Prevalence of proteinuria and its associated factors in hypertensive diabetic patients.

OBJECTIVE: Hypertensive diabetic patients are at increased risk for chronic kidney disease. Proteinuria is an early sign of kidney damage. Limited research is available on proteinuria and on its associated factors in hypertensive patients with diabetes. This study aimed to assess the prevalence of proteinuria and its associated factors in hypertensive diabetic patients. PATIENTS AND METHODS: The current retrospective study utilized medical records and hospital computers to collect sociodemographic and medical information about the study patients in two major hospitals in Jordan. Binary regression analysis was used to find the factors that are significantly and independently associated with the presence of proteinuria. RESULTS: Data from 522 hypertensive diabetic patients were investigated. Factors including age (OR=0.691; 95% CI: 0.930-0.994; p<0.01), high-density lipoprotein level (OR=0.450; 95% CI: 0.211-0.960; p<0.05), and higher glomerular filtration rate (OR=0.964; 95% CI: 0.950-0.977; p<0.01) were associated with proteinuria among the study patients. In contrast to metformin (OR=0.237; 95% CI: 0.098-0.572; p<0.01), patients who received insulin (OR=1.992; 95% CI: 1.136-3.492; p<0.05), thiazide diuretics (OR=1.848; 95% CI: 1.108-3.083; p<0.05), calcium channel blockers (OR=1.833, 95% CI: 1.110-3.028, p<0.05), or beta-blockers (BBs) (OR=2.199, 95% CI: 1.257-3.848, p<0.01) had a higher likelihood of having proteinuria. CONCLUSIONS: For preserving kidney function, it is deemed necessary to perform regular checkups for proteinuria among hypertensive diabetic patients, particularly in young patients, patients with low levels of high-density lipoprotein, and those with a lower glomerular filtration rate.

The role of TNF-α G-308A promoter polymorphism in glycemic control in Type 2 diabetes patients.

BACKGROUND: TNF-α polymorphisms were shown to be associated with insulin resistance and diabetes development and complications. AIM: To investigate the association between glycemic control in Type 2 diabetes patients and TNF-α G-308A single nucleotide polymorphism (SNP). METHODS: This was a cross-sectional observational study, where diabetes patients from both genders (170 male and 185 female) were enrolled in the study. Patients were divided into two groups: good glycemic control (n = 158) and poor glycemic control (n = 197). Genotyping of TNF-α G-308A SNP was carried out using restriction fragment length polymorphisms-polymerase chain reaction. RESULTS: The results showed that TNF-α G-308A SNP is strongly associated with glycemic control in type 2 diabetes patients. Patients with the AA and AG genotypes had better glycemic control than those with GG genotype (P < 0.01). Other parameters that impacted glycemic control include duration of the disease (P < 0.01) and response to insulin therapy (P < 0.01). However, no contribution for gender or statins use to glycemic control was observed (P > 0.05). CONCLUSION: TNF-α G-308A SNP might modulate glycemic control among type 2 diabetes patients.

Frequency of MDR1 single nucleotide polymorphisms in a Jordanian population, including a novel variant.

The multidrug resistance gene (MDR1 or ABCB1) codes for P-glycoprotein, which plays an important role in regulating absorption, distribution, and elimination of drugs. We examined MDR1 gene variants in 100 unrelated subjects from various regions of Jordan. The MDR1 gene was scanned using direct sequencing. Six rare variants in MDR1 were detected, including a new variant, T3075A. This variant did not affect the protein sequence (synonym for threonine). Among the common SNPs, the frequencies of rs1128503 (C1236T) genotypes were: 0.23 (CC), 0.41 (CT) and 0.36 (TT). For the rs2032582 (G2677T) SNP, genotype frequencies were 0.38 for GG, 0.45 for GT, 0.13 for TT, 0.03 for GA, and 0.01 for TA, whereas for rs1045642 (C3435T), genotype frequencies were 0.17 for CC, 0.5 for CT and 0.33 for TT. The observed distribution of the common variants in the Jordanian population was within the range detected in other populations. These data on MDR1 gene variants in the Jordanian population will be useful for investigations on response to P-glycoprotein substrate drugs.

