CRHR1 polymorphism at rs242941, rs242940, and rs72834580: association of symptoms improvement with intranasal corticosteroids in allergic rhinitis Jordanian patients.

OBJECTIVES: Rhinitis is classified into several types with allergic rhinitis (AR) being the most common. AR is among the inflammatory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), in which corticosteroids are administered to overcome the decrease in cortisol production. The treatment options available for AR vary with 1st line treatment being intranasal corticosteroids (INCS). The responsiveness to corticosteroids is due to their binding to corticotropin-releasing hormone receptor-1 (CRHR1). Various studies have studied the responsiveness to corticosteroids treatment in patients with asthma and COPD in association with CRHR1 gene single nucleotide polymorphisms (SNPs). METHODS: In our study, we investigated the association of three SNPs of CRHR1 gene (rs242941, rs242940, and rs72834580) with symptoms improvement post-treatment in AR patients. Blood samples were collected from 103 patients for DNA extraction and gene sequencing. Those patients started to receive INCS for 8 weeks and their symptoms were assessed, through a questionnaire, before treatment and post-treatment to check for symptoms improvement. RESULTS: Our data showed that improvement of eye redness is significantly less following INCS treatment in patients with allele (C) (AOR=0.289, p-value-0.028, 95 % CI=0.096-0.873) and genotype (CC) (AOR=0.048, p-value-0.037, 95 % CI=0.003-0.832) of rs242941 SNP. There was no correlation with other genotypes, alleles, or haplotypes of the investigated SNPs. CONCLUSIONS: Our findings show that there is no correlation between CRHR1 gene polymorphism and symptoms improvement following INCS treatment. Further studies are required to evaluate the association of INCS and symptoms improvement post-treatment with larger sample size.

Association between Gasdermin A, Gasdermin B Polymorphisms and Allergic Rhinitis Amongst Jordanians.

BACKGROUND: Gasdermin A (GSDMA) and Gasdermin B (GSDMB) have been associated with childhood and to a lesser extent with adult asthma in many populations. In this study, we investigate whether there is an association between GSDMA (rs7212938, T/G) and GSDMB (rs7216389, T/C) at locus 17q21.2 and risk of Allergic Rhinitis among Jordanians. Also, we aimed to determine if there is an association between such polymorphisms and the IgE level. METHODS: The study included 112 rhinitis patients and 111 Healthy controls. Gasdermin A (GSDMA) (rs7212938, T/G) and Gasdermin B (rs7216389, T/C) polymorphisms were genotyped using the PCRRFLP method. RESULTS: On the genotype level, three analysis models were applied namely co-dominant, dominant and recessive genotypes. GSDMB CC genotype was found to have a significant protective effect against allergic Rhinitis (< 0.05). cc genotype was also significantly associated with higher IgE level among the studied population. CONCLUSION: The GSDMB CC of homozygous minor genotype showed a protective effect against Allergic rhinitis. It also was found to be significantly associated with lower IgE level among the studied population. No association was found between GSDMA with the risk of allergic Rhinitis.

An intronic single-nucleotide polymorphism (rs13217795) in FOXO3 is associated with asthma and allergic rhinitis: a case-case-control study.

BACKGROUND: Asthma and allergic rhinitis are respiratory diseases with a significant global burden. Forkhead box O3 (FOXO3) is a gene involved in the etiology of a number of respiratory diseases. The objective of this study is to assess the association of rs13217795, an intronic FOXO3 single-nucleotide polymorphism, with asthma and allergic rhinitis. METHODS: In this case-case-control genetic association study, genotyping was conducted using the PCR-RFLP method. Genotype-based associations were investigated under the general, recessive, and dominant models of disease penetrance using binomial logistic regression; and, allele-based associations were tested using Pearson's chi-squared test. RESULTS: The final study population consisted of 94 controls, 124 asthmatics, and 110 allergic rhinitis patients. The general and recessive models of disease penetrance were statistically significant for both case-control comparisons. Under the general model, the odds of the asthma phenotype were 1.46 (0.64 to 3.34) and 3.42 (1.37 to 8.57) times higher in heterozygotes and derived allele homozygotes, respectively, compared to ancestral allele homozygotes. The corresponding odds ratios for the allergic rhinitis phenotype were 1.05 (0.46 to 2.40) and 2.35 (0.96 to 5.73), respectively. The dominant model of disease penetrance was not statistically significant. The minor allele in all study groups was the ancestral allele, with a frequency of 0.49 in controls. There was no deviation from Hardy-Weinberg equilibrium in controls. Both case-control allele-based associations were statistically significant. CONCLUSIONS: Herein we present the first report of the association between rs13217795 and allergic rhinitis, and the first independent verification of the association between rs13217795 and asthma. Marker selection in future genetic association studies of asthma and allergic rhinitis should include functional polymorphisms in linkage disequilibrium with rs13217795.

