Queen Rania Research Articles

Incidence of congenital hypothyroidism in Jordan

Objective The aim of the study was to compare the incidence of congenital hypothyroidism (CH) in Jordan with its incidence worldwide. Background CH is a preventable disease of mental retardation. Its incidence worldwide is almost 1 : 4000. Early screening, diagnosis, and treatment are mandatory to prevent later sequelae. Materials and methods This is a descriptive retrospective analysis of 13 452 newborns screened for CH. Data were collected from records during the period from February 2010 to November 2013 in the pediatric endocrine clinic in Queen Rania Al Abdullah Hospital for Children at King Hussein Medical Center, Amman, Jordan. There were 5978 male and 7474 female participants. Their age ranged between 3 and 10 days. Heel-prick whole blood was collected on a filter paper and sent everyday to the Princess Eman Laboratory Center for analysis. The thyroid-stimulating hormone (TSH) level using the enzyme-linked immunosorbent assay was considered as normal if the TSH value was less than 10 mU/ml, equivocal at values between 10 and 20 mU/ml, and positive for CH if TSH values were greater than 20 mU/ml. Parents of newborns with positive and equivocal results were called to return for further assessment. Central blood samples for free T4 and TSH were sent for patients with equivocal results and for those with TSH screen greater than 20 mU/ml. These two groups were reassessed for symptoms and signs of CH. Newborns screened for CH younger than the age of 3 days and older than the age of 10 days were excluded from the study. Newborns with clinical sepsis and premature babies were also excluded. Descriptive analysis using frequencies was applied to describe the study variables. Results Out of the 13 452 newborns tested, 5978 (44%) were male and 7474 (56%) were female. Newborns were categorized into three groups according to the TSH screening result. Group 1 included 13 231 newborns [5903 male (45%) and 7328 female (55%)] with normal TSH screen less than 10 mU/ml. Group 2 included 173 newborns [52 male (30%) and 121 female (70%)] with TSH 10-20 mU/ml. Group 3 included 48 newborns [23 male (48%) and 25 female (52%)] with TSH level greater than 20 mU/ml. Central samples for T4 and TSH were sent for group 2 and group 3. In group 2, one female newborn was confirmed to have primary hypothyroidism, whereas in group 3, five newborns were diagnosed to have CH, one male and four female. Conclusion The incidence of CH in Jordan is higher than the incidence worldwide; this could be due to the higher rate of consanguineous marriages in Jordan, which can increase the incidence of primary hypothyroidism due to dyshormonogenesis, although other contributing factors should be considered.

The First Ladies and the Arab Spring: A textual analysis of the media coverage of the female counterparts of authoritarian oppression in the Middle East

In textually analyzing the media coverage of the First Ladies of the Arab Spring, this paper argues that the media's approach to understanding the role of women in the structures of political power in the Middle East is often either too simplistic or too driven by a desire to exoticize the East, making it even harder to visualize and imagine the face of real female political empowerment in the region. While demonizing and condemning the greed of Leila Ben-Ali and Suzanne Mubarak in the immediate aftermath of the protests, prior to the Arab Spring, the Western media also glorified the presidential wives and royalty, such as Asma Al-Assad and Queen Rania, as symbolizing reform and openness to change, and in doing so, revealed an Oriental gaze that dichotomizes the gendered nature of politics and effectively denies the possibility of examining the complexities of women's political engagement in the Middle East.

Discourse and Social Values in Oprah Winfrey Show Hosting Queen Rania of Jordan

The analysis of values in textual structures is relevant in three overlapping areas. First, representations of social reality in discourse (and in sociological interpretations of discourse) are always value-related. Second, the definition of positive identities of the speaker as people who know and can be trusted, involves values that must be generated not only inter- or extra- textually but also in the structures of the text itself. Third, the arousal of emotions or even passion is based on values that are present but often hidden in textual structures. This paper investigates the values discussed in Oprah Winfrey episode hosting Queen Rania of Jordan, addressing the following question: how the social values of Oprah Winfrey and Queen Rania of Jordan were revealed in the episode? The transcript was analyzed based on Faiclough model for Critical Discourse Analysis and his contextual dimension approach of discourse.The results suggest that experiential values were revealed in Queen Rania’s dialogue using overwording and rewording. Relational values were revealed through formality of relation, as Oprah Winfrey expressed politeness, respect for the Queen’s status and position. Expressive values were shown in the Queen’s dialogue expressing herself as a subject who has a position as a Queen, and her own social identity as Jordanian women. Oprah Winfrey and Queen Rania draw upon personal pronouns dichotomy by classifying people into categories built upon each one ideological representation of reality. DOI: 10.5901/mjss.2013.v4n11p289

