviewed for age, gender, toxicological analysis, and relevant information provided by victims and their relatives. Results indicated that 53% of the cases were male victims, with a male to female ratio of 1:1. Ages ranged from 3 to 18 years with a mean age of 12.5 years. Most cases were considered indecent assaults, while 37.1% were cases of rape. In most cases, offenders were strangers. It could be concluded that Jordanian children are as susceptible to sexual assaults as their counterparts worldwide. This study is the first to report sexual offenses among children in Jordan. As such, it provides baseline data that can be used to inform policy and prevention strategies focused on reducing sexual violence among this vulnerable segment of the Jordanian population.

Tobacco smoking status and perception of health among a sample of Jordanian students.

Limited data are available from Jordan examining patterns of tobacco use among adolescents, or how use is related to health perceptions. This study aims to estimate the prevalence of tobacco use and to assess the relationship between use and health-related perceptions. A cross-sectional survey was conducted among a sample of 11-18 year old school students from a major governorate in Jordan. Using a multistage random sampling 1050 students were selected. Students were categorized as non-smokers, cigarette-only smokers, waterpipe-only smokers, or dual smokers. Rates of waterpipe-only and cigarette-only smoking were 7% and 3%, respectively, and were similar for boys and girls. In contrast, the rate of dual use was much higher than for single product use and was double in girls compared to boys (34% vs. 17%). Dual-smokers were significantly more likely to think that it is safe to smoke as long as the person intends to quit within two years compared to non-smokers, and had lower self-rated health status than other groups. This is the first study among Arab adolescents to document high rates of dual tobacco use, especially pronounced among girls. The study findings have significant implications for designing tobacco smoking prevention programs for school health settings.

Zizyphus jujuba protects against ibuprofen-induced nephrotoxicity in rats.

CONTEXT: Zizyphus jujuba Mill. (Rhamnaceae) has long been used for the treatment of anxiety and insomnia in Chinese traditional medicine. The edible part is the fruit. Different parts of Z. jujuba possess medicinal properties such as anti-inflammatory, anticancer and antifertility. OBJECTIVES: This study evaluated the therapeutic effect of Z. jujuba fruit aqueous extract (ZE) on nephrotoxicity induced by ibuprofen (IBP) in rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were grouped as normal saline (control), ZE (500 mg/kg), IBP (400 mg/kg) and ZE + IBP-treated groups. After five days of oral administration, rats were sacrificed. The protective effect of ZE was evaluated by measuring kidney biomarkers, and histopathological changes of kidney were observed. Kidney antioxidant enzymes such as superoxide dismutase, catalase (CAT), glutathione S-transferase (GST) and lipid peroxidase were investigated. RESULTS: Administration of IBP resulted in a significant increase in urea and creatinine (p < 0.05) and a significant decrease in albumin and total protein (p < 0.05). Damage in glomeruli and proximal convoluted tubules was observed. IBP also increased CAT (p < 0.05) and GST (p < 0.001) activities compared to the control group. Administration of ZE with IBP significantly decreased serum urea and creatinine (p < 0.05) and reduced the severity of kidney damage. There was also a significant increase in the activities of CAT (p < 0.05) and GST (p < 0.001). DISCUSSION AND CONCLUSION: These results indicated that Z. jujuba aqueous extract could have a therapeutic role in reducing nephrotoxicity induced by ibuprofen.

Mushroom poisoning: a case report from Jordan.

An eight years male child with his family ate fresh mushroom at lunch time from back garden at their home in a village in the North of Jordan. By the evening approximately six hours later all started feeling nausea, abdominal cramps and vomiting they rushed to nearest primary health care center. After getting general medical medication they were transfer to a referral hospital at city of Irbid. The boy got deteriorated with diarrhea in addition to the previous gastrointestinal complains and died on third day. The message from this case is to ascertain in the public opinion that unknown type of mushroom even eaten previously could be poisonous and fetal.

Screening for domestic violence in Jordan: validation of an Arabic version of a domestic violence against women questionnaire.

