Adipocyte "Fatty Acid Binding Protein" Gene Polymorphisms (rs1054135, rs16909196 and rs16909187) in Jordanians with Obesity and Type 2 Diabetes Mellitus.

Background: Obesity, type 2 diabetes mellitus (T2DM), and dyslipidemia may result from the interactions of genetic and environmental factors. There are controversial reports concerning the association of polymorphisms (rs1054135, rs16909196 and rs16909187) in the gene of adipocyte fatty acid binding protein (FABP4) with obesity and T2DM. Therefore, we designed this study to determine the association of these polymorphisms with obesity, T2DM, and dyslipidemia among Jordanian subjects. Methods: The study was approved by the National Center for Diabetes, Endocrinology, and Genetics (NCDEG) Institutional Review Board (IRB). A total of 397 subjects were enrolled in the study and divided into four groups as described in materials and methods section. The fatty acid binding protein 4 (FABP4) gene containing (rs1054135, rs16909196 and rs16909187) single nucleotide polymorphisms (SNP) was amplified by polymerase chain reaction (PCR) followed by Sanger DNA sequencing of the PCR product. Results: None of the three SNPs were associated with T2DM (p > 0.05). The rs16909187 and rs16909196 were significantly associated with obesity. The wild type (CC) of rs16909187 was significantly higher among the overweight and obese group compared with normal weight controls (OD = 2.17, 95% CI = 1.18 - 3.96, p =0.01). The wild type of rs16909196 (AA) was significantly higher among the overweight and obese group compared to controls, (OD = 2.26, 95% CI = 1.24 - 4.14, p = 0.01). These results may indicate that the wild-type may be a risk factor for obesity.Only the rs1054135 SNP was significantly associated with increased low density lipoprotein (LDL) levels in the overweight and obese group compared with the controls (p = 0.03). Conclusions: The wild-type genotypes of rs16909196 and rs16909187 may be risk factors for obesity but not T2DM. None of the three SNPs was associated with T2DM.

Are insulin analogues an unavoidable necessity for the treatment of type 2 diabetes in developing countries? The case of Jordan.

Despite their reported benefits in terms of glycaemic control, insulin analogues are expensive for patients in developing countries. This study in Jordan aimed to compare the effectiveness and adverse events of premixed human insulin (BHI30) versus premixed insulin analogue (BIAsp30) in patients with type 2 diabetes. In a retrospective cohort study from October 2012 to March 2013, outcomes (HbA1c, weight, hypoglycaemia and lipohypertrophy) were compared at baseline and 6 months after treatment in 628 patients. BHI30 produced a significantly greater reduction in HbA1c than did BIAsp30. This difference in HbA1c remained significant after controlling for the effects of age, sex, duration of diabetes, body mass index and hypoglycaemia (ß-coefficient was -0.18 in favour of BHI30). Weight gain and mild hypoglycaemia was significantly higher with BHI30 than with BIAsp30. BHI30 achieved better reduction in HbA1c compared with BIAsp30, with less cost, slightly more weight gain and greater reported mild hypoglycaemia.

Depression is associated with low levels of 25-hydroxyvitamin D among Jordanian adults: results from a national population survey.

Although low serum 25-hydroxyvitamin D (25(OH)D) and elevated serum parathyroid hormone (PTH) have been associated with depression in clinical settings, this link in community-dwelling individuals is inconclusive. The present study aimed at examining the association between serum 25(OH)D and PTH levels and the presence of depression in a national population-based household sample of 4,002 Jordanian participants aged ≥25 years. The DASS21 depression scale was used to screen for depression, and serum concentrations of 25(OH)D and PTH were measured by radioimmunoassay. Multiple logistic regression models were used to explore the association between serum 25(OH)D and PTH levels and depression. The unadjusted odds ratio (OR) decreased linearly with increasing quartiles of serum 25(OH)D (P(trend) = 0.00). The OR for having depression was significantly higher among individuals in the first and second quartiles (OR = 1.4, 1.23, respectively) than among those in the fourth quartile (P values = 0.00 and 0.03, respectively). This relationship remained significant after adjusting for age, sex, marital status, education, BMI, serum creatinine, number of chronic diseases (OR = 1.39 and 1.21 and P values = 0.00 and 0.05, respectively) and after further adjustment for exercise, altitude, and smoking (OR = 1.48 and 1.24, respectively, and P values = 0.00 and 0.03, respectively). No significant association was found between serum PTH levels and depression. The decrease in risk of depression among participants started to be significant with serum 25(OH) D levels higher than 42.3 ng/ml (lower limit of the range of the third quartile). This value may help pinpoint the desirable level of serum 25(OH)D to be attained to help aid the prevention and treatment of depression.

