Queen Rania Research Articles

Management and Outcome of Acute Appendicitis in Pediatrics; Our Experience at Queen Rania Al Abdullah Hospital for Children

Objectives: the purpose of our study was to report our experience at Queen Rania Al Abdullah Hospital for Children (QRHC) in the diagnosis and management of acute appendicitis regarding the outcome, complications and hospital stay. Method: A retrospective study was carried out at QRHC by reviewing the medical records of patients who were younger than 14 years that admitted to pediatric surgical ward in the period from Jan 2019 to Jan 2020 with a diagnosis of acute appendicitis. The study included 196 patients, 116 were males and 80 were females with a male to female ratio of 1.45:1. The ages of the patients ranged from 3 years to 14 years with the highest incidence between 10 -13 years. The duration of symptoms ranged from 8 hours to 1 week. The period of hospital stay ranged from 1 to 8 days with a median stay of 2 days. Results: all patients underwent appendectomy, 120 via open approach and 76 by laparoscopy with only 1.53% conversion rate to open (3 cases). 110 cases (56.1%) were non complicated appendicitis while the remaining 86 cases (43.9%) were complicated (perforated appendix), of those 20 cases were less than 5 years old. The rate of negative appendectomy (histopathological normal appendix) was 11.2% (22 cases). Fever was presented in 60 cases (30.6%) and leukocytosis was presented in 130 cases (66.3%).U/S was suggestive of acute appendicitis in 108 patients (55.1%) while the appendix was not visualized in the remaining 88 patients. CT scan was required in 40 patients (20.4%). The overall postoperative complications was 10.7% which occurred in 21 patients, 8 patients (4.1%) developed post-operative ileus , 6 patients (3.1%) complicated with wound infection, 4 cases (2%) developed intra-abdominal abscess and 3 patients (1.5%) had intestinal obstruction. Conclusion: Acute appendicitis is the commonest cause of abdominal surgical emergency in pediatrics and a common cause of misdiagnosed surgical emergency in children. Delayed diagnosis can result in ......

Ocular and Dental Causes of Headaches Among School-Age Children in Jordan: A Retrospective Study.

IntroductionHeadache disorders are becoming increasingly prevalent among the younger population. In this study, we aimed to explore the varying causes of headaches among school-age children in Jordan.MethodologyThis was a retrospective observational study conducted at the Queen Rania Hospital for Children between June 2019 and June 2020. All the data of the patients were extracted from the patient files with the permission of the administration. All children who were referred to the ophthalmology and dental clinic with headaches as the presenting complaint were included in the study. A detailed history was initially obtained regarding age, gender, medical history, as well as the duration and characteristics of headaches. The patients underwent detailed ocular examination including best-corrected visual acuity (BCVA) using the Snellen chart, anterior and posterior eye segment examination, and intraocular pressure measurement. Refraction under the effect of cyclopentolate was performed for all patients. A detailed dental and oral exam was performed on all children at the dental clinic by the same dentist.ResultsA total of 712 patients aged between five and 13 years (mean ± SD: 9.3 ± 2.86 years) presented with headaches during the study period. Headaches were more frequent in males [n=441 (61.9%)], but a slight female predominance was found among patients aged 11 years and older. At the ophthalmology clinic, 230 (32.3%) patients with headaches had positive findings; the majority of these patients [n=228 (32%)] had refractive errors with astigmatism as the most common type. Of note, 515 patients (72.3%) had dental caries with a Decayed, Missing, and Filled Permanent Teeth (DMFT) score ranging from 1.5 to 4.3.ConclusionRefractive errors, particularly astigmatism, were found at higher rates among children with headaches. Also, temporomandibular disorders were more prevalent among children with headaches, particularly those aged between 11 and 14 years. Routine ophthalmic and dental assessment is recommended for children presenting with chronic headaches.

