Suleimman A. Al-Sweedan

Prevalence of depression among cancer patients in Jordan: a national survey

GoalsThe aim of this study is to investigate the prevalence of depression among cancer patients in Jordan and to study the relation between several socio-demographic, disease- and treatment-related factors, and the occurrence of depression among those cancer patients.Patients and methodsA cross-sectional survey study was conducted at a major university hospital in Jordan. Cancer patients were interviewed for socio-demographic information and medical records were checked for information about disease and treatment of patient. Patients’ psychological status was assessed using The Hospital Anxiety and Depression Scale (HADS).ResultsThe prevalence of depression in our sample was 51.9%. Significant correlation was detected between depression and appetite among cancer patients. Knowledge of having cancer and stage of the disease were also significantly associated with occurrence of depression.ConclusionIn an effort to reduce the occurrence of depression among cancer patients, special attention is needed for changes in the psychological status in patients with knowledge about their diagnosis and patients in advanced disease stage.

Factors predicting the hematopoietic stem cells content of the umbilical cord blood

Umbilical cord blood (UCB) has been demonstrated to be alternative source of hematopoietic stem cells (HSCs). Unfortunately, the wide use of UCB Transplantation is limited due to the low number of HSCs. The aim of this study was to determine factors that affect the number of HSCs collected from UCB. 200 eligible donors were included for HSCs testing, including total nucleated cells (TNCs) and CD34+ cell number, by using univariate and multivariate analysis. In univariate analysis, factors positively associated with higher number of TNCs were maternal weight (P=0.002), preeclampsia (P=0.03), neonatal weight (P<0.001), neonatal platelet count (P=0.02), neonatal Rh (P=0.03), gestational age (P=0.04) and delivery type (P<0.001). Factors positively associated with higher number of CD34+ cells were maternal weight (P<0.007), preeclampsia (P=0.02), maternal hypertension (P=0.02) neonatal weight (P<0.001), neonatal Rh type (P=0.02) and delivery type (P=0.04). In multivariate analysis, factors significantly influence TNCs were neonatal weight (P<0.001), preeclampsia (P=0.008), neonatal Rh type (P=0.02) and delivery type (P<0.001). While factors significantly influence number of CD34+ cells were maternal weight (P=0.025), neonatal weight (P=0.005), neonatal Rh (P=0.006), nuchal cord (P=0.026) and delivery type (P=0.009). Conclusions factors significantly influence TNCs content of UCB were neonatal weight, preeclampsia, neonatal Rh and delivery type. While factors significantly influence number of CD34+ cells were maternal weight, neonatal weight, neonatal Rh, nuchal cord and delivery type.

Intrauterine Upper Limb Ischemia Associated with Fetal Thrombophilia: A Case Report and Review of the Literature

Neonatal extremity gangrene is rare, even rarer are those born with evidence of intrauterine vascular occlusion. Intrauterine limb ischemia has been attributed to several etiological factors which include thromboembolic disease occluding the arteries of the affected limb or compression of the limb during intrauterine life. In this report, we present a case of brachioradial arterial thrombosis associated with mild homocysteinemia and double heterozygosity of methylenetetrahydrofolate reductase 677C-T and factor V Leiden gene mutations. We suggest investigating the neonates and their mothers for possible genetic prothrombotic risk factors when they present with intrauterine thrombosis as this issue is important for management and counseling.

Seroprevalence and genotyping of hepatitis C virus in multiple transfused Jordanian patients with β-thalassemia major.

OBJECTIVE The main objectives of this study are to investigate the prevalence of HCV among patients with β-thalassemia major and to determine the most prevalent genotype for this virus among them. METHODS One hundred twenty-two β-thalassemia major patients who were previously diagnosed at the molecular level were included. All plasma samples were tested for the presence of antibodies by ELISA. Real-time polymerase chain reaction (PCR) was used in the quantitation the HCV RNA viral loads, and consequently, patients with high virus titer were genotyped by the linear array. RESULTS Forty of the patients were anti-HCV positive. The prevalence of anti-HCV was significantly higher in patients who received blood transfusion before 1993 (83.7%) than in those who received it after 1993 (16.3%) (p=0.000). β-thalassemia major patients with HCV infection had significantly higher rates of elevated aspartate aminotransferase (54.4% vs 40.5%, p=0.045) and alanine aminotransferase (72.47% vs 37.47%, p=0.00) and of splenectomy (54.8% vs 45.2%, p=0.004) than β-thalassemia major patients without HCV. CONCLUSION HCV genotype 4 is the commonest genotype in multi-transfused patients with β-thalassemia major in Jordan.