The role of type II deiodinase polymorphisms in clinical management of hypothyroid patients treated with levothyroxine.

STUDY OBJECTIVE: Several factors can affect achieving the goals with levothyroxine (L-T4) therapy. This study investigates the clinical and biochemical response to L-T4 replacement therapy in hypothyroid patients in correlation with genetic variation in Deiodinase type || (DIO2) gene. DESIGN AND SETTING: This is a cross-sectional correlation study. The setting was the diabetes and endocrinology clinics at 2 Jordanian Hospitals. METHODOLOGY: Patients with primary hypothyroidism who are controlled on stable L-T4 replacement therapy were recruited and thyroid function test was performed. Genetic analysis to detect 4 single nucleotide polymorphisms (SNPs) rs225011, rs7140952, rs225012 and rs2839858 in DIO2 gene was carried out using the polymerase chain reaction-based restriction fragment length polymorphism assay (PCR-RFLP). RESULTS: There was no correlation between the 4 SNPs in DIO2 gene and replacement doses of L-T4, whereas a statistical significance was found between rs7140952 and central obesity (P<0.05), and systolic and diastolic blood pressure (P<0.05). The dose of L-T4 was associated with lower levels of TSH, fT4, central obesity, body mass index and waist circumference. CONCLUSION: While L-T4 dose is associated with several positive effects on hypothyroid patients, none of the examined SNPs in DIO2 is correlated with replacement doses of the drug. However, rs7140952 polymorphism is associated with components of metabolic syndrome including blood pressure and central obesity.

An audit on the knowledge, beliefs and attitudes about the uses and side-effects of antibiotics among outpatients attending 2 teaching hospitals in Jordan.

This study aimedto assess general knowledge, beliefs and attitudes of people towards the use of antibiotics. Individuals referring to the outpatient pharmacies of 2 major teaching hospitals in the north of Jordan completed a self-administered, validated questionnaire. A total of 1091 individuals (56.8% males) participated in the study. Of these, 20.1% of the participants stated that antibiotics were used for bacterial infections, while 18.3% thought they were used for viral infections and 43.6% for mixed bacterial/viral infections. The average knowledge score of the participants about antibiotic uses and side-effects was low. Middle-aged participants and those with an education beyond high school had significantly higher knowledge scores about antibiotics use. Almost 75% of the participants disagreed that antibiotics could be given without a prescription.

An audit on the knowledge, beliefs and attitudes about the uses and side-effects of antibiotics among outpatients attending 2 teaching hospitals in Jordan

This study aimed to assess general knowledge, beliefs and attitudes of people towards the use of antibiotics. Individuals referring to the outpatient pharmacies of 2 major teaching hospitals in the north of Jordan completed a self-administered, validated questionnaire. A total of 1091 individuals [56.8% males] participated in the study. Of these, 20.1% of the participants stated that antibiotics were used for bacterial infections, while 18.3% thought they were used for viral infections and 43.6% for mixed bacterial/viral infections. The average knowledge score of the participants about antibiotic uses and side-effects was low. Middle-aged participants and those with an education beyond high school had significantly higher knowledge scores about antibiotics use. Almost 75% of the participants disagreed that antibiotics could be given without a prescription

Prophylactic use of aspirin does not induce anaemia among adults.

BACKGROUND: Aspirin is considered one of the most prescribed drugs worldwide, predominantly for its cardioprotective effects. However, its use may be precluded by gastrointestinal and haematological side-effects. OBJECTIVE: To investigate the association between the prophylactic use of aspirin and the prevalence of anaemia among adults. Other demographic factors and co-morbid conditions such as kidney or liver failure, diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease, ulcer, ulcer medications, and the use of non-steroidal anti-inflammatory drugs, which might be associated with anaemia, were also investigated. RESULTS: No association between aspirin use and prevalence of anaemia was observed. Age and smoking were the only factors contributing significantly to the occurrence of anaemia. Moreover, gender, age and the use of peptic ulcer medication were associated with reduced haemoglobin levels. CONCLUSION: The results may help in minimizing concerns about the development of anaemia among patients on aspirin. They highlight the importance of age, gender, smoking and ulcer medication in determining the incidence of anaemia among those patients.