Juvenile idiopathic arthritis in Jordan: single center experience

BackgroundJuvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders, including all forms of arthritis, which develops in children who are less than 16 years old. This study aimed to evaluate the clinical and laboratory features of JIA in a single center in Jordan.MethodsA retrospective analysis of the electronic medical records of Pediatric patients diagnosed with JIA based on the International League of Associations for Rheumatology (ILAR) criteria during the period from 2015 to 2019 at the Pediatric Rheumatology Clinic in the Queen Rania Children’s Hospital. All patients were below the age of 14 years at the time of diagnosis and followed for at least 6 months. Collected data consisted of age, gender, age at initial presentation and diagnosis, JIA subtype, laboratory data, treatment options, and outcome.ResultsA total of 210 patients were included in this cohort (94 males and 116 females) with the mean age at diagnosis and mean age at onset of 5.33 ± 3.40 years and 5.08 ± 3.40 years (range: 7 months – 14 years), respectively. Oligoarticular JIA was the commonest subtype (54.7%), followed by systemic arthritis (17.1%) and polyarticular arthritis (12.3%). ANA was positive in 70 patients (33.6%). Uveitis occurred in 30 (14.2%) patients.ConclusionTo the best of our knowledge, this study on this cohort is the first report on JIA in Jordan, in comparison with other regionally and internationally published reports. Oligoarticular JIA was found to be the most common subtype. For detailed knowledge on JIA characteristics and patterns, a population-based, rather than a single center study, should be conducted in Jordan.

Categories of the Patients Attending Metabolic Clinic, Queen Rania Al-Abdullah Children Hospital

Categories of the Patients Attending Metabolic Clinic, Queen Rania Al-Abdullah Children Hospital

Hematopoietic Stem Cell Transplantation During the Era of COVID-19 in Queen Rania Children's Hospital.

Background:Corona virus disease 2019 (COVID-19) is causing a health crisis nowadays, and all countries are following the recommendations of the WHO to decrease the spread of the disease. Till now, few data are available regarding the clinical course, severity of the disease and the duration of infectivity of COVID-19 in patients received Hematopoietic Stem Cell Transplantation (HSCT).Objective:To evaluate the medical protocols and outcome of patients who underwent HSCT during the pandemic of COVID-19.Methods:A retrospective review of the medical files of patients who underwent hematopoietic stem cell transplantation during the era of COVID-19. The following data were reviewed for all patients: age, gender, primary disease, viral screening protocols for donors and recipients, COVID-19 status and outcome. The European society for blood and marrow transplantation (EBMT) guidelines were applied strictly on all of our patients, donors and bone marrow transplant unit staff.Results:A total of 10 children were transplanted, 8 of them received allogenic transplant from matched donor and two patients received autologous transplant. Regarding allogenic transplants, all of our patients except two were transplanted as an emergency, 2 of them were Aplastic anemia, 2 patients were Fanconi anemia, one patient was Amegakaryocytic thrombocytopenia, and one patient was Acute myeloid leukemia. Only two patients were not an emergency as one of them had Thalassemia major and the other one was Sickle cell anemia. The autologous transplant was done for two patients with Neuroblastoma stage 4 as part of their treatment protocol. At a median follow up of 5.5 months (range, 2 month-7 months) two patients (20%) developed COVID-19, which was asymptomatic in both of them. One of our patients (10%) died due to cytomegalovirus (CMV) pneumonia. No one of our patient was affected by the emergency regulations applied by the country and hospitals during the pandemic of COVID-19 virus.Conclusion:Hematopoietic stem cell transplantation can be performed safely for emergency cases, if we strictly follow the guidelines of EBMT.

