Knowledge and practice of foot care among diabetics at King Hussein medical center, Jordan

Objective: To assess the knowledge and practices of foot care among a diabetic Jordanian cohort

Methods: A cross-sectional design was employed. The study implied a randomized study selecting every other patient who is suffering from diabetes and attending the endocrine and internal medicine clinics of a large tertiary hospital in Amman. Written consent was obtained from participants who were interviewed on individual bases using a questionnaire seeking information on knowledge and practice of foot self-care. Medical records were checked for latest reading of HbA1C. Data obtained were analyzed using Statistical Package for Social Sciences [SPSS] version 17. Levels of knowledge as well as levels of foot care practices were classified as good, satisfactory or poor according to scores computed for participants' responses to questionnaire items. Each correct response worthed one score [point]

Results: A total of 982 participants, were involved in the study, 505 [51.4%] were males and 477 [48.6%] were females. The mean age is 52.16 years [SD +/-13.4]. Of all participants, 156 [15.9%] were illiterate, 640 [65.2%] had an education of high school or less, and 186 [18.9%] had more than high school education. Out of 982 participants, 16.6% had poor knowledge; 41.9% had satisfactory and 41.5% had good knowledge scores of diabetic foot care. The mean knowledge score for the participants was 6.6 [SD +/-2.1]. Regarding practice scores, 24.8% of the study participants had poor practice, 56.9% had satisfactory score and only 18.2% had good practice of diabetic foot self-care. The mean practice score for the participants was 7.1 [SD +/-2.3]

Conclusion: Our study documented variations between knowledge and practice of diabetic foot self-care. Specifically, patients' satisfactory knowledge is associated with inadequate practices of foot self-care. In order to improve concordance between knowledge and practice of foot self-care; staff and patient's education must be encouraged and carried out at all primary health care centers and hospitals. Furthermore, measures must be taken to improve patient compliance to proper foot care practices

Prevalence of peripheral neuropathy among patients with diabetes mellitus at King Hussein hospital, Amman, Jordan

To determine the prevalence of prevalence peripheral neuropathy [PN] among patients with Diabetes Mellitus [DM] at King Hussein hospital. This descriptive study was done at King Hussein Hospital, Amman, Jordan and included 202 patients od DM using convenience sampling technique. Data were collected through face-to-face interview. Data collection instrument is composed of two parts; the first part assessed the demographic characteristics, while the second part was a translated version of Michigan Neuropathy Screening Instrument [MNSI]. Descriptive and inferential statistics were used for data analysis. Out of 202 patients, 102 were male and 100 female. The age ranged from 16 to 88 years [mean 56.19 +/- 14.31]. The mean duration of diabetes was 10.69 +/- 8.24 years. The overall prevalence of PN was 54.45 +/- 49.92. The prevalence was higher in women than men [55 +/- 50 VS 53.92 +/- 50.09]. There was significantly higher prevalence of PN among patients with non target glycosylated hemoglobin [HbAIc] [p<0.05], age ? 65 years [p<0.05], duration of diabetes ?10 years and body Mass index [BMI] ?25 kg/m2 [p<0.05]. The prevalence of peripheral neuropathy was high. Diabetic patient should be screened for PN continuously using simple instrument such MNSI. The initial measures that may help in prevention of PN were glycemic control and body weight control

Thyroid dysfunctions among Jordanian patients with rheumatoid arthritis and systemic lupus erythematosus: a hospital-based study