Association Between Gasdermin A and Gasdermin B Polymorphisms and Susceptibility to Adult and Childhood Asthma Among Jordanians.

INTRODUCTION: Gasdermin A (GSDMA) and gasdermin B (GSDMB) have been associated with childhood, and to a lesser extent with adult, asthma in many populations. AIMS: In this study, we investigated the association between GSDMA and GSDMB variants and the incidence of adult and childhood asthma among Jordanians. METHODS: Subjects were divided into two groups: adults and children. Within the adult group there were 129 asthma patients and 111 healthy controls. In the pediatric group there were 98 asthma patients and 112 healthy children. Gasdermin A (GSDMA) (rs7212938, T/G) and Gasdermin B (rs7216389, T/C) polymorphisms were genotyped using the PCR-RFLP method. Three analysis models were applied to the genotype data: co-dominant, dominant and recessive. RESULTS: An association between the GSDMB T/C single nucleotide polymorphism (SNP) genotype and the incidence of childhood asthma was found (< 0.05). GSDMB T/C SNP in children also showed a very high tendency toward significance with p = 0.0532 in the single locus analysis. In adults, no significant differences in the allelic frequencies of any of the SNPs analyzed were found between the case and control populations. At the haplotype level, GC haplotype was found to be associated with the risk of asthma in children while none of the tested haplotypes were found to be associated with asthma risk in adults. CONCLUSIONS: The findings of this study confirm the previously reported association between the GSDMB gene and the risk of childhood asthma.

Association between ADAM33 polymorphisms and susceptibility with adult and childhood asthma among Jordanians.

Disintegrin and metalloprotease 33 (ADAM33) have been associated with childhood and adult asthma in many populations. ADAM33 mutations might predispose to altered lung function in early infancy. In this study, we investigated the association between single-nucleotide polymorphisms in ADAM33 and the incidence of adult and childhood asthma among Jordanians. One hundred seven pediatric asthmatic patients, 115 healthy pediatric patient controls, 160 adult asthmatic patients, and 110 healthy adults were enrolled in this study. ADAM33 polymorphisms were genotyped using the polymerase chain reaction/restriction fragment length polymorphism method. A strong association between the V4 genotype and incidence of childhood asthma was found. In the single-locus analyses of asthma risk, V4 C/G single nucleotide polymorphism (SNP) showed a trend toward significance with p=0.07. Interestingly, the CC homozygous mutant genotype frequency was significantly higher in asthmatic subjects (15.9%) than in control subjects (2.6%), resulting in an odds ratio of 7.05. In adult cases, S2, the F+1 and Q-1 genotype showed a significant association (p≤0.05) with the incidence of asthma. Two haplotypes also exhibited a significant association with asthma (p≤0.05). In conclusion, the findings of this study confirm the already reported association between V4 SNP and the incidence of childhood asthma as well as between S2, F+1, and Q-1 SNPs and the incidence of adult asthma in several populations.

Surgical Treatment of Otosclerosis: Eight years' Experience at the Jordan University Hospital.

INTRODUCTION: To report the experience of the Jordan University Hospital with respect to the surgical treatment of otosclerosis and to compare results and complications with published studies. MATERIALS AND METHODS: The medical records of all patients who underwent stapes surgery for otosclerosis at the Jordan University Hospital during the period January 2003 to December 2010 were reviewed. RESULTS: Out of 130 patients who underwent stapes surgery, 104 (80%) fulfilled the criteria and were enrolled in this study. There were 68 (65.4%) females and 36 (34.6%) males (female-to-male ratio, 1.9: 1). The disease was bilateral in 86 (82.7%) patients. Family history for otosclerosis was positive in 37(35.6%) patients. Tinnitus was observed at presentation in 82 (78.8%) patients and spontaneously resolved or improved in 51(62.2%) patients after surgery. Air bone gap after surgery was ≤ 10 dB in 79 (76.0%) patients, between 10 and 20 dB in 10 (9.6%) patients, and between 20 and 30 dB in four (3.8%) patients. Complications occurred in 17(16.3%) patients, which included: one (1.0%) deaf ear, two (2.0%) sensorineural hearing loss, two (2.0%) facial nerve palsy, six (5.8%) vertigo lasting more than 7 days, three (2.9%) chorda tympani damage, one (1.0%) floating of footplate, and two (2.0%) perforation of the tympanic membrane. CONCLUSION: The results of this study are comparable with those reported in the literature by surgeons with the same level of experience, but below than those with large series experience. Therefore, we believe that an experienced general ear, nose, and throat (ENT) surgeon can perform stapes surgery safely and successfully in the absence of an otologist.

Frequency of genetic polymorphisms of ADAM33 and their association with allergic rhinitis among Jordanians.