The Changing Spectrum of End Stage Renal Disease at Queen Rania Al-Abdullah II Hospital of Pediatrics

Objective: End stage Renal Disease is a rare condition in children. It is usually the result of slowly progressive irreversible kidney damage. The aim of this study is to determine the causes, outcome and describe the demographic features of all children with end stage renal disease on regular dialysis at Queen Rania Al-Abdullah II Hospital of Paediatrics. This is the referral centre for all pediatric subspecialties in Jordan. Methods: A retrospective review of all computerized data for all children with end stage renal disease who were on regular dialysis at Queen Rania Hospital during the period January 2006 to April 2011 were done. The data was reviewed regarding gender, age at the initiation of dialysis, mode of dialysis and primary disease. The outcome of these children was also followed and reviewed. Results: Out of 98 children who were on regular dialysis at Queen Rania Hospital, 90 (92%) were on hemodialysis and eight (8%) were on peritoneal dialysis, 53 (54%) were female, 45 (46%) were male. The mean age at the initiation of dialysis was 8.2±2.3 years; the commonest cause of end stage renal disease was congenital anomalies of the kidney and urinary tract which occurred in 34 (34.5%) children. However unknown causes were found in four cases (4%). Thirty-nine children (39.5%) were transplanted and 25 (25.5%) children died while they were on dialysis. Conclusions: The most common cause of end stage renal disease at our center was congenital anomalies of the kidney and urinary tract, which is a preventable cause when detected early. The increased percentage of renal transplants observed among patients with end stage renal disease on regular dialysis at our centre is promising as it offers the best choice of renal replacement therapy.

ANTIBIOTIC RESISTANCE PATTERNS OF MULTIDRUG RESISTANT AND EXTENDED-SPECTRUM Β-LACTAMASE PRODUCING ESHCHERICHIA COLI URINARY ISOLATES AT QUEEN RANIA AL-ABDULLAH HOSPITALFOR CHILDREN, JORDAN

To determine the prevalence and the antibiotic resistant patterns of the multi-drug resistant Extended-Spectrum Β-Lactamase(ESBL) producing E. coli isolates from children urine samples, in Queen Rania Al-Abdullah Hospital for children.A total of 61 non-repetitive urine samples from various outpatient clinics and inpatient wards were collected retrospectively over a period of 5 months (May 2012 to September 2012). The resistant patterns, screening and confirmatory tests for phenotypic detection of ESBL-producers were studied using the VITEK 2 system against a set of antibiotics found on the antimicrobial susceptibility extend card AST-EXN8.Children were nearly equally infected by both types of E. coli isolates, ESBL-producers 31 (50.8%) and non ESBL-producers 30 (49.2%). ESBL-producing E. coli showed maximum rate resistance to Cefuroxime and Piperacillin (100%), Aztreonam, Cefixime, Ceftriaxone plus Levofloxacin (96.8%), Ampicillin/Sulbactam and Cefepime (93.5%), and Moxifloxacin (90.3%), while minimum resistance rate was seen with Tigecycline (12.9%), Colistin (3.2%) and meropenem (0%). ESBL-producing isolates were significantly more resistant than Non-ESBL-producers (p < 0.05) to the following antimicrobials (Ampicillin/Sulbactam, Aztreonam, Cefepime, Cefixime, Ceftriaxone, Levofloxacin, Moxifloxacin, Piperacillin and Tetracycline). Multi-drug resistance was found to be higher in ESBL-producing isolates, which were resistant to at least 9 antibiotics. To limit the spread of the multi-drug resistant ESBL-producers E. coli isolates, we should perform screening test for these isolates on daily basis, isolate the infected patients and choose the best therapeutic option.According to the resistant pattern and safety issue, Morepenem can be considered as first line treatment and colistin as last resort therapy. Keywords: Resistant patterns, E. coli, MDR,ESBL, UTI, children, VITEK 2, AST-EXN8.