To determine the frequency of thyroid dysfunction among Jordanian patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis. This study was conducted in collaboration between Rheumatology and Endocrine clinics at King Hussein Medical Center in the period between January 2010 and July 2010. One hundred and twenty-two patients were studied; 80 patients with Systemic Lupus Erythematosus and 42 patients with Rheumatoid Arthritis were screened for thyroid diseases [clinical or subclinical hyper/hypothyroidism] regardless of their symptoms. The results were compared with 304 apparently healthy controls. A total number of 122 patients, female to male ratio 7.7:1 and a mean age [SD] of 37.1 +/- 13.5 years, were included in the study. Twenty-six patients were found to have thyroid function abnormalities. The frequency of thyroid disease was 21.3%. The mean age in the control group was 49.4 years. The frequency of thyroid dysfunction in the control was 6.6%. Subclinical hypothyroidism was seen in 5% of healthy controls, 13.7% of Systemic Lupus Erythematosus and 7.1% of Rheumatoid Arthritis patients. The majority of cases of subclinical hypothyroidism with Systemic Lupus Erythematosus and all cases with Rheumatoid Arthritis were females. Overt hypothyroidism was seen in 0.9% of controls, 8.7% of Systemic Lupus Erythematosus and 4.7% of Rheumatoid Arthritis patients. Biochemical hyperthyroidism was seen in 0.3% of controls, 2.5% of Systemic Lupus Erythematosus and 2.3% of Rheumatoid Arthritis patients, all of whom were female. Patients with rheumatologic disorders have high frequency rate of thyroid dysfunction. These dysfunctions are often subclinical in nature with female predominance. Screening should be regularly conducted in all patients with rheumatologic diseases for proper early detection and management

Impact of age, gender, diabetes mellitus duration and body mass index on metabolic control of type 2dm among a group of Jordanian patients

To assess the impact of age, gender, duration of diabetes and body mass index confounders on diabetes control among a Jordanian cohort of T2DM at the Endocrine Clinic in King Hussein Medical Center. Patients were selected over 18 months from outpatient clinic at King Hussein Medical Center in Amman-Jordan. Diabetes control assessed by mean of latest 3 HbA1c and fasting blood sugar. Patients were divided in 2 groups according to age [55 years], gender, duration [10 years] and BMI [normal, overweight, and obese according to WHO criteria]. Statistical analysis is performed using SPSS11.5.Good diabetes control is assessed according to American Diabetes Association criteria A total of 405 patients were selected [223 males, 182 females]. 115 patients [28.4%] were having a good control with HbA1c 55 years [n=222] [29%vs.28%; p=0.812]. Females in both age groups were having non statistically significant better control than males. Of those with DM duration 10 years duration [n=163] [P-value=0.001, RR=1.83, OR=2.26]. Females were again having a better diabetic control in both duration groups, p=0.024. There was no statically significant difference in diabetic control in all BMI categories studied. Thirty percent of overweight patients were having good control Vs 10 year. The mean HBA1C of the group aged< 55 years was 8.1 +/- 1.8 Vs 7.9 +/- 1.5 in those >55 years of age. In this Jordanian group with T2DM the diabetic control was modest at 28.4%. Females were having a better diabetic control at all categories. Diabetes duration less 10 years was the only indicator of adequate control of diabetes

Effect of smoking, alcohol and exercise on the prevalence of metabolic syndrome in a cohort of Royal Jordanian Air Pilots

To assess whether smoking, alcohol intake and exercise cofounders have an impact on the development of metabolic syndrome in a Jordanian cohort of air pilots. A random sample of 111 subjects serving at Royal Jordanian Air Force were recruited at the routine annual examination. Complete history and physical exam was done. The criteria of the National Cholesterol Education Program-Adult Treatment Panel III were used to define features of metabolic syndrome. Waist and hip circumference and height were measured to nearest centimeter, body weight to the nearest kilogram. Blood pressure was taken after 10 minutes of rest. Blood was drawn in fasting state for complete kidney function test, liver function test, lipid profile and fasting blood sugar. The cohort was divided into groups according to exercise, alcohol intake and smoking habit and comparison among groups was performed. Metabolic syndrome in Jordan ranges from 19-36% in different studies. The prevalence of metabolic syndrome in air pilots was 15.3%. Mean age was 32.5 +/- 7.2 years. There were 72 smokers of 17.3 +/- 5.4 cigarettes/day for a duration of 10.3+ 6.7 years. Thirteen subjects consume alcohol on social basis and 58 subjects who do regular excises of a mean of 3 sessions per week. There was no difference in the prevalence of metabolic syndrome among all groups studied as well as for components of metabolic syndrome. Smokers were having a statistically significant higher rates of low HDL-C vs. non smokers [47.2% vs. 23.1%, p=0.0012; OR=2.98[95% CI: 1.15-7.9] RR =2.05 [95% CI :1.1-3.81] and their mean HDL-C level was lower [42.3 +/- 10.1 vs. 48.1 +/- 12.5] for non smokers [p= 0.0041].The systolic blood pressure and body weight were significantly lower in the smoker group. Smoking, alcohol intake and exercise as confounders did not affect the prevalence of metabolic syndrome in this cohort. Smoking has a significant impact on low HDL-C rates and levels in smokers. Further, larger studies are needed to elicit differences and significant results of these confounders

