Prevalence of coeliac disease among adult patients with autoimmune hypothyroidism in Jordan.

The prevalence of coeliac disease among patients with autoimmune hypothyroidism has not been studied before in Jordan and other Arab countries. A cross-sectional record-based review was made of all adult autoimmune hypothyroidism patients who attended a referral centre in Jordan, during an 8-month period. Coeliac disease in these patients was diagnosed by the attending physician based on positive serological tests for anti-endomysial antibodies IgA and IgG followed by duodenal biopsy to confirm the diagnosis of coeliac disease. Of 914 patients recruited, 117 (12.8%) were seropositive for coeliac disease. Of 87 seropositive patients who underwent duodenal biopsy, 39 had positive histological findings of coeliac disease (44.8%). Extrapolating from these findings the overall rate of coeliac disease among autoimmune hypothyroidism patients was estimated to be 5.7%. In multivariate logistic regression coeliac disease was significantly associated with older age (> 40 years), presence of other autoimmune diseases, vitamin B12 deficiency and anaemia.

Prevalence of coeliac disease among adult patients with autoimmune hypothyroidism in Jordan

The prevalence of coeliac disease among patients with autoimmune hypothyroidism has not been studied before in Jordan and other Arab countries. A cross-sectional record-based review was made of all adult autoimmune hypothyroidism patients who attended a referral centre in Jordan, during an 8-month period. Coeliac disease in these patients was diagnosed by the attending physician based on positive serological tests for anti-endomysial antibodies IgA and IgG followed by duodenal biopsy to confirm the diagnosis of coeliac disease. Of 914 patients recruited, 117 [12.8%] were seropositive for coeliac disease. Of 87 seropositive patients who underwent duodenal biopsy, 39 had positive histological findings of coeliac disease [44.8%]. Extrapolating from these findings the overall rate of coeliac disease among autoimmune hypothyroidism patients was estimated to be 5.7%. In multivariate logistic regression coeliac disease was significantly associated with older age [> 40 years], presence of other autoimmune diseases, vitamin B12 deficiency and anaemia

Bleeding tendency in Wolfram syndrome: a newly identified feature with phenotype genotype correlation.

Wolfram syndrome (WS) is a recessively inherited disorder associated with recognised clinical features. Bleeding tendency was noticed in some of our patients, although this has not been reported before. We therefore studied this problem in all our WS patients and tried to postulate a possible pathogenesis. At the same time, a genetic linkage study provided evidence of locus heterogeneity of this syndrome and showed that the majority of our patients belong to the second WS locus identified in that study. Our study group consisted of 13 WS patients, belonging to WSF2 locus (group I). Controls consisted of 4 healthy siblings of WS patients (group II) and 7 diabetics who do not have WS (group III). Relevant clinical data were obtained, and a coagulation screen was carried out for all groups. All individuals in the three study groups have normal platelet count, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (aPTT), clot retraction, Factor VIII activity (FVIIIc) and von Willebrand factor antigen (vWAg). Eleven of the WS patients have prolonged template bleeding time (BT) compared with both control groups. Patients with WS have a longer BT (mean 9.6 min, 95% CL 8.61-10.53 min) than the siblings group (mean 6.75 min, 95% CL 5.52-7.98 min) and the diabetic group (mean 5.49 min, 95% CL 4.56-6.42 min). The differences between the study group and controls are statistically significant, p = 0.02 and 0.0002, respectively. In the three groups, platelet aggregation studies were normal using adenosine diphosphate (ADP), ristocetin and epinephrine. Aggregation with collagen was either absent or impaired, with failure of secondary wave being noticed in 11 of the WS patients (85%) and normal in the control groups. The pathogenesis of this problem is not known, but could be due to an inhibitory effect of vWAgII, deficiency of thrombospondin or a defect in the platelet membrane GPIa/IIa. Bleeding diathesis is a new additional feature to the clinical spectrum of WS, which is probably a feature of the disorder WFS2 and not WFS1, as bleeding has never been reported in the latter. This provides further evidence for the phenotypic and genotypic heterogeneity of this complex disorder and may provide clues to the search for the second gene responsible for this phenotype.

Helicobacter pylori in dyspeptic Jordanian patients.