Allergic rhinitis is a chronic inflammatory disease that is assumed to be due to an interaction between different genetic and/or environmental factors. A disintegrin and metalloprotease domain 33 (ADAM33) has been extensively studied as a susceptibility gene in asthma and has been linked to bronchial hyper-responsiveness. In this study, we investigated the association between ADAM33 single nucleotide polymorphisms and the incidence of allergic rhinitis among the Jordanian population. We conducted a case-control association study on 120 adult individuals diagnosed with allergic rhinitis and 128 normal healthy controls. 8 single-nucleotide polymorphisms in ADAM33 were genotyped using PCR-RFLP method. No significant differences in the allelic frequencies of all SNPs tested between AR patients and the control volunteers were found, although S2 C/G SNP showed a tendency toward significance with P=0.06. On the genotype level significant association were found in the following genotypes: T1 AA, T1 AG, T2 GG, T2 AG, T+1 GG, T+1 AG, V4 CG, S2 CC, S2 CG, Q-1AA. Seven haplotypes were present only within AR patients and eight haplotypes were completely absent from the AR patients. Three haplotypes exhibited significant association with AR P ≤ 0.05, two of them were present only in AR patients. In conclusion, the polymorphisms in the ADAM33 gene are associated with susceptibility to AR in the Jordanian population. Furthermore, the haplotype of the tested SNPs were also associated with the risk of AR.

Antibiotics do not reduce post-tonsillectomy morbidity in children.

The objectives are to assess the efficacy of antibiotics in reducing post-tonsillectomy morbidities in children. This is a clinical trial study that was undertaken at the Jordan University Hospital during the period from June 2008 to July 2009. All patients undergoing tonsillectomy were randomly divided into two matched groups on alternating basis: group A included patients who received antibiotics (amoxicillin with clavulanic acid) for 5 days in the post-tonsillectomy period and group B included patients who received none. The two groups were compared with respect to fever, secondary bleeding, throat pain, and the time to resume to normal diet. Bleeding was more common in group A (5.5 %) than in group B (2 %). The average duration of throat pain was 4.2 days in group A, while it was 3.9 days in group B. The average time to resume normal diet was 5.7 days in group A, whereas it was 5.3 days in group B. Fever was noted in 17 (31 %) patients from group A, while it was observed in 15 (30 %) patients from group B. The use of antibiotics in the post-tonsillectomy period does not reduce post-operative morbidity in children and therefore it is advised to use antibiotics on an individual basis rather than routinely for patients undergoing tonsillectomy.

Early vs. late tracheostomy for the ICU patients: Experience in a referral hospital.

OBJECTIVES: The aim of this study is to present our experience with elective surgical tracheostomy for intensive care unit (ICU) patients who needed prolonged translaryngeal intubation in order to evaluate the proper timing and advantages of early vs. late tracheostomy and to stress upon the risks associated with delayed tracheostomy. METHODS: Medical records of all patients, who underwent elective tracheostomy for prolonged intubation from September 2006 to August 2010 at Jordan University hospital, were reviewed. RESULTS: A total of 106 patients (74 males) were included; their age ranged from 2 months to 90 yr with mean age of 46.5 yr. The mean time at which tracheostomy was done after initial tracheal intubation was 23 days (range 3-7 weeks). Trauma was the most frequent cause of ICU admission 38 (35.8%), followed by post-surgery causes 14 (13.2%). An early tracheostomy showed less complication vs late procedure. The length of stay in the ICU for patients who had an early tracheostomy was 26 days while this period for patients who had late tracheostomy was 47 days. Mortality rate among patients who had early tracheostomy was 17.1% while for late tracheostomy patients, it was 36.1%. CONCLUSION: Proper assessment and early tracheostomy is recommended for patients who require prolonged tracheal intubation in the ICU.

Aspirated tracheobronchial foreign bodies: a Jordanian experience.

We conducted a descriptive study of 524 patients who had been suspected of having aspirated a foreign body and who had been evaluated at one of two major hospitals in Jordan from January 1993 through December 2003. A tracheobronchial foreign body was found in 386 of these patients (73.7%). Most of them (66.8%) were younger than 2 years, and the male-to-female ratio was 3 to 2. The mean duration between aspiration and diagnosis was 48 hours. The most common presenting symptoms were cough (90.4% of foreign-body-positive patients), diminished air entry (66.8%), and dyspnea (65.0%). The most frequently aspirated objects were seeds (35.4%), particularly watermelon seeds, nuts (26.8%), and vegetables (25.3%). The most common site of foreign-body impaction was the right bronchus (60.9%). Rigid bronchoscopy was used to remove the foreign body in all cases. The complication rate was 3.4%. Our experience with aspirated tracheobronchial foreign bodies in Jordan was not substantially different from that reported in other countries. The only difference was that the most frequently aspirated foreign body in our study was seeds.