Discourse Analysis: Personal Pronouns in Oprah Winfrey Hosting Queen Rania of Jordan

Discourse Analysis: Personal Pronouns in Oprah Winfrey Hosting Queen Rania of Jordan

Pseudo-bartter syndrome, pattern and correlation with other cystic fibrosis features

Pseudo-Bartter Syndrome (PBS), although quite common in patients with cystic fibrosis (CF), is often missed as simple dehydration or Bartter syndrome. This study was performed in patients with PBS to compare the pattern and course of the disease with those with CF not manifesting with this syndrome. All patients with CF who attended the respiratory clinic at Queen Rania Al-Abdallah Hospital from January 2000 to April 2010 were included in this retrospective case-control study. A specially formulated data sheet was used and those with PBS and those not having the syndrome were identified. A total of 110 patients (51% female) with CF with a median age of seven years were followed-up. Eighteen (16.3%) of them had one or more episodes of PBS. The median follow-up period was 6.2 years. All the episodes occurred during summer and in infancy. Median age of the initial episode of PBS was three months. One-third of them were initially followed at the nephrology clinic. Three patterns of PBS were identified: single episode in three (16.6%) patients, recurrent in 12 (66.6%) patients and chronic in three (16.6%) patients. Early colonization of Pseudomonas spp before 1 st birthday was seen in 44% patients with PBS compared with 12% in other CF patients (P-value = 0.0075). The total number of colonized patients and other CF features at the time of the study did not differ significantly among patients, although the mean Shwachman-Kulczycki score is significantly lower in those with recurrent PBS (69 compared with 85 in other CF patients). Gene mutation was identified in only 30% of the entire cohort. PBS is common in patients with CF, and it should be kept in mind in any patient with hypotonic dehydration and metabolic alkalosis. Recurrent pattern is associated with earlier Pseudomonas colonization.

A Content Analysis Case Study: The Story Picture Book “The Sandwich Swap” by Queen Rania Al Abdullah of Jordan with Kelly DiPucchio as a Children’s Literature

This study aimed at analyzing "The Sandwich Swap” by her majesty queen Rania Al Abdullah of Jordan with Kelly DiPucchio and illustrated by Tricia Tusa as a type of children's literature to find out to what extent it agrees with a group of criteria developed by the researcher himself. The criteria is a checklist of thirteen items grouped under five subheadings: a) the title, b) the story, c) characters, d) the theme and e) the illustrations. Each of the criterion follows Likert Scale: Excellent, good, adequate, poor, totally lacking mandatory ,optional and not applicable. After analyzing the story depending on those criteria, the findings of the study revealed that "The Sandwich Swap” as a story picture book is of great educational value that reflects a unique royal writing in children's literature and it agrees with criteria used in the analysis process with an "Excellent of four points “in Likert Scale in all the thirteen items.

The role of electroencephalogram in childhood neurological disorders

The aim of this study was to obtain a baseline for clinical application of electroencephalography (EEG) in children and to evaluate the EEG findings in children with various acute and chronic central nervous system disorders and nonepileptic events. EEG records of 250 patients were studied in Neurophysiology Departments of Queen Rania Al-Abdullah Hospital for Children in Jordan. For each patient who had undergone EEG the following data were recorded: age, sex, source of referral (inpatient or outpatient department), reason for EEG, diagnostic impressions, clinical presentation, the result of the EEG examinations and clinical correlation between the seizure type and EEG finding. Males (55%) were slightly outnumbered than females. The majority of cases were between 6-12 years. Total of 63.2% of all referrals for EEG were from outpatient clinics while inpatients accounted for 36.8% of referred cases, with Pediatric Neurology Department referrals being the highest (28.8%). Majority of diagnosis at referral were suspected epilepsy (80%) with epileptiform EEG abnormalities in 32%. Over all 64% the EEG records were normal, including all EEG records of children with syncope and headache. We conclude that there are many unnecessary routine EEG recordings in children. Investigation of epilepsy and acute encephalopathies appear to be the most valuable indications for routine pediatric EEG. EEG can be helpful in classification of seizures. Finding a way to reduce EEG requests is recommended.