Predictors of severe hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency following exposure to oxidant stresses

BACKGROUND AND OBJECTIVES Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder that affects millions of people worldwide, and is a major health problem in Jordan. We studied factors that may predict severe hemolysis in children with G6PD deficiency. METHODS We reviewed the records of patients with low G6PD activity admitted to a teaching hospital be- tween 1996 to 2007. We collected demographic data, details of sign and symptoms, history and type of fava bean ingestion, blood and Rh group, history of neonatal jaundice, history and type of drug use, abdominal pain at admission and the results of tests for hemoglobin, white blood cells (WBC), and hepatic function. We classified patients into mild and severe groups based on hemoglobin levels at admission. RESULTS Of 428 children with G6PD deficiency, 79 (18%) were severe cases and 349 (82%) patients with mild disease. There were no statistically significant differences in most factors between the two groups. Factors that achieved statistical significance for severe hemolysis included younger age (P<.05), male gender (P<.05), higher alkaline phosphatase (ALP) (P<.05), presence of fever at admission (P<.01), presence of vomiting during the at- tack (P=.006), and a negative family history for G6PD deficiency (P=.005). CONCLUSIONS Severe hemolysis can be predicted during hemolytic episodes in children with low G6PD by young age, male gender, a negative family history of G6PD deficiency, the presence of fever and vomiting and a high ALP.

Diagnostic value of platelet indices in children with leukemia.

The purpose of this study was to investigate whether platelet indices [mean platelet volume (MPV) and platelet distribution width (PDW)] could serve as diagnostic tools for screening or as surrogate marker for follow-up in children with leukemia. Blood samples were obtained from 47 patients with leukemia at diagnosis before chemotherapy (mean age: 67 mo; 30 males and 17 females) and from 47 healthy controls (mean age: 59 mo; 27 males and 20 females). We measured the blood platelet indices using an automated counter. MPV was higher in the leukemia group, but it was not statistically significant. However, PDW was significantly lower (P<0.001) in leukemia group. There was no significant difference in the MPV or PDW in patients with acute lymphoblastic leukemia versus acute myeloblastic leukemia. In conclusion, we found no significant difference in the MPV between the 2 groups. PDW proposed as indicators of certain pathologic conditions and it seems possible to use PDW as screening. However, platelet indices (MPV and PDW) cannot be used as indicator to discriminate between the subtypes of leukemia in children. The potential role of platelet indices in leukemia remains to be investigated by a multi-institutional level to verify the possible clinical significance of this finding.

The prevalence of factor V Leiden (G1691A), prothrombin G20210A and methylenetetrahydrofolate reductase C677T mutations in Jordanian patients with β-thalassemia major

One hundred beta-thalassemia major (β-TM) patients and 100 individuals as control were included. Factor V Leiden and prothrombin G20210A and methylenetetrahydrofolate reductase (MTHFR) gene mutations were genotyped by PCR and allele-specific restriction enzyme techniques. The prevalence of factor V Leiden G1691A, MTHFR C677T and prothrombin G20210A in patients was insignificantly higher than controls. Patients with β-TM have insignificantly higher frequencies of mutant A allele in factor V Leiden G1691A (11.5 vs. 10.5%), mutant T allele in MTHFR C677T (21.5 vs. 21%) and mutant A allele in prothrombin G20210A (3 vs. 2.5%) than controls. Double heterozygosity for two of the three mutations discussed in this study was found in (10 vs. 8%, P = 0.62) in β-TM patients and controls. The prevalence of factor V Leiden G1691A, prothrombin G20210A and MTHFR C677T mutations was slightly but insignificantly higher in β-TM patients than controls. β-TM is a chronic hypercoagulable condition independent of predisposing genetic factors.