Prevalence of blindness and visual impairment among Jordanian diabetics.

PURPOSE: To investigate the prevalence of blindness and visual impairment among a population of Jordanian diabetics. METHODS: A total of 986 diabetic patients were fully assessed, including complete history, examination, and laboratory tests. All patients underwent detailed eye examination, which included visual acuity, slit-lamp examination, tonometry, funduscopy, and fundus fluorescein angiography (FFA). RESULTS: Of all patients examined, 53.2% were male and 46.8% were female. The mean age and duration of diabetes were 55.3 and 11.9 years. Of all patients, 93.3% had type 2 while 6.7% had type 1 diabetes mellitus (DM). Over half (50.3%) were on oral hypoglycemic agents, 34% on insulin, and 14.5% on both types of treatment, whereas only 1.2% were on diet alone. The mean value for HbA1c was 7.7%. The prevalence of blindness among participants was found to be 7.4%, while 10.1% were visually impaired. Diabetic retinopathy (DR) was present in 64.1%, 37.8% had cataract, and 8.7% had undergone cataract surgery. Using multivariate logistic regression analysis, visual impairment was significantly associated with age, treatment of diabetes, and DR, while only age and retinopathy were significantly related to blindness. CONCLUSIONS: DM is a common disease in Jordan and DR is highly prevalent among Jordanian diabetics. National screening and educational programs are highly needed to reduce the risk of blindness and visual impairment among diabetic patients.

Prevalence and associated factors of hypertension: results from a three community-based survey, Jordan.

The aim of this study was to estimate the prevalence of hypertension, to determine its association with certain cardiovascular disease risk factors, and to evaluate level of hypertension awareness and control in an adult population in Jordan. The study used a cross-sectional population survey of a systematic sample of three communities. Data for the sample of 2299 adults, aged 25 years and older, were collected from September 1994 to September 1995. A total of 370 subjects or 16.1% were found to have hypertension. The prevalence rate was higher among women (17.1%) than men (14.4%). Logistic regression analysis indicated that hypertension was positively associated with gender, age, family history of hypertension, diabetes mellitus, and total serum cholesterol, but negatively associated with level of education. No association between hypertension and smoking was detected in this study. About one-half (48.6%) of hypertensives in this study were unaware of their diagnosis. Awareness of hypertension was positively associated with age and family history. More than one-third (36.5%) of those aware of their diagnosis did not achieve control of their hypertension. Hypertension appears to be a common public health problem in Jordan. Awareness and control of hypertension are far below optimal levels.

Prevalence, awareness and management of hypertension in a recently urbanised community, eastern Jordan.

The objectives of this study were to: (1) estimate the magnitude of hypertension, and its levels of awareness and control of hypertension among a recently urbanised community of Jordanian aborigines; and (2) to compare the study findings with findings from other Jordanian communities. A sample was randomly selected from the roster of all inhabitants of the community aged 25 years or older. Data on 545 subjects included in the sample were collected during the months of January and February of 1995. A total of 89 (16.3%) subjects were suffering hypertension defined as systolic blood pressure > or =160 mm Hg and/or diastolic blood pressure > or =95 mm Hg or on antihypertensive medication. Prevalence rate of hypertension was comparable to that reported from other Jordanian communities who have experienced an urban lifestyle earlier than the reference community. Logistic regression analysis indicated that hypertension was positively associated with age, illiteracy, body mass index, family history of hypertension, and diabetes mellitus. No association was detected between hypertension and each of gender, smoking, and total serum cholesterol. This study showed that the vast majority of hypertensive patients (82.0%) were aware of their diagnosis. However, more than two-thirds (68.5%) of those aware of their diagnosis did not achieve control of their hypertension. In conclusion, hypertension is a common public health problem in this community and that the hypertension management programme is far below the optimal level.

Ophthalmologic findings in fifteen patients with Wolfram syndrome.

PURPOSE: To look for ophthalmologic abnormalities in 15 patients with Wolfram syndrome, also known as DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). METHODS: Fifteen patients from four inbred families diagnosed as having Wolfram syndrome at the National Center for Diabetes, Endocrinology and Genetics, in Amman, Jordan, were evaluated ophthalmologically. Their examination included best-corrected visual acuity, color vision testing, pupillary light reflexes, slit-lamp biomicroscopy and fundus examination. Fundus fluorescein angiography was done in all patients. RESULTS: The prevalence of optic atrophy was (93.3%), colordefect (92.9%), cataract (66.6%), pigmentary retinopathy (30%) and diabetic retinopathy (20%). Abnormal pupillary light reflexes and nystagmus were also reported. CONCLUSIONS: Although ourgroup of patients was genetically heterogeneous, the ophthalmic findings are consistent with those reported in other series, except for cataract which was highly prevalent but mild and did not contribute significantly to loss of vision.

