Sexual dysfunction among Jordanian men with diabetes

To estimate the prevalence and severity of erectile dysfunction [ED] and its correlations among Jordanian men with diabetes. We conducted this study at the National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan, between January and August 2004. The study included 988 married diabetic men. Patients were interviewed by one of our medical staff based on a health care questionnaire and an Arabic translation of the 15-item International Index of Erectile Function. Scores of the questions in each of the 5 sexual function domains were summed up. Dysfunction was categorized as absent, mild, moderate or severe. The overall prevalence of ED was 62%; and we found that 30.3% had severe ED. The prevalence increased with age from 26.5% [13 out of 49] of patients <40 years of age to 91% [87 out of 96] in the age group >/= 70 years. Severity of ED increased with age as well. Multivariate logistic regression analysis identified age, glycemic control, hypertension, coronary artery disease, retinopathy and neuropathy as independent risk factors of ED. Among patients with ED, 7% reported having treatment for ED. Prevalence of ED among Jordanian diabetic patients is high. It increases with age and poor glycemic control. Other independent risk factors include: hypertension, coronary artery disease, retinopathy and neuropathy.

Radiological findings in wolfram syndrome

To determine the precise radiologic findings in Wolfram syndrome [WFS] patients using objective techniques in order to better define the reference population for the clinical evaluation. Sixteen patients [6 males and 10 females] with WFS found in 4 families were included in this study. Fourteen patients with WFS-2 came from 3 families while 2 patients with WFS-1 from one family. All patients were studied at Jordan University Hospital, Amman, Jordan, from January 2001 through to January 2003 by definite radiologic techniques as part of a thorough clinical comprehensive assessment. These include intravenous urography, abdominal and pelvic ultrasonography, barium meal, upper gastrointestinal endoscopy and magnetic resonance imaging with and without contrast to the brain and the pituitary gl and s. Five of the female patients had a small uterus. Spina bifida was found in 7, hydronephrosis in 9 and hydroureter in 5 patients. Peptic ulcer was detected in 10 out of 14 available patients and helicobacter pylori in 7 out of 16 patients. Atrophy was detected in all brains, 9 brain stems, 12 cerebellums and 14 optic tracts of all patients. The size of the pituitary gl and s was variable. The particular radiologic assessment of patients with WFS proofed that, urinary tract dilatation was detected in WFS-1 and WFS-2 patients though all WFS-2 patients have no diabetes insipidus. Peptic ulcer was frequently higher in WFS-2 patients. No significant radiologic difference was found between patients with WFS-1 and WFS-2

Prevalence and predictors of diabetic foot syndrome in type 2 diabetes mellitus in Jordan

To detect feet changes and to identify risk factors leading to amputation among type 2 diabetics. A total of 1142 patients with type 2 diabetes mellitus; 595 males [52%], and 547 females [48%] were seen between January and December 2001 at the National Center for Diabetes, Endocrinology, and Genetics [NCDG] Amman, Jordan. The mean age was 56.1 years [SD=10.2] and the mean duration of diabetes was 9 years [SD=7.1]. All patients had a complete medical assessment including history, physical examination, glycosylated hemoglobin [HbA1c] [the mean of the last 4 readings] and microalbuminuria. Statistical analysis were performed to identify significant risk factors leading to amputation using Epi info, version 6 software. Mean HbA1c was 7.4% [SD=1.4]. The prevalence of hypertension was 52%, retinopathy 45% and microalbuminuria 33%. Impaired vibration, position and protective sense were found in 19%, 13%, and 18%. The prevalence of all amputations was 5%. The following were strong predictors of amputation; duration of diabetes [P= 0.04], smoking [P=0.01], microalbuminuria [P=0.02], retinopathy [P=0.008], legs hair loss [P=0.003], neurological deficit [P=0.0001], ulceration [P=0.00001] absent dorsalis pedis [P=0.0006] and insulin therapy [P=0.0001]. The rate of amputation was directly proportional to high HbA1c >= 8% [P=0.01]. Age and gender were not found to have an impact on prevalence of amputation. Prevalence of amputation correlates with duration of diabetes, poor glycemic control, smoking, neurological impairment, peripheral vascular disease and microalbuminuria

Neurologic involvement in wolfram syndrome

To study 10 patients with Wolfram syndrome sometimes referrd to as DIDMOAD [diabetes insipidus, mellitus, optic atrophy and deafness] from three Jordanian families to assess for neurologic involvement, all of them had diabetes mellitus, nine [90%] patients had optic atrophy [OA], and eight [80%] patients had sensorineural deafness. All patients had standard full clinical neurologic examination. Eight patients were seen by staff psychiatrist for one time interview. Standard non-contrast brain and pituitary magnetic resonance imaging was carried out for all the patients. five patients had full field pattern shift visual evoked response. Eight patients had nerve conduction study of one upper and one lower limb. Six patients had 18 channel electroencephalogram. Five patients had brainstem evoked response study. Apart from defining features of the syndrome [diabetes mellitus, optic atrophy, sensorineural deafness] 3 patients [30%] had abnormal neurologic examination [depressed deep tendon reflexes, stuttering and mild ataxia], two [20%] had mildly abnormal psychiatric findings [temper outburst and depression] three patients [30%] had abnormal brain magnetic resonance imaging, three patients [30%] had abnormal visual evoked response with demylinating pattern in early optic involvement and axonal pattern in late disease. Two patients [20%] had abnormal nerve conduction study [mild sensory motor polyneuropathy with axonal and demyelinating features]. One patient [10%] had abnormal electroencephalogram and all patients tested for brainstem evoked response [100%] had normal brainstem evoked response study. This study shows part of the spectrum of neurologic involvement in Wolfram syndrome. It is consistent with the degenerative nature of this clinical entity. Early demyelination followed by degeneration may be inferred from this study, and this is important to prove or disprove in the light of lacking enough neuropathologic data and understanding of its pathogenesis. Further pathologic and neurophysiologic studies are required