Prevalence of diabetic foot ulcer and its associated risk factors among diabetic patients in Jordan

The objectives of this study were to assess the prevalence of diabetic foot ulcers and their risk factors among patients attending the National Center for Diabetes, Endocrinology, and Genetics [Amman, Jordan]. A systematic random sample of 1,000 diabetic patients was selected from patients attending the diabetes clinic at the National Center for Diabetes, Endocrinology, and Genetics [Amman, Jordan]. Vascular, neurological, musculoskeletal, and ulcer risk categories were all assessed. There were 49% males in the sample. The mean age of the sample was 52 years, and the mean duration of diabetes was 9.7 years. Diabetic foot ulcer prevalence was 4.6%, sensory neuropathy 14.9%, lower limb ischemia 7.5%, and amputation 1.7%. Ulceration was associated mainly with the male gender, neuropathy, and increased duration of diabetes. Future efforts should be directed toward educating both healthcare professionals and patients about proper foot care. Community based studies are also necessary to determine the actual prevalence of diabetic foot complications

Infantile and early childhood masturbation: sex hormones and clinical profile

Few studies have explored the hormonal triggers for masturbation in infants and young children. Thus, we aimed to study the sex hormones and clinical profiles of masturbating infants and young children. This case-control study involved infants and young children who masturbate and were referred to three pediatric neurology clinics between September 2004 and 2006 [n=13], and a similar control group. All children underwent basic laboratory investigations prior to referral. Other tests included electroencephalography [n=8] and brain neuroimaging [n=9]. We measured dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, free testosterone, estradiol, dehydroepiandrosterone, sex hormone-binding globulin [SHBG], and androstenedione in all participants. The median age at the first incident was 19.5 months [range, 4-36 months]; the median masturbation frequency, 4 times/day; and the median duration of each event, 3.9 min. The subjects masturbated in both prone [n=10] and supine positions [n=3]; two subjects used the knee-chest position. All subjects showed facial flushing; 6, friction between the thighs; 5, sweating; 9, sleeping after the event; and 12, disturbance on interruption. EEG was abnormal in one of eight subjects tested, and neuroimages were normal in all of nine subjects examined. The case and control groups had comparable levels of all sex hormones, except estradiol, which showed significantly lower levels in the case group [P=.02]. Masturbation in children seems to be associated with reduced estradiol levels, but not with other sex hormones. Further studies are needed to confirm our findings

Factors associated with sexual dysfunction in Jordanian women and their sexual attitudes

Female sexual dysfunction [FSD] is defined as disorders of libido, arousal, and orgasm, as well as sexual pain, that leads to personal distress or interpersonal difficulties. Social aspects of FSD have been understudied. The aim of this study was to explore the social aspects of FSD and sexual attitudes of Jordanian women. Six hundred thirteen married females were studied between October 2006 and August 2007 at the National Center for Diabetes, Endocrinology and Genetics [NCDEG], Amman, Jordan. Females were interviewed using a special questionnaire that was suitable to our culture and added to the Arabic translation of the Female Sexual Function Index [FSFI] Questionnaire. Older age was associated with a decreased total FSD index and its domain scores. Women with obesity were more likely to have impaired arousability and impaired capability of reaching orgasm. About 58.5% of women reported that they prepared themselves if they had sexual desire and 68.2% reported wearing special attire for this purpose. Only 37.2% of women could ask their husband for a special excitement. FSD is prevalent in Jordan. Its social aspects are understudied and need more research in the future

Approach to dysglycemia: Do we need to treat impaired glucose tolerance and impaired fasting glucose?

Impaired glucose tolerance [IGT] and impaired fasting glucose [IFG] are not only a surrogate for the state of insulin resistance but are also associated with the microvascular and macrovascular complications traditionally linked to diabetes. They predict an increased risk for death and morbidity due to cardiovascular disease. There is growing evidence that early detection of this state of [pre-diabetes] enables us to limit fehese recognized complications and perhaps to halt the progression to diabetes. For all pre-diabetes patients' life style modifications, emphasizing modest weight loss and moderate physical activity are strongly recommended. Pharmacological intervention may also be necessary. Many studies have shown several drugs, both antidiabetic and nonhypoglycemic agents to be useful. If pharmacological treatment is required, Metformin is considered the first choice because of its safety, tolerability, efficacy and low cost

Pituitary magnetic resonance imaging experience in Jordan

To assess the pituitary findings as demonstrated on MRI and to compare the results with the data published in the literature. One thousand, one hundred and thirty-eight pituitary MRI's with and without intravenous contrast media [gadolinium] were performed over 6 years from 2001 to 2007 in the Department of Diagnostic Radiology, Jordan University Hospital, Amman, Jordan. The patients were referred from various departments and were evaluated for pituitary, other sellar, and juxtasellar abnormalities. The results were compared with those in the published literature. Four hundred and eight-three normal scans were excluded from the study. The remaining 655 were abnormal, pituitary adenoma was detected in 327 [49.9%], microadenoma was present in 213 [32.5%], and macroadenoma in 114 [17.4%]. Partial empty sella was seen in 157 [24%], diffuse pituitary gland enlargement in 98 [14.9%], ectopic pituitary posterior lobe in 13 [2%], and other findings in 31 [4.7%]. The incidence of pituitary adenoma was equal in both genders; however, microadenoma was more common, affected a younger age group, and was predominately seen in females. The other parameters showed agreement with the published literature

