Single Nucleotide Polymorphism in the ADIPOQ Gene Modifies Adiponectin Levels and Glycemic Control in Type Two Diabetes Mellitus Patients.

Diabetes mellitus (DM) is the ninth leading cause of death worldwide. Mortality from DM is largely attributed to disease complications. Glycemic control of DM patients reduces mortality. Studies indicated that the lack of glycemic control in DM patients could be influenced by the genetic background of the patients. Evidence suggests that adiponectin levels are dysregulated in DM patients with poor glycemic control. Serum adiponectin level is a heritable trait influenced by single nucleotide polymorphisms (SNPs) in the ADIPOQ gene. It is hypothesized that SNPs in ADIPOQ could modify glycemic control in DM patients. To test this hypothesis, 375 type 2 DM (T2DM) patients were recruited. Patients were classified into good vs. poor glycemic control according to hemoglobin A1c levels. Study subjects were genotyped for variations of four SNPs in ADIPOQ (rs17300539, rs266729, rs2241766, and rs1501299). Adiponectin levels were measured from the serum. Our analysis showed that reduced serum adiponectin, a longer duration of treatment, and increased insulin resistance were all significant predictors of poor glycemic control. Moreover, the T allele and the TT genotype of rs2241766 were significantly more frequent in patients with poor glycemic control (P < 0.05). Individuals with the TT genotype of rs2241766 had significantly lower levels of serum adiponectin (P < 0.05). It was concluded that lower levels of serum adiponectin and the T allele of rs2241766 SNP in ADIPOQ were associated with poor glycemic control in T2DM patients.

Is methicillin-resistant Staphylococcus aureus a common pathogen in ventilation-associated pneumonia?: The experience of a tertiary teaching hospital in Jordan.

ABSTRACT: Ventilator-associated pneumonia is a life threatening device related infection in intensive care units. Methicillin-resistant Staphylococcus aureus is considered a common contagious pathogen causing pneumonia and sepsis.To assess the prevalence of S aureus in comparison to other pathogens, and their antibacterial sensitivity profile in ventilator-associated pneumonia.Data regarding ventilator-associated pneumonia of adults admitted to the intensive care unit, at the Jordan University of Science and Technology Hospital, between 2012 and 2018 were extracted from the computerized system. Microorganisms and their susceptibility profiles were identified according to the Clinical and Laboratory Standards Institute.There were 547 isolates, of which 35 (6.4%) were Gram positive, 59% were methicillin resistant. Gram-negative isolates were present in 507 (92.6%) isolates, of which 82% were multidrug resistant, and 1% were Candida species.Gram-negative bacterial infections were significantly associated with ventilation usage. S aureus was not the predominant pathogen.

Leptin and the GA genotype of rs2167270 of the LEP gene increase the risk of prediabetes.

Prediabetes is a precursor stage that frequently develops to definitive type 2 diabetes mellitus (T2DM). Therefore, identifying individuals with prediabetes can allow for early intervention measures that delay or prevent disease progression to T2DM. Several biochemical changes appear to be associated with prediabetes, including an increase in the serum levels of leptin. In Jordan, this association has not been previously investigated. In the present study, the serum levels of leptin were measured in 122 prediabetes subjects and 122 controls. Furthermore, the genotypes of three single nucleotide polymorphisms in the LEP gene (rs7799039, rs2167270 and rs791620) were investigated for their association with prediabetes using PCR-restriction fragment length polymorphism. The results revealed a significant increase in serum leptin levels in the prediabetes group. It was also shown that the GA genotype and the A allele of rs2167270 were significantly associated with an increased risk of prediabetes (P<0.05). These findings were shown to be independent of body mass index, waist circumference and serum glucose levels. To the best of our knowledge, the present study is the first in Jordan to have reported an association between serum leptin levels and the GA genotype of rs2167270 with an increased risk of prediabetes, identified both in the univariate and multivariate models.

Maternal morbidity: results of a country-wide review.

