Effect of gonadotropin-releasing hormone analogue on final adult height among Jordanian children with precocious puberty.

OBJECTIVES: To study the effect of gonadotropin-releasing hormone analogue (GnRHa) on final adult height (FAH) among Jordanian children with central precocious puberty (CPP). Methods: It is a retrospective historical cohort study. We assessed the FAH and height gain in 43 children with CPP (39 females and 4 males) who received GnRHa and 13 children with CPP (11 females and 2 males) who did not receive GnRHa and achieved FAH between 2004 and 2014. Final adult height was compared to target height (TH) and mid- parental height (MPH) in both groups. Results: In GnRHa treated females, the FAH was 158.5±6.6 cm compared to 151.2±8.4 cm in the untreated females (p=0.004). Height gain was 2.9±8.5 cm in the treated females compared to -3.8±7.7 cm in the untreated group (p=0.022). In GnRHa treated females, FAH was found to be closer to TH (p=0.01) and MPH (p=0.01) in comparison to untreated females. Conclusion: Gonadotropin-releasing hormone  analogue is effective in increasing FAH in Jordanian children with CPP, particularly those with advanced bone age.

The incidence, risk factors, and mortality of preterm neonates: A prospective study from Jordan (2012-2013).

OBJECTIVE: To explore the incidence of preterm delivery, maternal risk factors for having a preterm neonate, and preterm neonates' mortality in Jordan. MATERIALS AND METHODS: A cross-sectional population-based design was applied. Socio-demographic, perinatal, delivery risk factors, and survival information were gathered in pre- and post-hospital discharge interviews with 21075 women who gave birth to live neonates at ≥20 weeks of gestation in 18 hospitals in Jordan. Women were interviewed between 2012 and 2013. The sample was limited to singleton women who gave birth to live neonates. Women who gave birth to stillborn babies were excluded. RESULTS: Preterm delivery incidence was 5.8%, of which 85% were in 32-36 gestational weeks. Male sex, primigravidity, hypertension, preeclampsia, and diabetes were significantly associated with an increased risk of preterm delivery. Women aged 20-35 years had the lowest risk of preterm delivery. Mother's weight <50 kg, hospitalization at 24-34 gestational weeks, lack of antenatal care visits or <8 visits during pregnancy, a history of preterm delivery, and a history of stillbirth/neonatal death were associated with increased risks of preterm delivery. The neonatal mortality rate was 4/1000 live births among full-term and 123/1000 live births among preterm babies. Prematurity, congenital anomalies, and maternal diseases were the causes of 84% of preterm neonatal deaths. CONCLUSION: The mortality rate was considerably higher among preterm neonates than among term neonates; discrepancies between Jordan and other countries existed. Systematic prenatal risk assessment and quality postnatal health care improvements are required to improve the survival rates of preterm neonates.

Level, Causes and Risk Factors of Neonatal Mortality, in Jordan: Results of a National Prospective Study.

OBJECTIVE: The present study aimed at assessment of the magnitude of neonatal mortality in Jordan, and its causes and associated factors. METHODS: Through a multistage sampling technique, a total of 21,928 deliveries with a gestational period ≥20 weeks from 18 hospitals were included in the study. The status of their babies 28 days after birth, whether dead or alive, was ascertained. Extensive data were collected about mothers and their newborns at admission and after 28 days of birth. Causes of death were classified according to the neonatal and intrauterine death classification according to etiology. Preventability of death was classified according to Herman's classification into preventable, partially preventable, and not preventable. RESULTS: Neonatal mortality rate, overall and for subgroups of the study was obtained. Risk factors for neonatal mortality were first examined in bivariate analyses and finally by multivariate logistic regression models to account for potential confounders. A total of 327 babies ≥20 weeks of gestation died in the neonatal period (14.9/1000 LB). Excluding babies <1000 g and <28 weeks of gestation to be consistent with the WHO and UNICEF's annual neonatal mortality reports, the NNMR decreased to 10.5/1000 LB. About 79 % of all neonatal deaths occurred in the first week after birth with over 42 % occurring in the first day after birth. According to NICE hierarchical classification, most neonatal deaths were due to congenital anomalies (27.2 %), multiple births (26.0 %), or unexplained immaturity (21.7 %). Other important causes included maternal disease (6.7 %), specific infant conditions (6.4 %), and unexplained asphyxia (4.9 %). According to Herman's classification, 37 % of neonatal deaths were preventable and 59 % possibly preventable. An experts' panel determined that 37.3 % of neonatal deaths received optimal medical care while the medical care provided to the rest was less than optimal. After adjusting for socio-demographic characteristics, type of the hospital, and clinical and medical history of women, the following variables were significantly associated with neonatal mortality: male gender, congenital defects, inadequate antenatal visits, multiple pregnancy, presentation at delivery, and gestational age. CONCLUSION: The present study showed the level, causes, and risk factors of NNM in Jordan. It showed also that a large proportion of NNDs are preventable or possibly preventable. Providing optimal intrapartum, and immediate postpartum care is likely to result in avoidance of a large proportion of NNDs.

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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: In contrast to normal men there was no change in androgen levels in diabetics but the 17-OH progesterone was elevated.

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

OBJECTIVE: To detect feet changes and to identify risk factors leading to amputation among type 2 diabetics. METHODS: 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. RESULTS: 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. CONCLUSION: Prevalence of amputation correlates with duration of diabetes, poor glycemic control, smoking, neurological impairment, peripheral vascular disease and microalbuminuria.

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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Biochemical thyroid dysfunction and thyroid autoimmunity were evident in type 1 diabetics who were apparently euthyroid, with no significant difference between diabetics and controls.

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

OBJECTIVE: To study the effect of metformin on androgens in normal men. METHODS: A total of 12 healthy males volunteered to participate in the study. A blood sample was obtained from each of them and analyzed for the following: Testosterone (total and free), sex hormone binding globulin dehydroepiandrosterone sulphate, 17-hydroxyprogesterone, luteinizing hormone, and follicle stimulating hormone. In addition, each participant was subjected to a glucose tolerance test and his insulin level was measured. Metformin 850 mg twice daily for 2-weeks was given to each subject after which the above tests were repeated. A paired t-test was used to assess the statistical significance of any observed differences before and after metformin. RESULTS: After metformin administration, there was a significant reduction in serum level of total testosterone (p=0.0001), free testosterone (P=0.002), and 17 hydroxyprogesterone (p=0.0001). There was also a significant increase in serum level of sex hormone binding globulin (p=0.009) and dehydroepiandrosterone sulphate (P=0.0008). Serum levels of luteinizing hormone and follicle stimulating hormone showed no significant changes. Similarly, there were no changes in fasting plasma glucose, fasting serum insulin, weight, or blood pressure. CONCLUSION: Metformin administration was associated with a reduction in total testosterone, free testosterone, and 17-hydroxyprogesterone and an increase in sex hormone binding globulin and dehydroepiandrosterone sulphate in normal males. The clinical significance of these findings needs further investigation.