Hypertension prevalence, awareness, treatment and control, and associated factors: results from a national survey, jordan.

The study examined prevalence, awareness, treatment and control of hypertension (HTN), and associated factors and to evaluate the trend in hypertension between 2009 (period 2) and 1994-1998 (period 1). A national sample of 4117 adults aged 25 years and older was selected. Prevalence rate of HTN (SBP ≥ 140 or DBP ≥ 90 or on antihypertensive therapy) was 32.3% and was higher than the 29.4% prevalence rate reported in period 1. Prevalence rate was significantly higher among males, older age groups, least educated, obese, and diabetics than their counterparts. The rate of awareness among hypertensives was 56.1% and was higher than the 38.8% rate reported form period 1 data. Awareness was positively associated with age, smoking, and diabetes for both men and women, and with level of education and body mass index for men. Rate of treatment for HTN among aware patients was 63.3% and was significantly higher than the 52.8% rate reported in period1. Control rate of HTN among treated hypertensives was 39.6%; significantly higher than the 27.9% control rate in period 1. Control of HTN was positively associated with age but only for women. In conclusion, HTN is still on the rise in Jordan, and levels of awareness and control are below the optimal levels.

Severe hypertelorism, midface prominence, prominent/simple ears, severe myopia, borderline intelligence, and bone fragility in two brothers: new syndrome?

We report on two brothers, born to double first cousin Jordanian Arab parents, with a syndrome comprising severe hypertelorism with upslanted palpebral fissures, brachycephaly, abnormal ears, sloping shoulders, enamel hypoplasia, and osteopenia with repeated fractures. Both have severe myopia, mild to moderate sensori-neural hearing loss and borderline intelligence. Results of chromosome analysis were normal as was a FISH assay for subtelomeric rearrangements. The father has mild hypertelorism but the family history is otherwise unremarkable. We think that this represents a previously unrecognized autosomal or X-linked recessive syndrome.

Failure of diazepam to affect growth hormone and prolactin in acromegalics.

To demonstrate the effect of diazepam on serum growth hormone and prolactin levels in acromegaly, 7 acromegalics were studied. Every patient received 10 mg diazepam orally at zero time, and blood samples were obtained at 30-min intervals. The same patients also underwent a standard L-dopa test. They were given 500 mg L-dopa orally at zero time, and blood samples were obtained at 30-min intervals. The administration of diazepam did not induce any significant changes in either growth hormone or prolactin levels. On the other hand, the administration of L-dopa resulted in a significant decrease in growth hormone level from 74.25 +/- 22 ng/ml (mean +/- SEM) at zero time to a level of 52.8 +/- 21 and 58.77 +/- 22.7 ng/ml at the 60- and 90-min intervals, respectively (p less than 0.05), and a significant decrease in prolactin level from a baseline of 56.18 +/- 17 to 25.5 +/- 8.4 ng/ml (p less than 0.001) at the 60-min interval. It is suggested that the response of growth hormone to diazepam in acromegalics is qualitatively different from nonacromegalic controls.

The effect of neuroleptics on prolactinoma growth in a Jordanian schizophrenic girl.

We describe a case of a schizophrenic girl who developed prolactinoma while being treated with neuroleptics. The clinical history and special investigations of the pituitary tumor suggest that neuroleptic medications may have enhanced the growth of the tumor in our patient. The author suggests that the relationship between the occurrence of prolactinoma and neuroleptic medications ought to be investigated in a large controlled study.

Prolactin responses to vasoactive intestinal polypeptide and thyrotropin releasing hormone in chronic renal failure.