PURPOSE: To determine the incidence of maternal morbidity and to identify its main causes in Jordan. METHODS: A national cohort sample of pregnant women was enrolled before their 22nd week of gestation, and was followed-up throughout the antenatal period, labour and puerperium. A total of 4,501 women were included in the study. A total of 80 physicians were responsible for completing the questionnaire and data sheet. RESULTS: The overall morbidity rate was 60.8%. The morbidity rate during the ante natal period was 41.3%. During labour and delivery, 34.5% of women suffered from at least one morbid condition. In the puerperium, 18.7% of women suffered from one or more morbidities. The caesarean sections rate was 27.7%. The prevalence of anaemia at enrolment and delivery were 20.1 and 26.3%, respectively. The commonest morbidities of the antenatal period were urinary tract infections at 20.2% and genital infections at 19.4%. Parity of >4 was independently related to increased morbidity during the antenatal period and labour but not in the puerperium. There were no maternal mortalities. CONCLUSIONS: Parity of >4 was a significant predictor of antenatal period and intrapartum morbidity. The commonest maternal morbidities were urinary tract infections, vaginal genital infections and anaemia.

Accuracy of sonographic fetal weight estimation within 14 days of delivery in a Jordanian population using Hadlock formula 1.

OBJECTIVES: To assess the accuracy of sonographic fetal weight estimation within 14 days of delivery in a Jordanian population using Hadlock formula 1 in the third trimester. MATERIALS AND METHODS: Estimated fetal weights and actual fetal weights data were collected from the medical records of pregnant women who had undergone sonographic fetal weight estimation within 14 days of delivery over the period of March 2008 to June 2010. The analysis included 409 Jordanian women; 6 of them had twins, so the study involved estimation of 415 fetal weights, and these were compared to the actual recorded neonatal weights. Using Hadlock formula 1, we compared the estimations with the infants' actual birth weights. The data were analyzed in 2 groups: within 7 days and 8-14 days. RESULTS: The mean estimated fetal weight was 3,133 ± 475 g (range 1,343-4,420 g). The mean actual birth weight was 3,179 ± 450 g (range 1,300-4,450 g). The mean absolute percentage of error of ultrasound fetal weight estimation for all infants was 6.5%; however, it was 6.1 and 8.2% if the fetus was delivered within 7 days or 8-14 days of sonography, respectively. Overall, 78.8% of fetal weight estimations were within 10% of actual birth weight; however it was 81.3 and 69.9% if the fetus was delivered within 7 days or from 8-14 days of sonography, respectively. CONCLUSION: The use of Hadlock formula 1 for sonographic fetal weight estimations in Jordanian women showed acceptable results relative to the actual neonatal weight at birth. However, fetal weight estimation was more reliable when performed within 7 days of delivery.

Effect of folic acid fortification on the incidence of neural tube defects.

In a few countries enriched cereal grains have been fortified with folic acid to reduce the incidence of neural tube defects. The objective of this study was to analyse the effect of folic acid fortified foods on the incidence of neural tube defects in live newborns at Princess Badea Teaching Hospital, in the north of Jordan, before and after the national food fortification with folic acid was implemented. For the 7-year period from 1 January 2000 to 31 December 2006, we retrospectively extracted the total number of births at Princess Badea Hospital, as well as the number of pregnancies affected by spina bifida and anencephaly, per 1000 births during the periods before (2000-01), during (2002-04) and after (2005-06) folic acid fortification of grain products, was implemented. Neural tube defects were defined in accordance with the International Classification of Diseases, 10th revision (ICD-10): anencephaly, encephalocele and spina bifida. A total of 78 subjects with neural tube defects were recorded among 61 447 births during the study period. The incidence of neural tube defects decreased from 1.85 per 1000 births before fortification [95% confidence interval (CI) 1.2, 2.4] to 1.07 per 1000 births during the fortification period [95% CI 0.7, 1.5], and 0.95 after full fortification [95% CI 0.5, 1.5], a 49% reduction. The difference between incidence of neural tube defects in the periods before and after food fortification with folic acid was statistically significant. We conclude that food fortification with folic acid was associated with a significant reduction in the rate of neural tube defects in north Jordan.