OBJECTIVES: Abuse against women causes a great deal of suffering for the victims and is a major public health problem. Measuring lifetime abuse is a complicated task; the various methods that are used to measure abuse can cause wide variations in the reported occurrences of abuse. Furthermore, the estimated prevalence of abuse also depends on how abuse is culturally defined. Researchers currently lack a validated Arabic language instrument that is also culturally tailored to Arab and Middle Eastern populations. Therefore, it is important to develop and evaluate psychometric properties of an Arabic language version of the newly developed NorVold Domestic Abuse Questionnaire (NORAQ). DESIGN AND METHODS: The five core elements of the NORAQ (emotional abuse, physical abuse, sexual abuse, current suffering of the abuse, and communication of the history of abuse to the general practitioner) were translated into Arabic, translated back into English, and pilot tested to ensure cultural sensitivity and appropriateness for adult women in the Eastern Mediterranean region. Participants were recruited from the Jordanian Ministry of Health-Maternal and Child Health Care Centers in two large cities in Jordan. RESULTS: A self administered NORAQ was completed by 175 women who had attended the centers. The order of factors was almost identical to the original English and Swedish languages questionnaire constructs. The forced 3-factor solution explained 64.25% of the variance in the measure. The alpha reliability coefficients were 0.75 for the total scale and ranged from 0.75 to 0.77 for the subscales. In terms of the prevalence of lifetime abuse, 39% of women reported emotional abuse, 30% physical abuse, and 6% sexual abuse. CONCLUSION: The Arabic version of the NORAQ has demonstrated initial reliability and validity. It is a cost-effective means for screening incidence and prevalence of lifetime domestic abuse against women in Jordan, and it may be applicable to other Middle East countries.

Knowledge of substance abuse among high school students in Jordan.

OBJECTIVES: The purpose a descriptive design was employed using a self-administrated questionnaire to collect the data from 400 high school students. METHODS: A multistage, random sample was generated in selecting schools from the educational directorate located in a large urban city located in the north of Jordan. This city district contains 23 public secondary schools and serves 56.8% of the adolescents in the entire province. RESULTS: The results revealed the following: Students of both sexes were knowledgeable about aspects of substance abuse, including its harmful effects on the body and society and reported that even occasional or frequent use of cigarettes, alcohol, and other drugs was extremely harmful. A majority of the students perceived substance abuse as a problem, although the older students were more acutely aware than the younger group. However, the results revealed that the students lack in-depth knowledge of substance abuse. In addition, the adolescents consistently refer to Islamic principles forbidding use of intoxicants but mistakenly presume that mosques are sources for assistance regarding substance abuse. CONCLUSIONS: Policy makers, health workers, and religious leaders must collaborate to build structured educational programs and readily accessible, evidence-based treatment programs for adolescents. Given that young people constitute the majority of the Jordanian population and that drug trafficking is prevalent in the region, the implications of prevention programs are critical to maintaining gains in public health outcomes as well as economic progress and development in Jordan.

Firearm fatalities in Dammam, Saudi Arabia.

This paper provides a database representing injury mortality in Dammam, Saudi Arabia, with the aim of establishing a system which will record information about the incidence of such deaths, identify new trends and give priority to violence prevention. The retrospective study was carried out on 64 fatalities from gunfire injuries at the Forensic Medicine Centre in Dammam, Saudi Arabia during the period from January 2002 - December 2006. The deaths included 55 cases of homicide, seven cases of suicide and two accidental shootings. Twenty-six victims were aged between 16-30 years and 24 victims were between 31-45 years. Fifty-nine of the cases were male. A handgun was the weapon used in 49 cases. The most common sites for the firearm entrance wounds were the head (45 cases) and the chest (35 cases). In the majority of cases (56.3%) a single shot was fired while in 15.6% of cases there were two shots. In 51.5% of cases no bullet was recovered from the body while a single bullet was recovered in 31.5% and two bullets in 6.2% of the cases. Distant range fire was observed in 65.6% of cases. Exit wounds were found on the head in 36.7% and on the chest in 28.7% of cases. The majority of victims were young males living in urban areas. This result should help in forming a strategy to improve the livelihoods of this group. The low incidence of alcohol abuse (one case, 1.56%) and only three cases (4.68%) of amphetamine abuse is significant.

