Socio-demographic characteristics of adolescents with epilepsy in Northern Jordan.

OBJECTIVE: The main objectives of this study were to determine the socio-demographic characteristics of epilepsy, and to compare these results with findings of comparable studies from other parts of the world. METHOD: Initially, the target population of this study consisted of 116 patients with epilepsy randomly selected, over a 6-month period, from those patients attending the neurology clinic at Princess Basma Teaching Hospital (PBTH) in Northern Jordan. However, seven patients were dropped from the study and eight others refused to participate in the study. A semi-structured clinico-epidemiological questionnaire was used to investigate the most significant socio-demographic characteristics of this group of adolescent Jordanian patients with epilepsy such as age, sex, living status, family history, type of epilepsy, and some other special clinical investigations. To further evaluate the significance of a family history of epilepsy, the education attainment and employment in these patients with epilepsy were compared with a similar number of age, sex matched control cases obtained from patients attending the hospital for reasons other than epilepsy. RESULTS: Among the study population, the mean age at presentation was 19 years (SD+/-2.7); 54 were males 47 were females. Fifty three patients had a poor level of education because they had less than 10 years of formal education, 29 had an average level of education (10-12 years) of formal education, and 19 had achieved a higher level of education. Thirty patients were employed, 21 unemployed and 50 were students. Twelve patients were living alone and leading independent lives, 88 patients were living with parents and siblings. One male patient was married and living with his wife and children. A positive family history was present in first degree relatives in 11 patients as compared to 3 in the control group. Ninety eight patients suffered from generalized epilepsy and three from partial epilepsy. Sixty seven patients reported an aura and 84 patients had post ictal complaints such as sleepiness, headache, or drowsiness. CONCLUSION: Socio-demographic characteristics of this group of adolescents with epilepsy are compatible with the results of the work of others such as Elwes [Neurosurg Psychiatr 54 (1991) 200], in the North East of England and Hauser from the Mayo clinic in his descriptive study of the epidemiology of epilepsy.

Symptoms of anxiety and depression among adolescents with seizures in Irbid, Northern Jordan.

In Jordan, individuals with epilepsy commonly attend neuropsychiatric clinics. The objective of this study was to assess the psychosocial outcome of epilepsy among adolescents. The study included 101 epileptic adolescents who attended the neurology clinic at the Princess Basma Teaching Hospital in Northern Jordan and 101 non-epileptic controls. Sociodemographic characteristics and all relevant clinical data were collected through interviewing the cases and controls. Identification of the symptoms of anxiety and depression was made according to DSM-IV criteria. The patients were age and sex matched with the controls. The controls had achieved a significantly better education (> 12 years education) than the patients with epilepsy. The adolescents with epilepsy were also shown to be disadvantaged in their living circumstances. Some of them were dependent on their parents in some daily physical activities, such as bathing, which might be a sign of overprotection by their parents. Those with epilepsy had a significantly higher tendency to develop symptoms of anxiety and depression than the control group. Moreover these psychiatric symptoms, especially anxiety symptoms, were more likely to happen when seizures had not been properly medically controlled. Overprotective parental behaviour towards their ill children could also delay their psychosocial maturation. Therefore, counselling of patients and parents about epilepsy is an important factor in the control of seizures and their sequelae.

Characterization of mutations that allow p-aminobenzoyl-glutamate utilization by Escherichia coli.

An Escherichia coli strain deficient in p-aminobenzoate synthesis was mutagenized, and derivatives were selected for growth on folic acid. Supplementation was shown to be due to p-aminobenzoyl-glutamate present as a breakdown product in commercial folic acid preparations. Two classes of mutations characterized by the minimum concentration of p-aminobenzoyl-glutamate that could support growth were obtained. Both classes of mutations were genetically and physically mapped to about 30 min on the E. coli chromosome. A cloned wild-type gene from this region, abgT (formerly ydaH) could confer a similar p-aminobenzoyl-glutamate utilization phenotype on the parental strain. Interruption of abgT on the plasmid or on the chromosome of the mutant strain resulted in a loss of the phenotype. abgT was the third gene in an apparent operon containing abgA, abgB, abgT, and possibly ogt and might be regulated by a divergently transcribed LysR-type regulator encoded by abgR. Two different single-base-pair mutations that gave rise to the p-aminobenzoyl-glutamate utilization phenotype lay in the abgR-abgA intercistronic region and appeared to allow the expression of abgT. The second class of mutation was due to a tandem duplication of abgB and abgT fused to fnr. The abgA and abgB gene products were homologous to one another and to a family of aminoacyl aminohydrolases. p-Aminobenzoyl-glutamate hydrolysis could be detected in extracts from several of the mutant strains, but intact abgA and abgB were not essential for p-aminobenzoyl-glutamate utilization when abgT was supplied in trans.

THF gamma 2 stimulates cytokine release by peripheral blood mononuclear cells of patients with chronic hepatitis B virus infection.

A recent study indicated that thymic hormones have antiviral effects in human hepatitis B virus infection and woodchuck hepatitis virus infection. These hormones are known to exert immunomodulatory effects on lymphocyte maturation and function; because these are abnormal in patients with chronic hepatitis B virus infection, we have examined the effects of a thymic hormone (THF gamma 2) on peripheral blood mononuclear cells from patients with chronic hepatitis B virus infection. THF gamma 2 (50 or 150 ng/ml) alone was without effect; in the presence of low doses of the mitogen phytohaemagglutinin, it had a broad effect in patients and controls. The effect on interleukin-2 production was greater in patients than controls with a significant increase in production at 150 ng/ml for patients alone (p = 0.037). Tumour necrosis factor alpha production was enhanced in all patients and controls, with a greater effect seen at 150 ng/ml THF gamma 2 than 50 ng/ml. There was no effect on interferon gamma production or on the expression of membrane markers of T-cell activation. THF gamma 2 has substantial immunomodulatory activity in chronic hepatitis B virus carriers and in vivo assessment of THF gamma 2 in chronic hepatitis B virus is indicated.

Sputum tumour necrosis factor-alpha and leukotriene concentrations in cystic fibrosis.

It is postulated that a vigorous host inflammatory response in the cystic fibrosis lung contributes to lung injury. Tumour necrosis factor-alpha (TNF-alpha) may play a part in that process and in the generation of leukotrienes. Therefore, the relationships between sputum TNF-alpha, leukotriene concentration, and lung function abnormalities in 16 children with cystic fibrosis were investigated. Each subject provided sputum samples and performed spirometry. TNF-alpha was measured by enzyme linked immunosorbent assay; individual leukotrienes were separated using high performance liquid chromatography and quantified by radioimmunoassay. The geometric mean concentration of TNF-alpha was 129.7 pg/ml and 95% confidence interval 48.2 to 348.3. Mean (SEM) leukotriene B4 (LTB4) was 97.8 (22.9) pmol/g and total cysteinyl leukotrienes were 60.9 (14.8) pmol/g. Mean (SD) forced expiratory volume in one second (FEV1) of the group was 53 (15)% of predicted and forced vital capacity (FVC) was 65 (14)% of predicted. There was a significant positive correlation between TNF-alpha and both LTB4 and the total cysteinyl leukotriene sputum content. An inverse relationship existed between TNF-alpha and FEV1 and FVC. Moreover, a negative correlation was observed between sputum LTB4 and FEV1 and FVC. These results suggest that TNF-alpha and the leukotrienes may participate in the airways inflammation and airflow obstruction observed in cystic fibrosis subjects and support the hypothesis that TNF-alpha upregulates the 5-lipoxygenase pathway in vivo.