UNLABELLED: To study the prevalence of Helicobacter pylori infection in dyspeptic Jordanian patients. PATIENTS AND METHODS: Two hundred and twenty seven consecutive dyspeptic Jordanian patients were studied with endoscopy, endoscopic biopsies, culture, and CLO urease testing for the detection of H. pylori. RESULTS: Helicobacter pylori positivity in both culture and CLO urease testing was 86%, being 78% in culture and 80% in CLO test separately. The majority of our patients were in the age range 21-60 years and H. pylori positivity was more than 90% in them. CONCLUSION: Helicobacter pylori is a common infection in dyspeptic Jordanian patients regardless of the underlying cause. Males were affected more than females.

Pattern of colonic disease in lower gastrointestinal bleeding in Jordanian patients: a prospective colonoscopic study.

PURPOSE: This study was developed to document causes of rectal bleeding of Jordanian patients and compare them with results from several parts of the world. METHODS: Diagnostic and therapeutic colonoscopy was used as a first-line investigation on 701 consecutive Jordanian patients presenting with rectal bleeding. When indicated, technetium 99m-labeled red blood counts or selective angiography were used also. RESULTS: Most common causes according to frequency were hemorrhoids, polyps, ulcerative colitis, amebic colitis, neoplasm, diverticulosis, anal fissure, Crohn's disease, and arteriovenous malformations. CONCLUSIONS: This is the first study addressing this problem from this part of the world. Findings were different from many other results published in western and eastern studies in certain disease entities.

Etiology of upper gastrointestinal bleeding in Jordanian patients: A prospective study.

Endoscopy within 24 hours from the onset of upper gastrointestinal (UGI) bleeding was carried out on 853 Jordanian patients. Lesions as a bleeding source were identified in 799 (93.7%) patients. Radioactively tagged red blood cell (RBC) scan, angiography and upper gastrointestinal follow-through radiography were complementary studies in endoscopy negative patients. Etiology remained unidentified in 16 patients. The six most common causes of UGI bleeding in this study were duodenal ulcer, gastric erosions, duodenal erosions, esophagitis, gastric ulcer and esophageal varices. Nonsteroidal anti-inflammatory drugs (NSAIDs) were a significant predisposing factor for UGI bleeding (28.6%). Mortality at the first admission was 3.4% and increased during 12 month follow-up to 6.9%. To our knowledge, this is the first study from Jordan concerning the causes of upper GI bleeding of all clinical types.

Endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of biliary and pancreatic duct disease: A prospective study on 668 Jordanian patients.

Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice in establishing the nature and the site of common bile and pancreatic duct disease and related complications. It was used in 668 Jordanian patients who presented with biliary or pancreatic disease and unexplained upper abdominal pain. Common bile duct (CBD) stones, postsurgical traumatic CBD strictures, papillary stenosis and malignant strictures were the most common findings in this study. The incidence of malignant strictures was less and the postsurgical CBD injuries, mainly CBD complete ligation, were more than what was reported by others. This procedure was also valuable in the investigation of unexplained upper abdominal pain and pancreatic disease.

Renal cell carcinoma presenting as Garcin's syndrome.

A 50 year old man presented with progressive unilateral cranial nerve palsies (Garcin's syndrome) for one year. Skull radiography and computed tomography (CT) showed intracranial extension of a soft tissue tumour from the right base of the skull. Necropsy revealed a papillary cell carcinoma of the right kidney and metastases in the base of the skull.

Patterns of hepatomegaly in Jordanians: a prospective study of 800 cases.

Eight hundred Jordanians with liver enlargement were studied: 369 (46%) were males and 431 (54%) females. Ages ranged between 13 and 85 years, with a mean of 47.4%: 766 cases demonstrated a single pathological process while 34 cases showed two or more processes. The most significant findings were: congestion secondary to cardiac failure in 323 cases (38.5%); inflammatory and parasitic processes in 192 cases (22.9%), including acute hepatitis (81 cases), hydatid cyst (63 cases), chronic hepatitis (27 cases), liver abscess (19 cases), brucellosis (one case) and malaria (one case); malignancy in 164 cases (19.6%); liver cirrhosis in 80 cases (9.5%); fatty metamorphosis in 47 cases (5.6%); metabolic and genetic disease in 11 cases (1.3%); miscellaneous conditions in nine cases (1.1%); and 15 apparently normal individuals (1.8%). Cardiac failure was the most frequent cause of hepatomegaly in this sample of Jordanians. Inflammatory processes were the second major cause, followed by malignancy and cirrhosis of the liver.