Consanguinity and adverse pregnancy outcomes: the north of Jordan experience.

This cross-sectional study was carried out to assess the association between consanguineous marriages and adverse pregnancy outcome in the north of Jordan. Women delivered in four major hospitals in the north of Jordan between April 2007 and May 2007 were included in the study. Non-Jordanian women and women with multiple pregnancies were excluded. Mothers answered a pilot-tested structured questionnaire administered by trained personnel in the maternity ward. Data regarding pregnancy outcomes were obtained from the patients' individual records. A total of 3,269 women with a mean age of 27.2 (SD 6.6) years were included. About 49% of women had consanguineous marriages. Consanguineous marriages were significantly associated with low birth weight delivery (13.9% vs. 10.1%), preterm delivery (19.9% vs. 12.3%), and births with congenital anomalies (4.1% vs. 0.8%) compared with non-consanguineous marriages. In the multivariate analysis, consanguinity was significantly associated with preterm delivery (OR = 1.5, 95% CI 1.2, 1.9), and congenital malformations (OR = 6.5, 95% CI 2.8, 15.3). In conclusions, this study supports the association between consanguinity and some adverse pregnancy outcomes.

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.

Vaginal schwannoma: a case report.

BACKGROUND: Schwannomas (peripheral nerve sheath tumors) of the female genital tract are extremely rare. CASE: A 31-year-old woman developed a benign schwannoma involving the anterior vaginal wall. CONCLUSION: Schwannomas of the female genital tract are extremely rare. They are generally benign, and simple excision is adequate treatment.

Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure.

BACKGROUND: The objective of this study was to determine the incidence of undiagnosed thrombophilic factors and its relation to IVF and embryo transfer failure in women who have had three or more previous IVF-embryo transfer cycles. METHODS: The study group comprised of 90 consecutive women with three or more previously failed IVF-embryo transfer cycles (group A). Two control groups were enrolled: group B (n=90) included women who have had successful pregnancy after their first IVF-embryo transfer cycle, and group C (n=100) included women who conceived spontaneously with at least one uneventful pregnancy and no previous history of miscarriage. All women were tested for the presence of inherited [factor V Leiden (FVL) mutation, prothrombin mutation, methylenetetrahydrofolate reductase (MTHFR) mutation and deficiencies in proteins S and C and antithrombin III] or acquired (lupus anticoagulant and anticardiolipin) thrombophilic factors. RESULTS: An increase in the incidences of FVL, MTHFR and antiphospholipid antibodies was found in the study group compared with the two control groups. At least one inherited or acquired thrombophilic factor was detected in 68.9% of women with repeated IVF failure compared with 25.6 and 25% in the groups B and C, respectively (P<0.01). Combined thrombophilia (two or more thrombophilic factors) was significantly higher in women who have had repeated IVF failure as compared with the two control groups (35.6 versus 4.4 and 3%) (P<0.0001). CONCLUSION: Thrombophilia has a significant role in IVF-embryo transfer implantation failure. Women with repeated IVF-embryo transfer failure should be screened for thrombophilia.

Hematologic status in patients with recurrent aphthous stomatitis in Jordan.

OBJECTIVE: To determine the prevalence of hematinic deficiencies in patients with recurrent aphthous stomatitis. METHODS: The study took place in the Oral Medicine Clinic of the Jordan University Hospital in Amman, Jordan, between January 1993 and December 2000. We studied the hemoglobin, serum ferritin, vitamin B12 and folate levels in 143 patients with recurrent aphthous stomatitis. We compared the results with a control group of 143 age- and gender-matched patients with a range of other oral diseases. RESULTS: In recurrent aphthous stomatitis patients, 14% were anemic and 37.8% showed hematinic deficiencies; 16.8% showed low serum ferritin; 26.6% showed low serum vitamin B12 and 4.9% showed low serum folate. In the control group, 10.5% were anemic and 18.2% showed hematinic deficiencies; 9.8% showed low serum ferritin; 12.6% showed low serum vitamin B12 and none showed serum folate deficiency. CONCLUSION: Patients with recurrent aphthous stomatitis have more hematinic deficiencies, particularly vitamin B12 deficiency, compared with controls. Correction of these hematinic deficiencies could help in the management of the disease.