The nephroprotective effects of pioglitazone and glibenclamide against gentamicin-induced nephrotoxicity in rats: a comparative study.

The aim of the current study is to comparatively examine the nephroprotective effects of pioglitazone and glibenclamide in a rat model subjected to gentamicin-induced nephrotoxicity. Six groups of rats were given either normal saline, or gentamicin, or pioglitazone, or gentamicin plus pioglitazone, or glibenclamide, or gentamicin plus glibenclamide for 11 days. The group administered gentamicin plus glibenclamide had a significant elevation of antioxidant enzyme activity and a significant reduction in lipid peroxidation when compared with the group treated just with gentamicin. The gentamicin plus glibenclamide group also showed mild necrosis according to histopathology when compared with the gentamicin-alone group. In contrast, the gentamicin plus pioglitazone group had a significant reduction in antioxidant enzyme activity and a significant elevation in lipid peroxidation levels when compared with the gentamicin-alone group. Our study showed that only glibenclamide but not pioglitazone has protective effects against gentamicin-induced nephrotoxicity in rats.

Headache syndromes amongst schoolchildren in Riyadh, Saudi Arabia.

We evaluated 1,400 randomly selected Saudi children in grades 1 through 9 to determine the prevalence of migraine and tension-type headache. Of the 1400 distributed questionnaires, 1,181 (84.3%) were completed properly and so served as the basis for analysis. There were 573 boys (48.5%) and 608 girls (51.5%). Ages ranged from 6 to 18 years. Five hundred eighty-eight children (49.8%; 272 boys and 316 girls) had recurrent headache episodes not related to febrile illness in the year preceding the survey. Eighty-four children (7.1%; 37 boys and 47 girls) had recurrent episodes of migraine, and 504 (42.7%; 232 boys and 272 girls) had recurrent episodes of nonmigraine headache. For both boys and girls, the age-specific prevalence rate for nonmigraine headache rose steadily from around 15% at aged 6 to 7 years to nearly 60% after aged 15. For migraine, there was a sharp increase in the prevalence rate (from around 2% to around 9%) at aged 10 to 11, also in both boys and girls. Age-adjusted prevalence for migraine between aged 6 and 15 was 6.2%. Due to the relatively poor sensitivity of some of the IHS criteria in children, this figure may underestimate the true magnitude of migraine in the population studied.

Home management of fever in children: rational or ritual?

Fever is extremely common in childhood. Parents have been shown to have unrealistic fears, resulting in inappropriate management of fever in their children. This study was conducted to survey parents about their knowledge concerning home management of fever in children in their care. Parents of 560 febrile children were randomly recruited and interviewed in the waiting areas of the outpatient clinics or emergency room in four hospitals in Riyadh city using a standard questionnaire. Most of the interviewees were mothers, aged within 20-39 years. Although more than one-half of fathers and one-third of mothers in the study were well educated, most were misinformed about recognition and definition of fever. Most parents had poor knowledge regarding minimum temperatures for administering correct doses of antipyretic drugs or for sponging/bathing with water of the correct temperature. Most parents demonstrated a poor understanding of the appropriate frequency for checking the child's temperature and administering antipyretics. Only one-third of parents indicated a reasonable educational imprint by health-care providers. Considerable efforts will be required to educate parents about fever and its management.

Neonatal gangrene of the extremities.

Vascular insufficiency of a peripheral limb is a well-recognized and serious complication occurring in newborn infants. A 15-year review of a Level III neonatal intensive care unit at The Children's Hospital of Eastern Ontario revealed 10 infants who had a vascular insult to a limb necessitating the amputation of a portion of the limb. Predisposing factors to vascular occlusion were prematurity, polycythemia, umbilical artery catheterization, and intensive care treatment for other life-threatening illnesses. The lower extremity was most commonly affected, requiring below-knee amputations in two infants, knee disarticulation in one, and toe amputations in five. The remaining infants required an elbow disarticulation and amputation of the fingers, and one child had a massive ischemic contracture of the lower limb. Care should be taken not to amputate prematurely and await definitive demarcation of the gangrenous portion. Amputation should be designed to preserve growth plates wherever possible to ensure an adequate stump for prosthetic fitting in the older child.