Electroencephalogram in Childhood Neurological Disorders

Aim of the study: The present study was done to obtain a baseline for clinical indications of EEG in children and to evaluate the Electroencephalography (EEG) findings in children with various acute, chronic CNS disorders and non epileptic events. Patients and methods: The Electroencephalography (EEG) records of 250 patients were studied, which was done at neurophysiology departments of Queen Rania AL-Abdullah Hospital for children in Jordan. For each patient underwent EEG record the following data were recorded, age, sex, source of referral ( in patient department or out patient ) , reason for Electroencephalography (EEG) , diagnostic impressions and clinical presentation , the result of the EEG examinations and clinical correlation between the seizure type and EEG finding . Results: Males slightly outnumbered females: 55% males. The majority of cases sent for EEG fell between 6-12 years , Total of 63.2 % of all referrals for EEG were from outpatient clinic while in patients account for 36.8%. pediatric neurology department referrals being highest 28.8 %, the majority of diagnosis at referral were suspected epilepsy (80%), epileptiform EEG abnormalities was detected in ( 32%) , Over all 64 % the EEG records were normal , All EEG records of children with syncope , headache were normal . Conclusion and recommendation: We conclude that there are many unnecessary routine EEG recordings in children; Investigation of epilepsy and acute encephalopathies appear to be the most valuable indications for routine pediatric EEG. EEG can help in classified of the seizure, finding a way to reduce EEG requests is request

Electroencephalogram in Childhood Neurological Disorders

Aim of the study: The present study was done to obtain a baseline for clinical indications of EEG in children and to evaluate the Electroencephalography (EEG) findings in children with various acute, chronic CNS disorders and non epileptic events. Patients and methods: The Electroencephalography (EEG) records of 250 patients were studied, which was done at neurophysiology departments of Queen Rania AL-Abdullah Hospital for children in Jordan. For each patient underwent EEG record the following data were recorded, age, sex, source of referral ( in patient department or out patient ) , reason for Electroencephalography (EEG) , diagnostic impressions and clinical presentation , the result of the EEG examinations and clinical correlation between the seizure type and EEG finding . Results: Males slightly outnumbered females: 55% males. The majority of cases sent for EEG fell between 6-12 years , Total of 63.2 % of all referrals for EEG were from outpatient clinic while in patients account for 36.8%. pediatric neurology department referrals being highest 28.8 %, the majority of diagnosis at referral were suspected epilepsy (80%), epileptiform EEG abnormalities was detected in ( 32%) , Over all 64 % the EEG records were normal , All EEG records of children with syncope , headache were normal . Conclusion and recommendation: We conclude that there are many unnecessary routine EEG recordings in children; Investigation of epilepsy and acute encephalopathies appear to be the most valuable indications for routine pediatric EEG. EEG can help in classified of the seizure, finding a way to reduce EEG requests is request

Impact of an educational program on nursing students' caring and self-perception in intensive clinical training in Jordan.

BackgroundFraming and development of clinical skills in nursing students during their clinical practice is critical because this can shape their future caring skills. Professional caring empowers patients and contributes to their well-being and health. Education may enhance the capacity of nurses to be effective caring practitioners. Their study program encourages caring behavior in nursing students, consequently affecting their professional self-perception.MethodsThe present study investigated the effect of an educational program on caring behavior and professional self-perception in nursing students using a controlled pre/post test study design. The study sample consisted of 50 nursing students undertaking their final year in 2010–2011. Subjects were randomly assigned to either an experimental or a control group. The study was conducted in two critical care units affiliated to the Ma’an and Queen Rania hospitals in the south of Jordan. The instruments utilized were the Caring Dimensions Inventory, Nursing Students Attitude Observational Checklist, and Professional Self-Concept of Nurses Instrument.ResultsThe study findings favor the effect of the educational program because there was increased knowledge and understanding of caring theory and related concepts, a more holistic approach to care, enhanced caring practices, and improved self-perception in the study group compared with the control group during different periods of assessment. The study group showed significantly better caring perception in psychological, technical, and professional terms than the control group during different periods of assessment. There was a significant positive trend of overall professional self-perception for the study group compared with the control group.ConclusionNursing curricula should incorporate concepts and principles that guide students in developing caring, safe, competent, and professional behavior. Nursing students must seek educational opportunities to acquire knowledge for role preparation, to participate in knowledge generation, and for personal and professional development.

