Acute rheumatic fever in Jordanian children.

Rheumatic fever remains a significant health problem in Jordan. We retrospectively reviewed medical charts of 28 boys and 22 girls (mean age at presentation 10.5 +/- 2.6 years) with confirmed diagnosis based on modified Jones criteria at Queen Alia Heart Institute from February 1999 to February 2002. Arthritis was the commonest major manifestation (88%; 68% migratory), carditis was second commonest (48%; 8% silent carditis) and chorea was seen in 6%. None had subcutaneous nodules or erythema marginatum. The mitral valve was most commonly affected (80%); both mitral and aortic valves were affected in 25%. Pericarditis was seen in 12.5% and acute congestive heart failure in 4%. Practitioners should be aware of diverse clinical presentations and emphasize strict adherence to prophylaxis guidelines.

Acute rheumatic fever in Jordanian children

Rheumatic fever remains a significant health problem in Jordan. We retrospectively reviewed medical charts of 28 boys and 22 girls [mean age at presentation 10.5 +/- 2.6 years] with confirmed diagnosis based on modified Jones criteria at Queen Alia Heart Institute from February 1999 to February 2002. Arthritis was the commonest major manifestation [88%; 68% migratory], carditis was second commonest [48%; 8% silent carditis] and chorea was seen in 6%. None had subcutaneous nodules or erythema marginatum. The mitral valve was most commonly affected [80%]; both mitral and aortic valves were affected in 25%. Pericarditis was seen in 12.5% and acute congestive heart failure in 4%. Practitioners should be aware of diverse clinical presentations and emphasize strict adherence to prophylaxis guidelines

Comparison of "direct" and "indirect" nuclear cystography in the diagnosis of vesicoureteric reflux.

This study was undertaken to compare "direct" and "indirect" nuclear cystography for the detection of vesicoureteral reflux (VUR). Forty-five children (15 males and 30 females), ranging in age from 5 months to 10 years, were studied at the King Hussein Medical Center, Amman, Jordan between January 1998 and December 1999, using both direct (catheter) and indirect techniques of nuclear cystography (NC). Of the 82 ureters that could be compared, 32 ureters were positive for VUR on the direct technique while only 20 ureters showed VUR on the indirect technique (sensitivity 62%). Nine ureters, which did not show VUR on the direct cystogram, were read as positive on the indirect cystogram (specificity 82%). The false positive results of indirect nuclear cystogram make it invalid for VUR screening program, while the ease of assessment and low radiation dose from the direct NC has made this the recommended test for screening and follow-up of VUR.

Adverse reactions of intravenous immunoglobulin.

OBJECTIVE: To study the frequency, type, and severity of adverse reactions to intravenous immunoglobulin infusions and possible preventable measures. METHODS: We prospectively studied the frequency, type, and severity of adverse reactions in 104 intravenous immunoglobulin infusions (IntraglobinTMF) given to 13 patients suffering from several immunodeficiency and autoimmune diseases over 15 months in King Hussein Medical Center. The severity of the reaction was classified as mild, moderate and severe. Transmission of infections such as human immunodeficiency virus, hepatitis B, and C was monitored. RESULTS: The total number of reactions documented was 16 out of 104 (14.5%) infusions and all resolved without medical aid. Excluding those reactions in which a predisposing factor was identified, the overall rate was 6%. CONCLUSION: This study has shown that the overall reaction rate in patients infused with intravenous immunoglobulin at hospital is low. However, establishment of specialized staff will decrease the adverse reactions considerably. We advise the care-taking staff to elicit the predisposing factors like infection and avoid infusion until antibiotics have been started for 24-48 hours. We found that strict application of manufacturer infusion protocols (IntraglobinTMF) will avoid reactions due to accelerating rate of infusion. Intravenous immunoglobulin is a useful life saving drug. It is safe if all precautions are taken into consideration.

Nephrocalcinosis and Bartter's Syndrome.

We report a case of a child with symptoms and signs of Bartter's syndrome and nephrocalcinosis. This report discusses the manifestations and management of this rare disease at a very early age.