The effect of low altitude on blood count parameters

BACKGROUND AND OBJECTIVES High altitude has an effect on blood count parameters, but low altitude (especially below sea level) has not been studied. DESIGN AND SETTING A cross-sectional study of aymptomatic subjects aged between 18 to 35 years of age who had reported to the blood bank at the King Abdullah University Hospital (KAUH)/Irbid and Ministry of Health, Jordan, during the period between January 2010 to June 2011 for blood donation. METHODS Hematological values were compared in healthy adult blood donors living in areas 200 to 300 meters below sea level and areas 500 to 1500 meters above sea level. The study population consisted of 800 females and 666 males aged between 18 to 35 years. RESULTS The mean values for hemoglobin level, mean corpuscular volume and leukocyte counts were significantly higher in people living above sea level than in people living below sea level (P < .0001), whereas platelet count and red cell distribution width were significantly higher in people living below sea level than in people living above sea level (P < .0001). CONCLUSION We found a significant difference in hematological parameters in healthy adults living above and below sea level. The hematological values presented here are from a large, representative population sample and the first report of people living below sea level.

Molecular Characterization of Glucose-6-Phosphate Dehydrogenase Deficiency among Jordanians

Background/Aims: In Jordan, glucose-6-phosphate dehydrogenase (G6PD) deficiency is a significant health problem, and the incidence was reported to be about 3.6%. The aims of this study are to investigate the most common molecular mutations of the G6PD gene among Jordanians in northern Jordan and to examine the correlation between the genotype and phenotype of this enzyme deficiency. Methods: Seventy-five blood samples were collected from patients attending King Abdullah University Hospital and Princess Rahma Teaching Hospital. The G6PD gene was scanned for mutations using a DNA sequencing technique. Results: Our results showed 11 variations (7 exonic and 4 intronic) as follows: c.202 G>A (rs1050828), c.376 A>G (rs1050829), c.404 A>C (CM962574 single-nucleotide polymorphism), c.542 A>T (rs5030872), c.563 C>T (rs5030868), c.1003 G>A (rs5030869), c.1311 C>T (rs2230037), c.486-90 C>T, c.486-60 C>G (rs2515904), c.770+175 C>T (rs2515905) and c.1311 C>T (rs2230037). Among these, G6PD Mediterranean (c.563 C>T) was the most common in our patients, with a frequency of 76.2%, followed by G6PD A– (c.202 G>A + c.376 A>G) with 19%, and an equal frequency of 1.6% was found for G6PD Chatham (c.1003 G>A), G6PD Santamaria (c.542 A>T + c.376 A>G) and G6PD Cairo (c.404 A>C). Conclusion: This is the first report of G6PD Santamaria and Cairo among our Jordanian population.

Comparison of Plasma Levels of Natural Anticoagulants (Protein C and Protein S) among Jordanian Smokers and Non-Smokers

Background: Protein C (PC) with its cofactor free protein S (FPS) are important anticoagulants. Any defect in the PC system is a risk factor for venous thrombosis. Aims: To assess the effect of intensity of smoking, and the dose-response for the number of cigarettes smoked on PC and FPS plasma levels. Methods: A comparative study was designed and carried out on a convenient sample of 50 healthy non-smokers and 150 non-symptomatic Jordanian male smokers. PC and FPS levels were measured using an automated system (Stago Analyzer, USA). Results: The plasma level of PC among smokers was 7.2% lower than that among non-smokers (p = 0.02). Moreover, smokers had 15.6% lower circulating FPS than non-smokers (p = 0.001). Furthermore, data showed significant negative correlations between both PC and FPS levels and the intensity of smoking (r = –0.21%, r = –0.23%, respectively; p = 0.01) and the period of smoking (r = –0.15%, r = –0.23%, respectively; p = 0.01, 0.12, respectively). Conclusions: The PC and FPS plasma levels were significantly lower in smokers than non-smokers. Both PC and FPS levels correlated inversely with the period and intensity of smoking, and FPS was more sensitive to smoking than PC.