Incidental thyroid nodules found during carotid doppler ultrasonography at King Hussein Medical Centre

To determine the incidence of thyroid nodules found during extra-cranial carotid Doppler examination. Between March 2005 and December 2007, a total number of 791 patients [354 females and 437 males] underwent carotid Doppler examination for different causes. The study included thyroid gland examination with gray scale and color Doppler. Patients with incidental thyroid nodules were referred to endocrinology out-patient clinic for further evaluation. Patients were divided according to age group and prevalence per decade. Incidental thyroid nodules were found in 98 [12.3%] patient. Bilateral nodules were found in 61 and unilateral in 37 patients. Nodules equal or larger than one cm were found in 89 patients. Fifty eight nodules were solid, 24 were cystic and 16 showed mixed echogenesity. Fine needle aspiration biopsy was performed in 87 patients, and results showed 79 [91%] benign and 8 [9%] malignant nodules. Most malignant nodules were papillary carcinomas. Younger age groups [<55 yrs] were reported to have a higher rate of thyroid nodules [18.3% vs.7.3%, RR: 2.51] [95% CI: 1.68-3.75; P=0.0000028]. Incidental thyroid nodules are a common finding during carotid Doppler ultrasound examination and some of these nodules may represent clinically significant pathology. Younger age constitutes a group of people with higher risk for thyroid nodules

Metabolic syndrome in a jordanian cohort: demography, complications and predictors of cardiovascular diseases

To assess the demographic features of Metabolic Syndrome and the prevalence of composite cardiovascular disease [ischemic heart disease and stroke] and predictor factors in a Jordanian cohort with metabolic syndrome. We studied a Jordanian cohort who fulfilled the National Cholesterol Education Program and the Adult Treatment Panel III criteria for metabolic syndrome. This cohort was evaluated at the outpatient clinics for the five metabolic syndrome components, the presence of ischemic heart disease and/or stroke. The cohort was divided into two groups according to gender, age by decade and the presence of overt diabetes. Comparative studies among the two study groups to compare the means and assessment of the metabolic syndrome components for prediction of cardiovascular disease was carried out. Three hundred and fifty eight [207 males and 151 females] patients fulfilled the Adult Treatment Panel III criteria, 226 patients were type II diabetics on treatment. Hypertriglyceridemia was the most frequent feature of metabolic syndrome encountered followed by hypertension, high fasting blood sugar, high waist circumference [>102 cm] and low high density lipoprotein in descending disorder. There was no difference between the groups with regard to waist circumference but females had the worst lipid profile compared to males. Diabetic males however were having more metabolic syndrome components and diabetics were having more cardiovascular disease than other groups. Using univariate analysis, waist circumference and fasting blood sugar were found to be strong predictors of composite cardiovascular disease and ischemic heart disease but not stroke. We conclude that diabetics with metabolic syndrome have the worst cardiovascular disease composite end point and females have the worse lipid profile in comparison to males. Waist circumference and fasting blood sugar are the strongest predictors of ischemic heart disease [and composite cardiovascular disease]. Further larger controlled studies are needed to reveal whether there is difference in the stroke prevalence

Glucagonoma presenting as necrolytic migratory erythema in a long-standing type II diabetic patient