Hypertension among 1000 patients with type 2 diabetes attending a national diabetes center in Jordan

In Jordan, there is a paucity of research on hypertension and its risk factors among patients with type 2 diabetes mellitus. This study was designed to assess the prevalence of hypertension, risk factors, and the level of awareness and control of hypertension among outpatients with type 2 diabetes. A cross-sectional study was carried out on a sample of 1000 patients with type 2 diabetes who were attending the National Center for Diabetes, Endocrine and Genetic Diseases for follow-up during the period of June to December 2006. Data were collected from medical records and through a structtured interview questionnaire. Logistic regression analysis was used to assess the independent effect of variables on hypertension. The prevalence of hypertension [BP >130/80 or on medication for high blood pressure] was 72.4% [70.9% of males and 73.9% of females]. The logistic regression indicated that hypertension was positively asssociated with age [P=.001], body mass index [P=.001], and duration of diabetes [P=.001]. About one-half of patients who were aware of having hypertension failed to keep their blood pressure under control. Hypertension is a common co-morbidity among diabetic patients. Despite a high rate of awarenness of hypertension among study subjects [93%], hypertension was not controlled to the recommended levels of blood pressure in about one-half [50.4%] of patients

Prevalence of dyslipidemia in patients with type 2 diabetes in Jordan

To determine the frequency and patterns of dyslipidemia in patients with type 2 diabetes mellitus [DM] and to estimate the effects of sociodemographic and clinical variables on dyslipidemia. The setting took place in The National Center for Diabetes, Endocrinology and Genetics [NCDEG] at the University of Jordan, Amman, Jordan. The NCDEG is the only referral center in the country; therefore, the patients represent the population in different parts of the country. A cross-sectional design was used. A total of 702 patients with DM from the NCDEG aged >/= 20 years were consecutively enrolled between June 2005 and July 2006. Medical record abstraction of sociodemographic, clinical, and laboratory data was performed. The frequency of hypercholesterolemia was 77.2%, low high-density lipoprotein [HDL] was 83.9%, high low-density lipoprotein [LDL] was 91.5%, and hypertriglyceridemia was 83.1%. Females had greater abnormalities in lipid profiles. High LDL-cholesterol was the most common dyslipidemia in combination [91.5%] and in isolation [12.8%]. Gender and hemoglobin A1C [HbA1c] predicted high total cholesterol; age and hypothyroidism predicted low HDL-cholesterol, gender predicted high LDL-cholesterol; and use of beta-blockers predicted high triglycerides. Over 90% of patients with type 2 DM had one or more types of dyslipidemia. The most common dyslipidemia in our study was high LDL-cholesterol and high triglycerides as reported in the literature. We recommend aggressive drug management, education, counseling, and behavioral interventions

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.

Effects of short term metformin administration on androgens in diabetic men.

Metformin, an oral hypoglycemic agent, has several other metabolic and hormonal effects. This study aims at identifying the metabolic effect of metformin on androgens in diabetic men. The study was conducted at The National Center for Diabetes Endocrinology and Genetics, Jordan University Hospital, Amman, Jordan from April 2001 to September 2001. We studied 15 men with type 2 diabetes mellitus by measuring fasting serum glucose, insulin, glycosylated hemoglobin, total and free testosterone, sex hormone binding globulin, dehydroepiandrosterone sulphate, 17-OH progesterone, luteinizing hormone, and follicle stimulating hormone before and after a short course of metformin. There was a significant decrease in fasting serum glucose and glycosylated hemoglobin and increase in the level of 17-OH progesterone. The remainder of the measured parameters did not show any significant change. Although serum glucose and glycosylated hemoglobin decreased insulin levels were not changed. In contrast to normal men there was no change in androgen levels in diabetics but the 17-OH progesterone was elevated