A study of wound fatalities in the north of Jordan.

The aim of the present study is to analyze the epidemiological and demographic features of sharp wound fatalities. A retrospective study was carried out of 58 fatalities from injuries induced by the use of sharp objects which were sent to the Forensic Medicine Teaching Centre of North Jordan--affiliated to Jordan University of Science and Technology--for the period January 1989 to December 2000. Results showed that the majority of cases (46-79.31%) were young people, below 30 years of age. Forty-six cases were male (79.31%) and 12 (20.69%) were female. The 58 cases sustained 182 injuries. The trunk sustained the maximum number of injuries 145 (79.63%). Sharp wound fatalities showed a slight variation over the 12-year study period and rose twice, in 1991 and 2000. Forty four cases (75.86%) were urban residents. Thirty-seven (63.79%) cases occurred during the warmer months of the year. Most cases were murder 47 (81.03%) and 51 (88%) victims died from acute haemorrhagic shock. Forty-three (74.14%) cases died before receiving any treatment. None of the 58 victims had used alcohol or drugs. One victim was a Syrian labourer. Cases of sharp wound fatality were more or less stable with two peaks in 1991 and 2000. As in other parts of the world, most victims were young males living in urban areas under stressful conditions. Socio-cultural factors have reduced the frequency of fatalities.

Drug poisoning in childhood.

OBJECTIVES: To determine and present the pattern of poisoning with drugs in Princess Rahmat Hospital, Irbid, Jordan, and to assess the effects of variables such as age, season, gender and agent on poisoning frequency. METHODS: We performed this retrospective cross-sectional study on 126 cases of poisoning with drugs hospitalized in Princess Rahmat Teaching Hospital, Northern Jordan, during a 6-year period from 1996 to 2001. The data collected included: age, gender, seasonal variation, material ingested, symptomatic or not on admission, time and place of ingestion, history of similar problem among the patient or his siblings, whether the parent induced vomiting before seeking medical help or not and the outcome regarding mortality and morbidity. We considered chi-square and values for the statistical analysis. RESULTS: There were 126 children (<12 years of age) admitted during the study period. Among the children, 54 (42.9%) were girls and 72 (57.1%) were boys. The majority (89.7%) was <6 years. There were seasonal variations of poisoning events with a higher frequency in the Spring (39%) and in Summer (35%). We considered severity mild in 60%, moderate in 27% and severe in 13% of cases. The large majority of drugs were psychotropic agents (56%) and principally diazepam's (39%). Self-poisonings were the most frequent cause of poisonings among children <12 years of age (mostly accidental poisonings such as drug poisonings). None of the children died or had a permanent sequel. CONCLUSION: Although we recorded no deaths in this study, drug poisoning in children remains a frequent problem, highlighting the need to develop an education program on primary prevention in our region. Parental education and intensified child supervision are the indicated measures of prevention for unintentional poisoning.

Kerosene poisoning in childhood: a 6-year prospective study at the Princess Rahmat Teaching Hospital.

