Diabetic retinopathy in patients with newly diagnosed type 2 diabetes mellitus in Jordan: prevalence and associated factors.

BACKGROUND: To determine the prevalence of diabetic retinopathy (DR) in patients with newly diagnosed type 2 diabetes mellitus (T2DM) in Jordan, as well as the factors associated with DR. METHODS: A cross-sectional study was conducted among 127 consecutive newly diagnosed (within the past 6 months) patients with T2DM attending one of two diabetic care centers. Complete ocular examinations were performed by an ophthalmologist and relevant data were collected. A fundus examination was performed using slit lamp indirect ophthalmoscopy after pupillary dilation with 1% tropicamide drops, with DR defined and classified according to the scale developed by the Global Diabetic Retinopathy Project Group. RESULTS: Of all the patients examined, 7.9% had DR. Of those with DR, 40% already had clinically significant macular edema necessitating laser photocoagulation or intravitreal injections. Multivariate analysis revealed that age and HbA1c were significantly associated with DR. The odds of DR increased by 11% for each 1 year increase in age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.02-1.20). For each 1% increase in HbA1c, the odds of DR increased by 43% (OR 1.43; 95% CI 1.09-1.88). CONCLUSIONS: Fewer than one-tenth of newly diagnosed Jordanian patients with T2DM had DR, but more than one-third of these patients had significant maculopathy. Therefore, early screening is strongly recommended for all newly diagnosed T2DM patients. Increased age and HbA1c values are associated with increased odds of DR. A study with a larger sample size is needed to elucidate the risk factors for DR in newly diagnosed T2DM.

Effects of pioglitazone add-on to gliclazide and metformin on glycemic control in patients with type 2 diabetes.

OBJECTIVES: This study aims to evaluate the efficacy and safety of adding pioglitazone to treatment with metformin (MF) and gliclazide in patients with type 2 diabetes mellitus (DM2) who had inadequate glycemic control. METHODS: This study is a retrospective cohort study based on King Abdullah University Hospital records concerning type 2 diabetic adult patients for year 2008. Patients included were assessed according to changes in glycosylated hemoglobin (HbA1c), lipid profile, albuminuria and liver enzymes before and after the addition of pioglitazone. RESULTS: The patients included in the study had an initial mean HbA1c of 9.44%, which decreased to 7.56% after the addition of pioglitazone (P-value < 0.005).

Overweight and obesity among school children in Jordan: prevalence and associated factors.

OBJECTIVES: To estimate the prevalence of overweight and obesity and determine their associated factors among school children aged 6-12 years in the north of Jordan. METHODS: A cross-sectional study was conducted among school children in the north of Jordan in the period between March 2006 and May 2006. A total of 2,131 children (1,052 boys and 1,079 girls) were selected at random using multistage cluster sampling method. The first part of the questionnaire was completed by pupils in schools and the second part was completed by their parents at home. The researchers measured height, weight, waist circumference, hip circumference, and mid upper arm circumference of each student in the class. Overweight and obesity were defined according to the international cut-off points of body mass index for boys and girls between 2 and 18 years of age. RESULTS: Of the total 2,131 children, 19.4% were overweight (18.8% of boys and 19.9% of girls) and 5.6% were obese (5.6% of boys and 5.5% of girls). Watching television >2 h/day, daily pocket money >20 piasters (1 piaster = 1.42 cents), having overweight or obese mother/father were significantly associated with increased odds of both overweight and obesity. Age > or = 10 years, female gender, and family size of < or =4 were significantly associated with being overweight and total monthly family income >300 Jordanian Dinars (JDs), (1 JD = $1.42) was associated with obesity. CONCLUSIONS: While the prevalence of overweight was high among Jordanian children compared with that in the neighboring countries, the prevalence of obesity was lower.

Maternal periodontal status and preterm low birth weight delivery: a case-control study.

OBJECTIVES: To assess the association between severity and extent of maternal periodontal disease and preterm birth/low birth weight (PLBW) among women in the north of Jordan. METHODS: A total of 148 woman who gave preterm birth/low birth weight birth and 438 women with uncomplicated full term vaginal delivery were included in this study. Socio-demographic characteristics, antenatal history, medical history, and family medical history were collected through personal interview or abstracted from maternal records. The oral hygiene status, and periodontal and dental parameters were assessed for all women. RESULTS: The average of probing pocket depth (PPD) and average of clinical attachment level (CAL) were significantly higher among women who gave PLBW babies. The mean gingival recession was not significantly different between the two groups. The percentages of sites with PPD > or = 3 mm and CAL > or = 3 mm were significantly higher among women who gave PLBW babies. Number of decayed teeth, number filled teeth, and number of missing teeth showed no significant association with PLBW delivery. CONCLUSION: The extent and severity of periodontal diseases appeared to be associated with increased odds of PLBW delivery. Nevertheless, more and larger intervention trials are needed before it can be fully accepted that periodontal infection is a true risk factor for PLBW.

Symptoms and risk of obstructive sleep apnea in primary care patients in Jordan.

PURPOSE: Primary care is central for the diagnosis and treatment of obstructive sleep apnea (OSA). The aim of this study was to estimate the prevalence of symptoms and risk of OSA in primary care in Jordan. METHODS: A cross-sectional survey was conducted between July and October 2006. Adult patients attending primary health care in the north of Jordan were included and the Berlin questionnaire was utilized. RESULTS: A total of 1,205 patients completed the questionnaire, 46% were males, and mean age was 32.2 years. Based on the Berlin questionnaire definition, the overall OSA risk was 16.8%, snoring was present in 28.7% and frequent daytime fatigue or tiredness in 33.9%. OSA risk increased with age. For age groups <30 years, 30-59 years, and >or=60 years OSA risk was 5.4%, 28.4%, and 45.9%, respectively, (p < 0.005). OSA risk was higher in men than women (19.3% vs. 14.7%, respectively, p < 0.04). Age of >or=30 years, chronic nasal congestion and illiteracy were associated with an increased risk of OSA. CONCLUSIONS: Obstructive sleep apnea, snoring, and daytime sleepiness were common among Jordanian patients attending primary care clinics. More attention to OSA is needed in primary care, and patients at risk should be referred for further evaluation.

Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis.

BACKGROUND: This meta-analysis was conducted to examine the relationship between periodontal diseases and coronary heart diseases (CHD) and cerebrovascular diseases (CVD) in observational studies. METHODS: This study was based on seven cohort studies and four studies of other designs that met prestated inclusion criteria. Information on study design, year of publication, study location, sample size, study population, participant characteristics, measurement of risk factors, exposure and outcome measures, matching, controlling for confounders, and risk estimates was abstracted independently by two investigators using a standard protocol. RESULTS: Subjects with periodontitis had an overall adjusted risk of CHD that was 1.15 times (95% confidence interval [CI]: 1.06 to 1.25; P = 0.001) the risk for healthy subjects. There was no heterogeneity among the studies in the overall relative risk estimate (P = 0.472). As compared to healthy subjects, those with periodontitis had an overall adjusted relative risk of CVD of 1.13 (95% CI: 1.01 to 1.27; P = 0.032). CONCLUSIONS: Findings indicated that periodontal infection increases the risk of CHD and CVD. However, this meta-analysis provided no evidence for the existence of strong associations between periodontitis and CHD and CVD. Larger and better-controlled studies involving socially homogeneous populations and measuring specific periodontal pathogens are required to identify a definite association between periodontal disease and the risk of coronary heart disease and cerebrovascular disease.