Neonatal mortality in Jordan: secondary analysis of Jordan Population and Family Health Survey (JPFHS) data

Objective: This study aimed to analyze the 2009 Jordan Population and Family Health Survey (JPFHS) data to determine the level, trend, and distribution of neonatal mortality (NNM) in Jordan and determine its associated factors.

Methods: Nationally representative data on NNM were extracted from the JPFHS data. Using multivariate analyses, the strength of associations between 12 clinical/sociodemographic variables and neonatal mortality were quantified after controlling for potential confounders.

Results: The weighted NNM rate for 2005–2009 period was 16 deaths per 1000 live births, with the early NNM rate and late NNM rates were 10 deaths per 1000 live births and six deaths per 1000 live births, respectively. Fluctuations of NNM according to year of birth and geographic variations were noted. Risk of NNM increased among male newborns, as mother’s education level decreased, in mothers 40–49 years old, in multiple gestations-low birth weight neonates, and as birth interval was <3 years.

Conclusions: The NNR rate for 2005–2009 period of 16 deaths per 1000 live births indicates that there are opportunities to decrease it. Risk factors of neonatal mortality with respect to predictors of death during first days of life and variables related to geographic variations require particular focus to improve the quality of obstetric and neonatal health services and to decrease neonatal mortality.     

Kawasaki disease with Glucose-6-Phosphate Dehydrogenase deficiency,case report

Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and children younger than 5 years of age. Coronary artery abnormalities are the most serious complication.Based on the literatures infusion of Intravenous Immunoglobulin of 2 g/kg and a high dose of oral aspirin up to 100 mg/kg/day are the standard treatment for Kawasaki disease in the acute stage, and should be followed by antiplatelet dose of aspirin for thrombocytosis. Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is an inherited X-linked hereditary disorder, and aspirin can induce hemolysis in patients with G6PD deficiency. We report a case of a 5 year and 8 month old male with KD and G6PD deficiency.     

Evaluation of Spironolactone Solid Dispersions Prepared by Co-Spray Drying With Soluplus® and Polyvinylpyrrolidone and Influence of Tableting on Drug Release

Solid dispersions of spironolactone with Soluplus^® and polyvinylpyrrolidone were prepared by spray drying according to a mixture experimental design and evaluated for moisture content, particle size, drug solubility, crystallinity (powder X-ray diffraction and differential scanning calorimetry), and physicochemical interactions (Fourier-transform infrared spectroscopy, Raman). In vitro dissolution was evaluated for the spray dried product itself and after compression into tablets, and prediction models were derived using multiple linear regression analysis. The spray dried products consisted of amorphous drug, indicated by the absence of crystalline powder X-ray diffraction peaks. Amorphization and interactions impacted changes in the Fourier-transform infrared spectroscopy spectra in the ranges 2900-3000 cm^?1 (C-H) and 1600-1800 cm^?1 (C=O) and caused merging at 1690 cm^?1 (C=O of lactone) and 1670 cm^?1 (C=O of thioacetyl group). In the Raman spectra, amorphization and interactions resulted in disappearance of peak at 1690 cm^?1 (C=O) and merging of peaks at 582 and 600 cm^?1 (C-S). Hydrogen bonding between the thioacetyl group of the drug with the hydroxyl groups of Soluplus^® caused marked suppression of the peak at 1190 cm^?1 (R-C(=O)-S vibration). Amorphization and interactions resulted in improved solubility and dissolution which was greatest for drug/Soluplus^® ratio 1:4 and was also demonstrated in the corresponding tablets.     

Single lead ST-segment recovery: a simple, reliable measure of successful fibrinolysis after acute myocardial infarction

Background

Successful reperfusion after acute ST-elevation myocardial infarction improves prognosis. Among the different electrocardiographic markers of reperfusion, sum ST resolution is considered the hallmark of reperfusion, but is cumbersome to use.

Methods

To assess the usefulness of a single lead ST resolution at 90 minutes after fibrinolysis compared with the sum ST resolution in predicting Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow, we used prospectively collected data from the Limitation of Myocardial Injury Following Thrombolysis in Acute Myocardial Infarction (LIMIT-AMI) study. All patients had electrocardiograms recorded at presentation and 90 minutes and a coronary angiogram 90 minutes after fibrinolysis.