Childhood Focal Epilepsies

Objective: The present study was done in order to obtain a baseline profile of childhood focal epilepsies Patient and methods: Subjects included in this study were children suffering from focal epilepsy with age above 2 y. They were attending pediatric neurology clinic in Queen Rania Hospital for children in Jordan . The study included 112 children with ages ranging from 2-14 years. The following data were obtained: age, sex, detailed of seizures type, age at first unprovoked seizure, family history of seizure disorders, history and type of febrile seizures, etiological factors, socioeconomic class, history of consanguinity, additional neuro -impairment, Electroencephalography and brain imaging finding and the use of antiepileptic drugs, the results were recorded for further study. Results: A total of 112 consecutive cases of focal epilepsy were enrolled , 59 were male. The commonest partial seizure recorded was simple partial type 52 (46.4%) while simple partial with secondary generalization had 17 (16.9%) and complex partial seizure formed 36.8 %. ), In partial onset seizures the peak age was between 11-14 years and complex partial seizures plateau was seen between ages 6-10 years. Twenty six (23.2%) patients reported a family history of epilepsy, 91% of low socioeconomic class .11.5 % of cases have history of febrile seizures, idiopathic epilepsy was 53.5 % . In most of epileptic patients have accessory neurological impairment, the most common were learning difficulties Electroencephalography was normal in 20.4 %, mono-therapy was used in 68.8 % Conclusion: the pattern of focal epilepsies in our country do not differ from that of developed countries, further population –based epidemiological research is indicated to confirm the prevalence of seizure disorders in this locality

Clinical profile of patients with infantile spasms

Objective: The present study was done in order to obtain a baseline profile of infantile spasms and associated neurological disorders Patient and methods:. The study included 50 patients with infantile spasm in Queen Rania Hospital for children in Jordan. The following data were obtained: sex, age of onset and presentation, details of seizure , family history of epilepsy, significant pre-/peri/post-natal insults, neuro imaging evaluation , detailed neurological and neuro developmental ,assessment were done by. Broad categories of possible etiologies were used the results were recorded for further study. Results: Age of onset of infantile spasm ranged from 1month to 1 year and 6 months , (mean 4.8 months). The mean time of presentation was 9.4 months . A male preponderance was noted (74 %). flexor spasms (52%) were the commonest. Other types of seizures also accompanied infantile spasm in 44% children. (84%) were born of normal delivery, History of birth asphyxia was obtained in 48%, 3 (6%) had positive family history Developmental delay was recognized prior to onset of spasms in 52% . microcephaly was the commonest associated problem , Imaging studies of the brain revealed abnormality in 18 patients. 78% patients symptomatic and 22 % as cryptogenic.. Conclusion: The pattern of infantile spasm in our country do not differ from that of developed countries, further researches is required to prevent both chronic epilepsy and psychomotor retardation and .preventive measurement to prevent birth asphyxia is recommended

Clinical profile of patients with infantile spasms

Objective: The present study was done in order to obtain a baseline profile of infantile spasms and associated neurological disorders Patient and methods:. The study included 50 patients with infantile spasm in Queen Rania Hospital for children in Jordan. The following data were obtained: sex, age of onset and presentation, details of seizure , family history of epilepsy, significant pre-/peri/post-natal insults, neuro imaging evaluation , detailed neurological and neuro developmental ,assessment were done by. Broad categories of possible etiologies were used the results were recorded for further study. Results: Age of onset of infantile spasm ranged from 1month to 1 year and 6 months , (mean 4.8 months). The mean time of presentation was 9.4 months . A male preponderance was noted (74 %). flexor spasms (52%) were the commonest. Other types of seizures also accompanied infantile spasm in 44% children. (84%) were born of normal delivery, History of birth asphyxia was obtained in 48%, 3 (6%) had positive family history Developmental delay was recognized prior to onset of spasms in 52% . microcephaly was the commonest associated problem , Imaging studies of the brain revealed abnormality in 18 patients. 78% patients symptomatic and 22 % as cryptogenic.. Conclusion: The pattern of infantile spasm in our country do not differ from that of developed countries, further researches is required to prevent both chronic epilepsy and psychomotor retardation and .preventive measurement to prevent birth asphyxia is recommended