Discourses of defense: Self and other positioning in public responses to accusations of corruption in Jordan

Public accusations of corruption leveled against public figures and institutions in Jordan have recently become a prominent feature of public discourse in the country. Informed by positioning theory as an analytical framework, this study focuses on public responses to such accusations through a discourse analysis of two major apologetic statements, or apologiae, issued in Jordan in 2018 and 2019: one by a controversial former royal court chief and minister of planning in response to public accusations of corruption and appropriation of public funds, and the other by the Office of Queen Rania of Jordan in response to accusations of wardrobe extravagance and overspending. The analysis shows that these two apologiae employed discourses that not only positioned the accused as blameless, but also as victims of defamation. Reference to one’s history, such as public service to the nation and one’s accomplishments, was exploited. In contrast, the accusers were explicitly or implicitly positioned as unjust, biased, vindictive, or motivated by hidden agenda. A variety of discursive strategies were deployed, particularly invoking cultural moral orders, resorting to banal nationalism, expressing pride in one’s public service and allegiance to the monarchy, and invoking a constellation of religious, professional and national identities. In the case of the royal apologia, it was implicitly positioned in western discourses, such as invoking feminine ‘corporeal modernity’, to respond to the wardrobe overspending accusations.

Laparoscopic Splenectomy in Children: Safety of Ligasure Usage.

Introduction:Laparoscopic splenectomy started to be more popular and nowadays it is the first choice for splenectomy in children. The main advantages of laparoscopic splenectomy over open approach are the shorter hospital stay, low complications and the cosmetic results despite the main concern of long operative time and the intra operative bleeding. Aim:The aim of this study was to report our experience with laparoscopic splenectomy in children’s with hematological diseases using ligasure regarding vascular control safety, efficacy and complications rate.Methods:A retrospective study was carried out at Queen Rania Al-Abdullah Hospital for Children over the period from January 2017 to February 2019. Total number of 18 patients with hematological diseases underwent laparoscopic splenectomy using ligasure. Demographic data, complications and outcomes were collected to assess the advantages of ligasure usage for vascular control safety.Results:Out of 18 patients underwent laparoscopic splenectomy using ligasure (10 with spherocytosis, 4 with immune thrombocytopenic purpura [ITP], 3 with sickle cell anemia, 1 with hemangioma), from which number, 8 patients were males and 10 were females. Mean age was 6.7 years (ranges from 4.3 to13.7 years). Mean operative time was 107 minutes (ranges from 70-180 minutes). There was no conversion to open splenectomy and no mortality. Intra operative blood loss was insignificant.Conclusion:Laparoscopic splenectomy using ligature is safe with excellent results in decreasing operative time, less complications and decrease incidence of intraoperative bleeding.

Hematopoietic Stem Cell Transplantation in Thalassemia Patients: a Jordanian Single Centre Experience.

Introduction:Beta thalassemia major is the commonest inherited hematological disorder worldwide which needs lifelong sufficient supportive management. Hematopoietic stem Cell transplantation (HSCT) is the only curative treatment available till now.Aim:To evaluate the outcome of children who underwent allogenic hematopoietic stem Cell transplantation as a curative approach for Thalassemia Major, treated at Queen Rania AL- Abdullah children Hospital (QRCH)Methods:A retrospective review of the medical files was conducted for all children (< 15 years) who had thalassemia major and received HSCT between January, 2010 and January, 2019. The following variables were studied for all patients: age , gender, Pesaro classifications, the count of infused raw bone marrow stem cell (CD34), engraftment time, outcome and complications.Results:A total of 34 children were transplanted for thalassemia major, at an average of 4 cases per year. All underwent allogenic raw bone marrow transplantation from matched related donors. Thirteen patients (38.2%) were males and twenty one (61.2%) were females. The age ranged between 2 and 15 years, with a median age of 6.5 years. According to Pesaro classification, 31 patients were class 2 (91.2%) and 3 patients were class 3 (8.8%) while no single case met the criteria for class 1 Pesaro classification. The median CD34 count was 3.5 million/Kg of recipient weight (range, 1.5*106-7*106 /kg). The median time for neutrophil engraftment was 15.5 days. At a median follow up of 5 years (range 1- 9.5), 33 patients were alive. One patient died before 100 days post transplantation due to grade IV acute gastrointestinal Graft Versus Host Disease (GVHD). Three patients had secondary graft failure (8.8%). Six patients (17.5 %) developed mild grade 1-2 skin GVHD while another patient developed hemorrhagic cystitis due to BK virus and cytomegalovirus (CMV) which reactivated simultaneously, and was successfully managed.Conclusion:The outlook for Thalassemia major has dramatically changed after HSCT, with a considerable success in Jordan and results comparable to international data.