Patency following vasectomy reversal. Temporal and immunological considerations.

OBJECTIVES: To evaluate the postoperative patency rates of microsurgical vasovasostomy and vasoepididymostomy at various vasectomy reversal time intervals, and to assess the implications of anti-sperm antibodies on results. METHODS: Three hundred and eighty-two patients underwent unilateral or bilateral vasectomy reversal between January 1997 and April 2001 at the Health Clinic, Highgate and Manor House Hospitals, London, United Kingdom. Patients were divided into 4 groups according to the time interval between vasectomy and reversal; less than 5 years, 5-10 years, 10-15 years, and more than 15 years. Data collected included patient's age at time of vasectomy reversal, seminal fluid analysis at 3, 6 and 12 months after surgery, and the presence or absence of anti-sperm antibodies before vasectomy reversal. RESULTS: Mean patient age at the time of reversal was 44.6 years. The mean vasectomy reversal time interval was 12.8 years. Overall patency rate of the patients groups was 62.9% with positive sperm in the ejaculate in 85.3% in the less than 5 years group, 75.3% in the 5-10 years group, 50.3% in the 10-15 years group and 26.9% in the more than 15 years group. Anti-sperm antibodies were positive in 31 patients (9.1%), of whom 12 patients (38.7%) were positive for sperm in the ejaculate. CONCLUSION: Microsurgical vasectomy reversal produces satisfactory patency rates to couples that consider reestablishing their fertility even more than 15 years after vasectomy. The presence of anti-sperm antibodies is associated with negative effects on sperm count, motility, and percentage of abnormal forms.

Tuberculous epididymitis and fertility in North Jordan.

OBJECTIVES: To describe the clinical characteristics of tuberculous epididymitis and its effect on male subfertility in a general hospital in the north of Jordan. METHODS: A retrospective case study of the hospital records of patients with genitourinary tuberculosis managed at Princess Basma Teaching Hospital in Irbid, North Jordan during the period of 1994-2001. RESULTS: Of the 16 patients with genitourinary tuberculosis, 9 were found to have tuberculous epididymitis. The mean age was 41.2 years. The main presentation was an insidious onset of painful scrotal swelling, mostly on the left side. Mean duration of symptoms was 10.6 weeks. Most patients had no history of previous tuberculosis and no Mycobacterium Tuberculosis in their urine. Six months of anti-tuberculous chemotherapy was effective, combined with surgery for scrotal abscesses. Although all patients recovered, the results on fertility are considerable. CONCLUSION: Isolated tuberculous epididymitis is the most common form of genitourinary tuberculosis. A 6-month course of anti-tuberculous chemotherapy is effective in combination with surgery for large scrotal abscesses. The fertility outcome is of concern. Sperm retrieval and cryopreservation have to be considered for potential intra-cytoplasmic sperm injection.

Obstetricians, gynecologists and the anti-smoking campaign: a national survey.

OBJECTIVE: To asses the role Jordanian obstetricians and gynecologists play as tobacco cessation counsellors through examining their smoking status, opinions on health risks, factors that influence tobacco use and their perceived barriers to providing effective counselling. STUDY DESIGN: The setting is a tertiary referral university hospital. A pre-tested postal questionnaire survey was mailed to all 462 licensed obstetricians and gynecologists in Jordan. Descriptive statistics were generated and statistical significance was determined by the chi2-test. RESULTS: Of 392 respondents, 37.9% were smokers. Most associated smoking with low birth weight and sudden infant death syndrome. Fewer associated smoking with infertility, ectopic pregnancy, placenta praevia, abruptio placentae and cancer of the uterine cervix. Friends, stress, parents' attitude, genetic predisposition, income and education were implicated factors for smoking. Current smokers were more likely to permit smoking in their practices. Non-smokers were most inclined to record their patients' tobacco habits. Only 54.3% provided cessation counselling. Lack of time and inadequate training were perceived barriers. CONCLUSIONS: A high proportion of obstetricians and gynecologists are smokers. A training program is needed to equip health workers with the skills necessary for the implementation of a successful anti-smoking campaign.