Childhood Focal Epilepsies

Objective: The present study was done in order to obtain a baseline profile of childhood focal epilepsies Patient and methods: Subjects included in this study were children suffering from focal epilepsy with age above 2 y. They were attending pediatric neurology clinic in Queen Rania Hospital for children in Jordan . The study included 112 children with ages ranging from 2-14 years. The following data were obtained: age, sex, detailed of seizures type, age at first unprovoked seizure, family history of seizure disorders, history and type of febrile seizures, etiological factors, socioeconomic class, history of consanguinity, additional neuro -impairment, Electroencephalography and brain imaging finding and the use of antiepileptic drugs, the results were recorded for further study. Results: A total of 112 consecutive cases of focal epilepsy were enrolled , 59 were male. The commonest partial seizure recorded was simple partial type 52 (46.4%) while simple partial with secondary generalization had 17 (16.9%) and complex partial seizure formed 36.8 %. ), In partial onset seizures the peak age was between 11-14 years and complex partial seizures plateau was seen between ages 6-10 years. Twenty six (23.2%) patients reported a family history of epilepsy, 91% of low socioeconomic class .11.5 % of cases have history of febrile seizures, idiopathic epilepsy was 53.5 % . In most of epileptic patients have accessory neurological impairment, the most common were learning difficulties Electroencephalography was normal in 20.4 %, mono-therapy was used in 68.8 % Conclusion: the pattern of focal epilepsies in our country do not differ from that of developed countries, further population –based epidemiological research is indicated to confirm the prevalence of seizure disorders in this locality

Bronchoscopy Findings in Children With Recurrent and Chronic Stridor

To describe the bronchoscopic findings and treatment decision of children with chronic or recurrent stridor referred to the pediatric respiratory clinic at Queen Rania Hospital for Children. All children who underwent flexible bronchoscopy at the pediatric bronchoscopy unit for chronic stridor from January 2009 to January 2010 were included. Stridor was divided into 3 groups: inspiratory, expiratory, or biphasic. All patients from 2 weeks of age till 14 years were included. Files of these patients were retrospectively reviewed. A specially formulated data sheet including clinical history and physical findings, type of stridor, bronchoscopic findings, and management decision was used. Radiologic investigation results were included when relevant. Flexible bronchoscopy was performed under sedation and topical anesthesia. A total of 64 children [35 (54.7%) male and 29 (45.3%) female] were included. Twenty-four patients had inspiratory stridor. There were 33 patients with biphasic stridor (subglottic stenosis in 9, paradoxical vocal cord movement in 6, vascular ring in 5, subglottic hemangioma in 3, vocal cord paralyses in 4, foreign body in 2, laryngeal web in 2, and absent vocal cord and tracheal bronchus in 1 each). Seven children had expiratory stridor. Of patients with laryngomalacia, 50% had associated tracheomalacia and 70% of those with laryngomalacia and all patients with tracheomalacia had associated gastroesophageal reflux. Two patients with paradoxical vocal cord movement were found to have Arnold-Chiari malformation. All patients with vascular rings underwent surgery. Flexible bronchoscopy should be performed in all patients with chronic or recurrent stridor to assess the airway and guide further investigations and management.

Clinical profile of infants with hypsarrhythmia.

Objective:The present study was done in order to obtain a baseline profile of infantile spasms and associated neurological disorders.Patient and methods:The study included 50 patients with infantile spasm in Queen Rania Hospital for children in Jordan. The following data were obtained: sex, age at onset of spasms, details of seizure, family history of epilepsy, significant pre-/peri/ post-natal insults, Electroencephalography and detailed neuro imaging evaluation , detailed neurological, neuro developmental ,assessment were done by. Broad categories of possible etiologies were used the results were recorded for further study.Results:Age of onset of infantile spasms ranged from 1month to 1 year and 6 months , (mean 4.8 months). The mean time of presentation was 9.4 months . A male preponderance was noted (74 %). flexor spasms (52%) was the commonest . Other types of seizures also accompanied infantile spasm in 44% children . (84%) were born of normal delivery, History of birth asphyxia was obtained in 48%, 3 (6%) had positive family history Developmental delay was recognized prior to onset of spasms in 52%, microcephaly was the commonest associated problem, Imaging studies of the brain revealed abnormality in 18 patients. 78% patients were classified as symptomatic and 22 % as cryptogenic.Conclusion:the pattern of infantile spasm in our country do not differ from that of developed countries, further researches is required to prevent both chronic epilepsy and psychomotor retardation and .preventive measurement to prevent birth asphyxia is recommended.

Prevalence of elevated hepatic transaminases among Jordanian patients with type 2 diabetes mellitus.