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

Thyroid dysfunction in patients with type 2 diabetes mellitus in Jordan

To investigate the prevalence of thyroid dysfunction and autoimmunity in type 2 diabetic patients. The study was conducted at the National Center for Diabetes, Endocrinology and Genetics, Jordan University Hospital, Amman, Jordan, between March 2000 and September 2000. A group of 908 type 2 diabetic patients [T2DM] were recruited in the study and underwent investigations for thyroid functions; free thyroxine [FT4], free tri-iodothyronine [FT3] and thyroid stimulating hormone [TSH]. Six hundred had performed thyroid autoantibodies, thyroid peroxidase antibodies [TPOab] or antimicrosomal antibodies [AMA] and thyroglobulin antibodies [Tgab]. They were compared with 304 non-diabetics, of those 282 had performed thyroid antibodies. Fifty-three [5.9%] of diabetic patients were known to have thyroid disease. As a direct result of screening, new thyroid disease cases were diagnosed in 6.6% of the patients. Thus, the overall prevalence of thyroid disease was found to be 12.5%. The most common was subclinical hypothyroidism [4.1%]. In the control group, the prevalence of thyroid disease was 6.6%. The most common was subclinical hypothyroidism [5%]. There was a significant difference between diabetics and control subjects p=0.0064. Positive TPOab was found in 8.3% of T2DM patients [N=600] versus 10.3% in the control group [N=282] p=0.412. Positivity for both TPOab and Tgab was found to be 2.5% of T2DM versus 6% of the control subjects p=0.0155. This study suggests that diabetic patients should be screened for asymptomatic thyroid dysfunction

Thyroid function and thyroid autoimmunity in patients with type 1 diabetes mellitus

An association between diabetes mellitus and autoimmune thyroid disease is well known. We have investigated the prevalence of thyroid dysfunction and autoimmunity in type 1 diabetic patients. Seventy-nine type 1 diabetic patients were recruited in the study, and underwent complete investigations for thyroid function, which included free thyroxine, free tri-iodothyronine, and thyroid stimulating hormone, of those only 64 patients had performed thyroid autoantibodies [TAb]; anti- thyroid peroxidase antibodies [TPOAb] or antimicrosomal antibodies and thyroglobulin antibodies [TgAb]. They were compared with 127 healthy subjects matched for sex and age. This study was carried out at the National Center for Diabetes, Endocrinology and Genetics, Jordan University, Amman, Jordan between 2000 and 2001. In the diabetic group, 7 cases [8.9%] of thyroid dysfunction were detected, 4 of these were diagnosed as subclinical hypothyroidism, whereas the other 3 had overt hypothyroidism and were on thyroxine replacement therapy. In the control group, 6 [4.7%] subjects were diagnosed as subclinical hyperthyroidism. There was a significant difference in thyroid function variables between diabetics and controls. Among type 1 diabetic patients, 7 [9.2%] had thyroid autoantibodies, 5 with positive TPOAb only and 2 with positive TAb; TPOAb or antimicrosomal antibodies and TgAb; compared with 8 [6.3%] in the control group, 4 with positive TPOAb only and 4 with positive TAb; TPOAb or antimicrosomal antibodies and TgAb P=0.68. Biochemical thyroid dysfunction and thyroid autoimmunity were evident in type 1 diabetics who were apparently euthyroid, with no significant difference between diabetics and controls

Epidemiology and management of hypertension among Bedouins in northern Jordan

To estimate the magnitude of hypertension, and its levels of awareness and control of hypertension among a community of Jordanian aborigines in Northern Jordan; and to compare the study findings with findings from other Jordanian communities. A systematic sample of 50% of all households of Qafqafa, Northern Jordan was selected and all members of the selected households were included in the study at Qafqafa Health Center, Qafqafa, Jordan. A structured questionnaire was administered to all study participants and measurement of blood pressure was performed according to a preset criteria. Data on 366 subjects included in the sample were collected during the months of April and May 2002. A total of 40 subjects or 10.9% were suffering from hypertension. Prevalence rate of hypertension was significantly lower than the 16.1% and 16.3% prevalence rates reported from other more modernized Jordanian communities. Logistic regression analysis indicated that hypertension was positively associated with masculinity, age, illiteracy, obesity, and with positive family history of hypertension. No association was detected between hypertension and each of smoking, Diabetes mellitus, and total serum cholesterol. This study showed that one-half [47.5%] of hypertensives were unaware of their diagnosis and more than one-half [57.1%] of those aware of their diagnosis did not achieve control of their hypertension. Population of the study community has significantly lower levels of hypertension than both semi-urban and recently urbanized Jordanian communities, and much of the rise in blood pressure levels is attributed to environmental factors. Moreover, hypertension management programs in Jordan are far below the optimal standards

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

Values, qualifications, ethics and legal standards in Arabic [Islamic] medicine

Many historians claim that the Western world pioneered in the setting of ethical, legal and professional standards in the practice of medicine. Informed medical consent is proposed by some as an American invention. Others claim that patient rights and legal protection propose have stated in the early decades of the 20th century. This review is an attempt to uncover the facts regarding the way Arabs practiced medicine during the golden era of Islam. Eight hundred to fifteen hundred AD this includes the qualification of physicians according to a well designed curricula covering the science and humanity of medicine. The rules governing the quality control of health care delivery system and to some degree the principles of informed medical consent and to a lesser degree the principles of litigation are discussed. We hope that this paper will be a call to all humanity loving persons to end prejudices against other people and to stop stereotyping