Prolactin response to iv bolus injection of 1 micrograms/kg vasoactive intestinal polypeptide was determined in 8 patients with chronic renal failure undergoing chronic hemodialysis and in 8 normal controls, age- and sex-matched. Plasma prolactin in the patients showed a blunted response following vasoactive intestinal polypeptide injection, whereas the controls showed significantly higher mean peak prolactin value over the baseline value (p less than 0.002). The net rise (peak levels minus basal levels) in plasma prolactin and area under the curve after vasoactive active intestinal polypeptide injection in the controls were significantly greater than those in the patients (p less than 0.001). On a separate day, each individual underwent a TRH (500 micrograms) challenge with the prolactin response determined. The patients had significantly higher peak prolactin values over baseline levels (p less than 0.02) which, however, were not significantly different from those in the control group. In the patients, the peak net prolactin increments and area under the curve were significantly higher following TRH than following vasoactive intestinal polypeptide (p less than 0.05). The net prolactin increments to TRH challenge were significantly higher in the control group than in the patients (p less than 0.001). The results demonstrate the blunted prolactin response to the stimulatory effect of vasoactive intestinal polypeptide and TRH in chronic renal failure. In chronic renal failure prolactin release after vasoactive intestinal polypeptide is more blunted than after TRH. These data suggest that the responsiveness of plasma prolactin to vasoactive intestinal polypeptide is defective in these patients, though the mechanism(s) are yet to be defined.

Congenital adrenal hyperplasia due to 11-beta-hydroxylase deficiency with skeletal abnormalities.

Classic congenital 11-beta-hydroxylase deficiency is a relatively uncommon cause of congenital adrenal hyperplasia and is characterized by virilization and often hypertension. The association of skeletal abnormalities (short metatarsal bone) and pulmonary stenosis in a patient with 11-beta-hydroxylase has been reported by our group. In this report, three new patients with congenital adrenal hyperplasia due to a defect in 11-beta-hydroxylase enzyme with short fourth metatarsals are described. Gynecomastia was noted in one patient. The relative rarity of 11-beta-hydroxylase deficiency and the association of skeletal abnormalities suggest the possibility that this is more than a mere coincidental finding.

Effect of exposure to the altitude of 300 meters below sea-level on testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin in man.

Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (PRL) responses to exposure to sea-level altitude (LA) were examined in 13 eugonadal males, age 21-22 yr, 3 and 5 days after residing at LA and on the second day of return to basal altitude 90 days later. After 3 days at their respective residence altitude, there was elevation in LH (p less than 0.05) and depression in testosterone levels (p less than 0.05), with similar results on day 5. These effects were all of transient nature, LH and testosterone concentrations returned to their basal levels on second day of the return to basal altitude. The FSH and PRL levels did not show any significant change during the stay at LA or after return to basal altitude. The observations suggest that exposure to LA is associated with increase in plasma levels of LH and decrease in testosterone. The decreased levels of testosterone could be due to a reduction in the sensitivity of the testis to LH, or due to inhibition of steroidogenesis in the testis.

Primary empty sella syndrome with panhypopituitarism in a child.

A 10-year-old boy presented with marked growth retardation. He was found to have an empty sella demonstrated by CT and Metrizamide cisternography. Endocrinological investigation confirmed the diagnosis of panhypopituitarism. This is the first case reported in a twin and the fifth pediatric case with marked endocrine dysfunction reported in the literature.

Arginine-vasopressin and endothelium-associated proteins in thyroid disease.

Plasma concentrations of endothelium-derived proteins (fibronectin and von Willebrand factor), liver synthesized proteins (haptoglobin, transferrin, ceruloplasmin, alpha 1-antitrypsin, antithrombin III and factor VIII-coagulant) and plasma arginine-vasopressin (AVP) were measured in 12 hyperthyroid, 9 hypothyroid and 15 age- and sex-matched normal controls. In hyperthyroid patients the plasma concentrations of AVP and endothelium-associated proteins (EAP) were significantly higher than in the control group (p less than 0.05 and p less than 0.01 respectively). Rendering hyperthyroid patients into the euthyroid state significantly lowered AVP (p less than 0.01), fibronectin (p less than 0.05) and von Willebrand factor (p less than 0.01) compared with pretreatment levels. Hypothyroid patients were studied at diagnosis and after replacement therapy with levothyroxine. Compared with pretreatment values, significant increases were noted in plasma concentrations of von Willebrand factor, fibronectin and AVP (p less than 0.01). With the exception of factor VIII-coagulant, the concentrations of hepatic synthesized proteins did not deviate from normal values in hyperthyroid and hypothyroid patients. Significant correlations were found between serum-free thyroxine on the one hand and the plasma concentrations of fibronectin (p less than 0.005), von Willebrand factor (p less than 0.001) and AVP (p less than 0.0001). Similarly, there was significant correlation between the plasma concentrations of AVP on the one hand and fibronectin (p less than 0.002) and von Willebrand factor (p less than 0.01). The results demonstrate elevated plasma levels of AVP in hyperthyroid patients and an increase during levothyroxine treatment of hypothyroid patients.(ABSTRACT TRUNCATED AT 250 WORDS)