Acute Rejection after Pediatric Kidney Transplantation at Queen Rania Abdullah Hospital for Children, Jordan

Acute Rejection after Pediatric Kidney Transplantation at Queen Rania Abdullah Hospital for Children, Jordan

Effective Professional Development and Change in Practice: The Case of Queen Rania Teacher Academy Science Network

This study aimed at evaluating the impact of Queen Rania Teacher Academy science teachers professional development program’s activities on teachers’ instructional practices by identifying the successes, challenge and ways to sustain the exemplary reformed instructional practices in the science classroom. The idea is to analyze participating science teachers’ reflections on a three-year journey of continuous professional development. Qualitative data collected in the form of participants’ self-reflection and field notes from 18 male and female participating science teachers. Findings indicate that even with effective professional development, science teachers encounter diverse challenges to implement the reformed instructional practices in the classroom. Teachers need support, time and resources to succeed in implementing what they learned in their classrooms. Findings also revealed that professional development efforts need to reveal and address existing teachers’ beliefs in order to be successful. Implications for future science continuous professional development efforts are discussed.

Effects of GRM4, SCN2A and SCN3B polymorphisms on antiepileptic drugs responsiveness and epilepsy susceptibility

BackgroundPharmacotherapy of epilepsy including antiepileptic drugs (AEDs) is one of the main treatment approaches. As a biological target, sodium channels (Nav channels) and glutamate receptor genes are playing a major role in the etiology and treatment of epilepsy. ObjectiveThis study aims to investigate the genetic associations of certain genetic polymorphisms with increased risk of epilepsy susceptibility and variability in response to AEDs treatment in a Jordanian Arab population. MethodA pharmacogenetics and case-control study on 296 unrelated epileptic Jordanian patients recruited from the pediatric neurology clinic at the Queen Rania Al-Abdullah Hospital (QRAH) in Amman, Jordan and 299 healthy individuals was conducted. Children up to 15 years old which receiving AEDs for at least three months were scanned for genetic association of 7 single nucleotide polymorphisms (SNPs) within three candidate genes (SCN2A, SCN3B and GRM4) with epilepsy susceptibility. ResultsSCN2A rs2304016 (P = 0.04) and GRM4 rs2499697 (P = 0.031) were statistically significant with generalized epilepsy. Haplotype of CAACG GRM4 was genetically associated with epilepsy and partial epilepsy (P = 0.036; P = 0.024, respectively). This study also found that TGTAA genetic haplotype formed within GRM4 gene was associated with generalized epilepsy susceptibility (P = 0.006). While, no significant linkage of SCN3B rs3851100 to either disease susceptibility or drug responsiveness was found. ConclusionThis study identified no significant associations of allelic or genotypic SNPs with the susceptibility of epilepsy and medication response with an exception of rs2304016 and rs2499697 SNPs that were associated with the generalized type of epilepsy among Jordanian population. Further studies are required in different populations to confirm our results and identify genetic factors that involved in susceptibility and treatment response.

Genotype Pattern of Pediatric Familial Mediterranean Fever in Jordan: A Single Center Experience

Background Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder caused by mutations in the MEFV gene. The disease is especially common among Mediterranean ancestry, mostly Armenian, Turkish, Jewish and Arab populations. We aimed to describe genotype pattern of FMF in the Jordanian children and to compare it with other populations. Materials and Methods A retrospective analysis of MEFV mutations in pediatric patients, who were below 14 years of age, diagnosed as FMF and followed up at Queen Rania Children’s Hospital in Jordan between 2014 and 2017. Results A total of 196 pediatric patients were diagnosed with FMF; 54% Females and 46% males. The mean age of patients was 7.8 ± 3.1 years; mean age at disease onset was 4.9 + 2.3 years old. MEFV gene mutations were homozygous in 47(24%) patients, heterozygous in 87(44.4%) patients, compound heterozygous in 55(28.1%), and negative genotype in 7(3.6%) patients. Five mutations were the most frequent; M694V, E148Q, M680I, M694I, respectively. Conclusion The five-founder FMF mutations were the most detected in Jordanian children but in different order than what had been reported.