We report a case of glucagonoma in a 60-year old diabetic lady who was seen by a dermatologist for a superficial erythematous skin eruption with flaccid bullae over both legs of recent onset. These findings warranted further investigations that revealed a pancreatic mass lesion involving the distal body and tail with three metastatic deposits within the right lobe of the liver. Distal pancreatectomy and splenectomy were performed and histological examination of the excised specimen confirmed the diagnosis of pancreatic glucagonoma with liver metastasis. Blood sugar levels became more controlled postoperatively. The skin lesion disappeared completely six months after surgery. The lady enjoys fairly good health, and is maintained on Somatostatin analogues for control of metastasis that are stable after 18 months of follow up

Thyroiditis in a Jordanian cohort with goitre: results of fine needle thyroid aspirate

To determine the prevalence of cytologically proven thyroiditis among patients with goiter referred to Endocrine clinic at King Hussein Medical Center using fine needle thyroid aspirate and to assess thyroid status among those patients. Case study of patients who underwent fine needle aspirate thyroid biopsy for different types of goiter from January 1995 to June 2004 was conducted. Fine needle aspirate thyroid biopsy was taken using a 20cc syringe on a pistol gun apparatus under aseptic technique. All reports including the diagnoses of thyroiditis, autoimmune thyroiditis [Hashimoto's thyroiditis], lymphocytic thyroiditis, and focal thyroiditis were included. Thyroid function tests and thyroid antibodies were also reported in some patients. A total of 1934 patients underwent fine needle aspirate thyroid biopsy during the study period, 279 cases were excluded because of inadequacy of the sample, missing reports and repeated sample in some patients with the same diagnosis. Those actually included in the study were 1655 [females 1475, males 180, male: female ratio was 8:1]. Thyroiditis was reported in 323 patients [females 93.5%], giving a total prevalence of 19.5%; 11.7% for males and 20.5% for females. Hashimoto, lymphocytic and unclassified thyroiditis were found in 66.25%, 22.6% and 8.6% of the patients respectively. Hashimoto' and lymphocytic thyroiditis are the commonest causes of thyroiditis in Jordanian patients with goiter, females being affected more commonly than males. Fine needle aspirate thyroid biopsy of thyroid gland is an important tool of investigation for thyroid disorders in general and thyroiditis in patients with goiter. Long term follow up of patients with thyroiditis should be adopted

Insulin therapy and nurses' professional knowledge

Nurses' knowledge about insulin and diabetes is very important to provide competent care. Nurses have the responsibility to ensure adequate education and management for diabetic patients. Several studies documented a deficiency in their knowledge. The aim of this study is to: a.] Assess the knowledge of nurses about insulin; duration of action, availability, administration and side effects. b.] Reveal the role of experience upon their knowledge. A questionnaire was formulated by the Endocrine Unit - King Hussein Medical Center [KHMC] that contained 10 questions of 17 items. 337 questionnaires were distributed to six Royal Medical Hospitals in Amman, Zarka and /Irbid regions. State registered nurses who have a direct role in preparing and administering insulin were included. 300 questionnaires were returned. Questions were answered as true or false. Nurses were subdivided into 3 groups according to years of experience. [Group A, 1-5 years, group B, 6-10 years, group C, > 10 years]. We obtained a return rate of 89%, with an overall true rate of 63.1% [SEP 0.0602, SD +/- 0.02985. 95% C.I.= 0.6858, 0.5766. corresponding to P< 0.05] and false rate of 36.9%. Best results were obtained in group B with 67.6% true rate then group C with 63.6% and group A with 58.1% true rate. It was concluded that our nurses are ill-equipped to educate patients and to administer insulin with their present level of knowledge. A well- organized, structured program of teaching is essential to raise their level of knowledge and eventually improve diabetic management and care

Mitochondrial myopathy case report and review of literature

This is to report a case of a 17- year- old female, who presented with bilateral ptosis since childhood, and progressive ophthalmoplegia for the past six 6 years associated with retinal pigmentation. She has short stature and primary amenorrhea. The clinical features and other investigations including C.S.F. examination, electromyography and muscle biopsy, were in keeping with mitochondrial myopathy; Kearne - Sayre Syndrome [KSS]