PURPOSE: Poisoning due to drugs is influenced to a large extent by the population's socioeconomic and cultural status. The purpose of our study was to determine and present the pattern of poisoning with kerosene in Princess Rahmat hospital, Irbid, Jordan, and to assess the effects of variables such as age, season, sex and agent on poisoning frequency in Princess Rahmat hospital, northern Jordan. METHODS: This retrospective cross-sectional study was performed on 122 cases of poisoning with kerosene who were hospitalized in Princess Rahmat hospital, northern Jordan, during a six-year period from 1996 to 2001. The data collected include: age, sex, seasonal variation, material ingested, symptomatic or not on admission, time and place of ingestion, history of similar problem among the patient or his siblings, whether vomiting was induced by the parent before seeking medical help or not and the outcome regarding mortality and morbidity. Chi-square and values were considered for the statistical analysis. RESULTS: In a 6-year prospective study of kerosene poisoning in children admitted to the Rahmat Hospital, between January 1996 and December 2001, a total of 122 children (under 11 years of age). Among the children 48 (39.3%) were girls and 74 (60.6%) were boys. Majority (80.1%) were below 2 years. The largest group of patients was admitted during the summer months. The most commonly observed symptoms were cough (67.2%), tachypnea (56.5%), fever (54.1%), and vomiting (27.8%). About one third of the patients showed signs of central nervous system (CNS) impairment, including drowsiness, restlessness, stupor, and convulsions. CONCLUSIONS: 1) There is a higher risk of kerosene poisoning during the hot months of the year; 2) the respiratory system is the main target organ affected; 3) pneumonia is in most cases interstitial and bilateral; 4) vomiting after hydrocarbon ingestion is related to the rate of development of pneumonia; 5) symptoms of CNS impairment were correlated with hypoxemia, pneumonia, and fever; and 6) CNS toxicity may occur without hypoxemia, concurrent pulmonary pathology, or other pathology.

P53 and heat shock protein 70 expressions in colorectal adenocarcinoma.

OBJECTIVE: To examine the localization and over expression of heat shock protein 70 (HSP70) and p53 in patients with colorectal cancer and compared it with control tissue (including normal colon tissue). METHODS: This was a retrospective study of 60 patients with colorectal adenocarcinoma at the Jordan University of Science and Technology (JUST), Irbid, Jordan from 1997 to 2000. The Pathology Department at JUST is the chief provider of surgical pathology services in the north of Jordan. It receives specimens from both government and private hospitals. Immunohistochemistry was the technique of choice. RESULTS: The HSP70 was over expressed more highly in colorectal cancers than in the control tissue. Immuno-histochemistry showed that over expression of HSP70 had no statistically significant difference with any of the different prognostic factors assessed, mainly the grade and the stage. The p53 was over expressed in 60% of the cases. Control tissue (normal colon) was negative, p53, cell-cycle-related oncogene product, was strongly over expressed in the nuclei of the cancer cells of the cancer tissue. We found no significant difference in terms of size, patient age, lymph node state, and stage. The rate of expression was significantly less in high grade tumors than in intermediate and low grade ones. CONCLUSION: The strong expression however, may be valuable in estimating a prognosis for patients with colo-rectal carcinoma.

Effect of fasting during the month of Ramadan on serum levels of luteinizing hormone and testosterone in people living in the below sea level environment in the Jordan Valley.

OBJECTIVES: To study a possible effect of Ramadan fasting on luteinizing hormone and testosterone in people of the Jordan Valley. METHODS: A comparative study (n=40) of serum levels of luteinizing hormone (LH) and testosterone (T) between people living in the Jordan Valley (JV), n=20, 360 meters below sea level, and those living in Ramtha City (RC), n=20, 600 meters above sea level, was conducted in December, 1998. A similar study (n=40) was also done during January 1999 in fasting people during the month of Ramadan. RESULTS: Serum levels of LH in non-fasting people of the JV were statistically similar to those in people of RC. There was also no difference in serum levels of T between non-fasting people of the JV and those in RC. Serum levels of LH in fasting people of the JV were statistically indifferent from those fasting in RC. Serum T levels in fasting people of the JV, on the other hand, were higher than those in fasting people of RC (76+/-18.3 ng/ml compared to 62.7+/-24.2 ng/ml). CONCLUSIONS: It is probably the environmental factors such as the higher barometric pressure of the JV compared to that at above sea level that play a role in higher serum levels of T in people of the JV. Other factors, such as genetic background and/or the cultural and nutritional characteristics of the people of the JV, may also contribute to this difference in serum T levels.