BACKGROUND AND OBJECTIVES:Since the extent of elevation of liver transaminases in type 2 diabetics in Jordan and most of the Middle East is unknown, we estimated the prevalence of elevated liver transaminase levels among patients with type 2 diabetes and determined associated risk factors.METHODS:This study was performed on 1014 consecutive type 2 diabetic outpatients who attended the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. The patients' age ranged between 26-85 years with a mean age of 56.8 (+9.8). Three- hundred and fifty three (54.5%) were males with a median age of 58 years (ranging between 26-82 years), and four hundred and sixty one (45.5%) were females with a median age of 57 years (ranging between 28-85 years). Body mass index, waist circumference, lipid profile, and hepatic transaminase levels were recorded. Ultraonography was performed in those with elevated alanine transaminase levels.RESULTS:Overall, the prevalence of elevated alanine transaminase (ALT) level was 10.4% (n=105) with the gender-wise prevalence being 12.8% (n=71) in men and 7.4% (n=34) in women. The prevalence of elevated aspartate transaminase (AST) levels was 5.4% (n=56) with the gender-wise prevalence being 5.6% (n=31) in men and 5.4% (n=25) in women.. Only 4.5% (n=44) showed elevated levels of both ALT and AST. Male gender (OR=2.35, CI:1.5-3.8) and high waist circumference (OR=1.9, CI:1.2-3.2) were associated with increased risk of elevated ALT levels. Younger patients had a higher tendency to have elevated ALT compared to those over 65 years (OR=12.4 for patients aged 25-45years, and OR=5.8 for those who were 45-65 years old). Non-insulin use was associated with a high odds ratio for elevated ALT levels (OR=1.7, CI: 1.1-2.9).CONCLUSIONS:Elevated ALT and AST levels are found in 10.4% and 5.4% of our type 2 diabetic patients respectively. Male gender, younger age, higher waist circumference; as an indicator of central obesity, as well as non insulin use are independent predictors of elevated liver transaminase levels.

Child maltreatment comes out of the shadows

Sabah and Nidal (names changed) were abandoned by their mother as toddlers and left with their father, who had no idea how to look after them. After feeding them and changing their diapers in the morning, he would leave them alone for 10 hours while he went to work. The Children are now in the care of the Dar Al Aman child protection centre in Amman, Jordan. Dar Al Aman--which means house of security in Arabic--is the only therapeutic centre in WHO's Eastern Mediterranean Region that offers psychological, medical, social and educational services to maltreated children. It also counsels families and teaches them the principles of good parenting. We aim to unify the family by using therapy to help the child overcome the problems they've faced and empower the family, so that the child can return home, said Dar Al Aman's child safety manager Nancy Naghour. Sometimes children who have suffered extreme physical, sexual and psychological abuse are sent to the centre by court order. Dar Al Aman accommodates 32 children at time and is privately funded. Established in 2000 by the Jordan River Foundation, charity chaired by Queen Rania of Jordan, Dar al Aman has helped more than 280 children and their families. Queen Rania has spearheaded child protection efforts in her country over the past decade by raising public awareness of abuse and the need to promote the well-being of children. Her Majesty Queen Rania was courageous. said we have to face this even if it's taboo subject, Naghour said. She said we have to open safe place to help these children and their families. Without her, it wouldn't have been easy to start dealing with such sensitive and complicated issue in our culture and society, she added. Other institutions in Jordan are also working to prevent child maltreatment and create greater public awareness of the problem, such as the Queen Rania Center for Child and Family, established in 2005, the Family Protection Department, the National Council for Family Affairs, Questscope's mentoring programme and the Jordan Society for Protecting Victims of Family Violence. But Dar Al Aman has served as model for other child welfare and safety programmes in WHO's Eastern Mediterranean Region, which spans 22 countries and includes the Palestinian territories. Egypt, Lebanon, Saudi Arabia, the Syrian Arab Republic and Yemen also host care centres, according to Dr Syed Jaffar Hussain, child safety expert from the World Health Organization's (WHO) Regional Office for the Eastern Mediterranean. These centres also have free helplines, which anyone can call, including the child, to report The centres make sure they follow up those cases, he said. Such centres are gaining acceptance from communities across the region, Hussain said, despite fear on the part of some families that they could become stigmatized by abuse. Stigmatization is one factor that makes it difficult to gain clear picture of the true extent of child Another is honour. Middle Eastern communities, where honour is to be preserved and shame to be avoided at all costs, are very private about family matters, even if [certain family practices] are harmful, Naghour said, adding that misconceptions among some parents that hitting children is necessary to discipline them also perpetuate child Such factors, said Hussain, can lead to a reluctance by parents or the children themselves to engage with those centres and seek assistance. Poor data is problem worldwide. Accurate and meaningful data on child abuse are hard to come by, and official statistics rarely reveal great deal about patterns of child abuse, according to the United Nations Children's Fund information sheet on child …