Intracytoplasmic sperm injection after total conventional in-vitro fertilization failure.

OBJECTIVE: This study assessed the value of delayed intracytoplasmic sperm injection after failure of initial in-vitro fertilization in patients with normal seminology. METHODS: A case series analysis was conducted on 82 couples who underwent delayed intracytoplasmic sperm injection after failure of initial in-vitro fertilization at Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia between January 1995 and January 2001. RESULTS: Seventy-eight couples had 616 unfertilized metaphase II mature oocytes after initial in-vitro fertilization. Second day "rescue" reinsemination by intracytoplasmic sperm injection (ICSI) resulted in 174 embryos that were suitable for transfer. This resulted in 4 clinical pregnancies (5.1% per started rescue ICSI cycle). CONCLUSION: The limited success rate in this study provides confirmatory data that rescue ICSI is not an efficient adjuvant laboratory procedure.

Bed rest versus free mobilisation following embryo transfer: a prospective randomised study.

OBJECTIVE: To evaluate the efficacy of two clinical methods of post-embryo transfer protocols in patients undergoing in vitro fertilisation. DESIGN: Prospective, randomised clinical trial. SETTING: Hospital-based clinic for reproductive medicine. SAMPLE: Women under 40 years of age who were undergoing in vitro fertilisation with GnRH pituitary down-regulation and controlled ovarian hyperstimulation. METHODS: Patients were randomised to rest for either 1 or 24 hours after embryo transfer. MAIN OUTCOME MEASURE: Clinical pregnancy per cycle rate (the percentage of cycles started that demonstrated a live fetus on ultrasound examination performed at six or seven weeks of gestation). RESULTS: The clinical pregnancy rates were 21.5% for the 1-hour and 18.2% for the 24-hour post-embryo transfer groups. The implantation rate per embryo was significantly higher in the 1-hour group (14.4%) than in the 24-hour group (9%). CONCLUSION: One-hour and 24-hour rest post-embryo transfer result in comparable rates of clinical pregnancy. However, 24-hour rest results in reduced implantation rate per embryo.

A flexible protocol for cryopreservation of pronuclear and cleavage stage embryos created by conventional in vitro fertilization and intracytoplasmic sperm injection.

OBJECTIVES: To evaluate the hospital's cryopreservation protocol. STUDY DESIGN: A retrospective cohort analysis of 30 conventional IVF and 44 ICSI cycles in an assisted conception unit at a tertiary referral hospital. All supernumerary embryos were cryopreserved at the pronuclear or blastomere stage. The survival, morphology, implantation and pregnancy rates were evaluated. The chi2 test and Fisher's exact test were used to determine the statistical significance. RESULTS: A total of 327 pronuclear and cleavage stage embryos were cryopreserved. The post thaw survival rates of 107 conventional IVF and 220 ICSI embryos were 90.6% and 69.0%, respectively. Of the thawed cleavage stage embryos from 43 IVF and 88 ICSI cycles, 90.6% and 69.3% were intact, respectively. Of the thawed pronuclear stage embryos from 64 IVF and 132 ICSI cycles, 90.6% and 68.9% were intact with cleavage rates of 57.8% and 56%, respectively. In the final 27 conventional IVF and 41 ICSI frozen-thawed embryo transfer cycles, the pregnancy rates were 18.5% and 19.5%, respectively. CONCLUSIONS: The adopted cryopreservation protocol flexibly allows for the selection of cleavage-stage embryos for fresh embryo transfer and the cryopreservation of all supernumerary embryos at the pronuclear or the cleavage stage in a single cycle with satisfactory pregnancy rates. Further validation of this protocol is required.