Results

Infarction artery patency was assessed in 238 patients with 4 different ST resolution criteria: single lead ST resolution ≥50% and ≥70% and sum ST resolution ≥50% and ≥70%. The most sensitive criteria for TIMI grade 3 flow was single lead ST resolution ≥50% (sensitivity rate, 70%; specificity rate, 54%), whereas sum ST resolution ≥70% was most the specific criteria (sensitivity rate, 45%; specificity rate, 79%). The proportion of patients with TIMI grade 3 flow was similar in all 4 ST resolution groups (P = .84). Pre-discharge infarction size and ejection fraction were also similar. No single lead or sum lead measure of ST resolution was significantly associated with an increased risk of death, heart failure, or reinfarction.

Conclusion

We propose that single lead ST-resolution ≥50% as an optimal electrocardiographic indicator for successful reperfusion 90 minutes after fibrinolysis. This simple electrocardiographic measure should be combined with bedside clinical and hemodynamic assessment to optimize decision making after fibrinolysis.     

Volume of Resected Stomach as a Predictor of Excess Weight Loss After Sleeve Gastrectomy

Background

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of obesity. The objective of this study was to evaluate the volume of the resected stomach (VRS) as a predictor of the percentage of excess weight loss (%EWL) 1 year after LSG.

Methods

This was a single-surgeon study of prospectively collected data of patients who underwent LSG at Jordan University Hospital (February 2009 to February 2012). The VRS was measured using a standardized technique. The %EWL was calculated at 3, 6, and 12 months postoperatively. The correlation between the VRS and %EWL was statistically evaluated.

Results

Ninety patients underwent LSG during the study period. Of these, 73 patients (57 female) completed at least 1 year of follow-up and were analyzed; their body mass index was 45?±?7.6 kg/m² (33–81). The VRS was 1,337.4?±?435.2 ml (600–2,800). The %EWL was 33.6?±?11.1 % at 3 months, 48.6?±?15.5 % at 6 months, and 56.8?±?18.9 % at 12 months. A significant correlation was observed between the VRS and %EWL at 1 year (p?=?0.003). Patients with a VRS of >1,100 ml (n?=?43) achieved significantly greater %EWL at 12 months than did those with a VRS of ≤1,100 (n?=?30). Removal of >1,100 ml of gastric volume was associated with a sensitivity and specificity of 75.5 and 46.2 %, respectively, for achieving a %EWL of ≥50 %.

Conclusion

The VRS can be used as an indicator of excess weight loss 1 year after LSG.     

Face and brow presentation in northern Jordan, over a decade of experience

BACKGROUND: Malpresentation is a deviation from the normal presentation, which occurs in approximately 5% of labours (Seeds and Cefalo in Clin Obstet Gynaecol 25:145-156, 1982). The commonest form of malpresentation at delivery is breech presentation followed by face and brow presentation. OBJECTIVES: To review the incidence and management of face and brow presentation in north of Jordan. MATERIALS AND METHODS: This was a retrospective review of the experience of face and brow presentation deliveries in the two main civil hospitals in north of Jordan between 1995 and 2005. RESULTS: The incidence of face and brow presentation was 1 in 813 and 1 in 1,689 deliveries, respectively. There was no significant increase in the incidence of prematurity nor very low birth weight and no higher incidence of postmaturity among those delivered by face or brow in the same period. All the foetuses presenting by the brow and by face (mentoposterior) and only 16.7 % of foetuses presenting by face (mentoanterior) were delivered by caesarian section. CONCLUSION: The incidence of face and brow presentation was 1 in 813 and 1 in 1,689 deliveries, respectively. All the babies presenting by brow presentation did undergo caesarean section. The management of face and brow presentation is heading towards a safe delivery and not merely to accomplish vaginal delivery.     

Hypothalamic-pituitary-gonadal function in adolescent females with beta-thalassemia major.

OBJECTIVE: To evaluate the function of the hypothalamic-pituitary-gonadal axis in adolescent female patients with beta-thalassemia major. MATERIALS AND METHODS: A prospective study of the function of the hypothalamic-pituitary-gonadal axis function of 31 beta-thalassemia major females aged between 13 and 22 years and in 12 control females aged between 12 and 22 years. All were treated at Princess Rahma Teaching Hospital, Irbid, Northern Jordan between April 2001 and April 2003. RESULTS: Of the 31 beta-thalassemia major females, 13 (41.9%) had delayed puberty. Hypothalamic-pituitary-ovarian axis dysfunction was found in 15 patients (48.4%). Twelve patients (38.7%) had hypogonadotropic hypogonadism and 5 (16.1%) had ovarian failure. High levels of serum ferritin were significantly higher in patients with delayed puberty. CONCLUSION: Pituitary and ovarian dysfunction are common problems in beta-thalassemia major patients. The main possible cause is iron overload. This stresses the need for intensive and regular use of chelation therapy to prevent damage to the hypothalamic-pituitary-ovarian axis.