Lactulose versus polyethylene glycol for disimpaction therapy in constipated children, a randomized controlled study.

Faecal disimpaction is very important for successful management of the constipation in children. Lactulose is cheap and widely available medicine compared to other polyethylene glycol (PEG) preparations. From our experience, lactulose is effective and safe medicine for both disimpaction and maintenance therapy in constipated children. The purpose of the present study was to evaluate the safety and efficacy of lactulose in faecal impaction management in children with constipation. We conducted a prospective controlled trial in children with functional constipation, who presented with faecal impaction to Queen Rania Hospital for Children from April 15, 2018 until October 15, 2018. Two randomised matched groups; group A included 33 constipated children treated for disimpaction with higher dose lactulose (10 g/15 ml) 4-6 ml/kg/day (max. 120 ml/day) and group B included 32 children treated for disimpaction with macrogol (PEG 4000) 1-1.5 g/kg (max. 30 g/day). Both groups received treatment until resolution or up to 6 days. Patients were followed over 1 week and success of disimpaction was observed. Moreover, any adverse events were recorded. All the patients in both groups achieved successful disimpaction by seventh day of the therapy, group B showed significant faster response. Both therapies were tolerated and no significant adverse events were reported. Both agents were safe, effective and well tolerated. Lactulose may be a good alternative to PEG in the treatment of faecal impaction in constipated children.

Non-Operative Management of Pediatric Blunt Abdominal Solid Organ Injuries : Our Experience at Queen Rania Al-Abdullah Hospital for Children

Non-Operative Management of Pediatric Blunt Abdominal Solid Organ Injuries : Our Experience at Queen Rania Al-Abdullah Hospital for Children

The Impact of Potassium Channel Gene Polymorphisms on Antiepileptic Drug Responsiveness in Arab Patients with Epilepsy.

This study aims to investigate the effects of the three potassium channel genes KCNA1, KCNA2, and KCNV2 on increased susceptibility to epilepsy as well as on responsiveness to antiepileptic drugs (AEDs). The pharmacogenetic and case-control cohort (n = 595) consisted of 296 epileptic patients and 299 healthy individuals. Epileptic patients were recruited from the Pediatric Neurology clinic at the Queen Rania Al Abdullah Hospital (QRAH) in Amman, Jordan. A custom platform array search for genetic association in Jordanian-Arab epileptic patients was undertaken. The MassARRAY system (iPLEX GOLD) was used to genotype seven single nucleotide polymorphisms (SNPs) within three candidate genes (KCNA1, KCNA2, and KCNV2). Only one SNP in KCNA2, rs3887820, showed significant association with increased risk of susceptibility to generalized myoclonic seizure (p-value < 0.001). Notably, the rs112561866 polymorphism of the KCNA1 gene was non-polymorphic, but no significant association was found between the KCNA1 (rs2227910, rs112561866, and rs7974459) and KCNV2 (rs7029012, rs10967705, and rs10967728) polymorphisms and disease susceptibility or drug responsiveness among Jordanian patients. This study suggests that a significant association exists between the KCNA2 SNP rs3887820 and increased susceptibility to generalized myoclonic seizure. However, the present findings indicate that the KCNA1 and KCNV2 SNPs do not influence disease susceptibility and drug responsiveness in epileptic patients. Pharmacogenetic and case-control studies involving a multicenter and multiethnic approach are needed to confirm our results. To improve the efficacy and safety of epilepsy treatment, further studies are required to identify other genetic factors that contribute to susceptibility and treatment outcome.

Familial Mediterranean fever in Jordanian Children: single centre experience.

Background:Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder caused by mutations in the Mediterranean Fever (MEFV) gene. The disease is especially common among Mediterranean ancestry, mostly Armenian, Turkish, Jewish and Arab populations. Our aim is to describe clinical phenotype, and genotype of FMF in the Jordanian children.Patients and Methods:A retrospective analysis was conducted on paediatric patients who were below 14 years of age and diagnosed as FMF at Queen Rania Children’s Hospital in Jordan between 2014 and 2017.Results:A total of 196 paediatric patients diagnosed with FMF were included; 54% females and 46% males. The mean age of patients at time of study was 7.8 years, at disease onset was 4.9 years, and at time of diagnosis was 6.6 years. The most common presenting features were abdominal pain (91.8%), fever (73%), arthralgia (16.8 %), and myalgia (12.8%). MEFV gene mutations were homozygous in 47 (24%) patients, heterozygous in 87 (44.4%) patients, compound heterozygous in 55 (28.1%), and negative genotype in 7 (3.6%) patients. Five mutations were the most frequent; M694V, V726A, E148Q, M680I, M694I. All patients were colchicine responsive. We reported only one case of amyloidosis.Conclusion:The five FMF founder mutations: M694V, V726A, E148Q, M680I, and M694I were the most common in Jordanian children, but had a different order from other ethnic groups.

The Use of Conjunctions as Grammatical Cohesion in the Speeches of Her Majesty Queen Rania of Jordan

Halliday and Hasan (1976) differentiated between four types of conjunctions namely, additive, causal, temporal and adversative. Thus, conjunctions are words used to combine two sentences, this paper examines the conjunctions in the speeches of Her Majesty Queen Rania of Jordan based on Halliday and Hasan (ibid). The investigator in this current study selected four different speeches which were delivered by Queen Rania in Jordan and USA in the years 2007, 2009, 2011 and 2013. The results show that there are some differences in the frequency of additive, causal, adversative and temporal conjunctions. The study concluded that, additive conjunctions were the most frequent conjunctions followed by adversative conjunctions and then causal conjunctions and finally the least occurrences were for temporal conjunctions.

The Use of Balloon Dilation in Pediatric Subglottic Stenosis : Experience at Queen Rania Al-Abdullah Hospital for Children

The Use of Balloon Dilation in Pediatric Subglottic Stenosis : Experience at Queen Rania Al-Abdullah Hospital for Children

Administrative style Catalyst for Excellence in Irbid Governorate School Principals from the Point View of the Teachers Who Won Queen Rania Al-Abdallah Award

Administrative style Catalyst for Excellence in Irbid Governorate School Principals from the Point View of the Teachers Who Won Queen Rania Al-Abdallah Award

Renal Impairment and Complication After Kidney Transplant at Queen Rania Abdulla Children's Hospital.

Kidney transplant is the treatment of choice for end-stage renal disease, but it is not without complications. We review the medical cause of significant renal impairment and complications that developed after kidney transplant in pediatric patients who required hospital admission and intervention and/or who were followed between 2007 and 2016. A retrospective noninterventional chart review study was conducted in pediatric patients who received a kidney transplant and/or followed at the nephrology clinic at Queen Rania Abdulla Children's Hospital between 2007 and 2016. In this study, 101 pediatric patients received a total of 103 transplants. Forty-eight patients (47%) experienced deterioration of kidney function out of a total of 53 episodes of complications; 37 of these episodes occurred early (0-6 mo after transplant), and 26 episodes occurred late. The causes of kidney function deterioration were surgical complications, acute tubular necrosis, cell- or antibody-mediated rejection, diabetes mellitus, urinary leak, recurrence of original disease, and chronic allograft nephropathy. Thirteen patients experienced graft loss; 50% of these losses were secondary to noncompliance to immunosuppressant medication treatment after transplant. A total of six patients died; 2 (23%) of these deaths occurred in the first week after transplant, whereas the other 4 patients died over a period of 10 years. Pediatric kidney transplant is not without complications; however, most of these complications are treatable and reversible. The most serious complications leading to graft loss and death occur early, in the first week after transplant. Improving immunosuppressant compliance after transplant would prevent 50% of graft losses.