Association between albumin and depression: a population-based study.

INTRODUCTION: Albumin is the most prevalent plasma protein and is involved in a variety of critical physiological processes. Low serum albumin levels have been linked to depression symptoms in people who had recent suicide attempts and those suffering from several mental diseases such as acute episodes of mania, and schizophrenia. However, there has been little investigation into the relationship between depression and serum albumin levels in community-dwelling persons. This research aimed to examine the relationship between serum albumin and depression in a population-based sample and whether it differs depending on other possible confounders. METHODS: Our data were derived from a national household population study conducted in 2017 with a sample size of 3,521 Jordanians aged > 17 years old. The Patient Health Questionnaire (PHQ-9) scale, a self-administered scale, was used to screen for depression. Concentrations of serum albumin and other medical biomarkers were measured by blood tests. Using descriptive statistics for depression distribution and multivariate logistic regression analysis, the connection between albumin levels and depression was investigated. RESULTS: The odds ratios (ORs) for depression were significantly lower in the third and fourth quartiles of serum albumin concentration compared to the first quartile (OR = 0.64 and 0.66, respectively; P values = <0.001 and <0.001, respectively). This association was statistically significant even after controlling for variables such as gender, age, marital status, education, and occupation (OR = 0.67 and 0.75, respectively, and P values = 0.001 and 0.02, respectively), as well as after further controlling for other health status variables such as nutrition, comorbidity, body mass index, somking status, and biomedical markers such as serum calcium, phosphate, and magnesium (OR = 0.58 and 0.59, respectively, and P values = <0.001 and 0.001, respectively). Moreover, the unadjusted and adjusted odds ratios in the three regression models declined linearly with rising quartiles of serum albumin (P trend = <0.001, 0.009, and 0.001, respectively). CONCLUSIONS: Our research found an inverse relationship between serum albumin and depression. Serum albumin could be a warning measure for depression. It is required for appropriate intervention measures to be implemented.

Predictors of glycemic control in children and adolescents with type 1 diabetes at 12 months after diagnosis.

Identifying risk factors for suboptimal glycemic control during the first year after diagnosis with type 1 diabetes (T1D) may provide early appropriate and individualized management. Our aim was to study possible predictors of early glycemic control during the first year after diagnosis with T1D in children and adolescents in Jordan. This is a retrospective study conducted through a review of medical records at Jordan University Hospital and the National Centre for Diabetes, Endocrinology and Genetics. Children and adolescents diagnosed with T1D at age younger than 16 years and with diabetes duration of at least 2 years were included. Demographic, clinical and socioeconomic factors were collected, in addition to glycosylated hemoglobin (HbA1c) values during the first year after diagnosis. Average age at diagnosis of the 337 patients who were enrolled in the study was 7.7 ± 3.8 years. HbA1c at diagnosis was 10.9 ± 1.9% (95.64 ± 20.76 mmol/mol). Factors such as the involvement of children's mothers in deciding insulin doses, higher mother's educational level and higher family monthly income were associated with better early glycemic control. HbA1c at 6 months after diagnosis, parental marital status and compliance to counting carbohydrates were significant predictors of glycemic control at 12 months after diagnosis. Many clinical and socioeconomic factors were associated with early glycemic control at 12 months after diagnosis. Modifiable risk factors must be addressed as early as possible to decrease future complications. Children with nonmodifiable risk factors should be identified early for closer observation and providing individualized diabetes care plan.

The prevalence of thyroid dysfunction in Jordan: a national population-based survey.

BACKGROUND: The objectives of this study are to assess the prevalence of clinical and subclinical hypo- and hyperthyroidism and their associated factors among Jordanian adults. METHODS: In a cross-sectional population-based survey, a representative sample that included 3753 Jordanian adults was selected from the 12 governorates that represent the three regions of the country, in the year 2017. Sociodemographic and clinical data were obtained and blood samples were collected from all participants. Thyroid stimulating hormone (TSH), free tri-iodothyronine (FT3), free thyroxine (FT4), thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were measured to evaluate the thyroid function. RESULTS: The overall prevalence of thyroid dysfunction was 11.9%. Around 76% of patients with thyroid dysfunction were previously undiagnosed. The prevalence of hypothyroidism and subclinical hypothyroidism was 3.1 and 5.3%, respectively. The prevalence of hyperthyroidism and subclinical hyperthyroidism was 1.0 and 2.5%, respectively. Female preponderance which was mainly related to hypothyroid disorders was evident. The prevalence of positive TPOAb and TgAb in the study population was 14.9 and 15.3%, respectively. The prevalence of detectable TPOAb and TgAb in the euthyroid participants was10.3 and 11.9%, respectively. Logistic regression analysis revealed that female sex, age ≥ 50 years and the presence of TgAb and TPOAb were strongly associated with hypothyroidism. Hyperthyroidism was significantly associated with the presence of TPOAb and age ≥ 50 years. CONCLUSION: The prevalence of unrecognized thyroid dysfunction is high among Jordanians. A public health policy of screening high risk groups particularly those ≥50 years of age is recommended.

The performance of anthropometric measures to predict diabetes mellitus and hypertension among adults in Jordan.

OBJECTIVES: This study aimed to evaluate and compare the abilities of waist circumference (WC), body mass index (BMI), hip circumference (HC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict recently and previously diagnosed diabetes and hypertension and assess their appropriate cut-off values among Jordanian adults. METHODS: Data from the 2017 cardiovascular risk factors survey were analyzed to achieve the study objective. The survey collected extensive data from a national population-based sample of Jordanian residents. A structured questionnaire was used to collect sociodemographic variables and clinical data. Blood samples were taken for biochemical measurements. Anthropometric characteristics were measured by the same team of trained field researchers. RESULTS: This study included a total of 1193 men and 2863 women. Their age ranged from 18 to 90 year with a mean (SD) of 43.8 (14.2) year. WHtR performed better than other anthropometric measures and had a good ability (AUC > 0.80) among women and fair ability among men to predict newly diagnosed diabetes and previously diagnosed diabetes and hypertension. The appropriate cut-off points for anthropometric measures among women were 92 cm form WC, 104 cm for HC, 30 Kg/m2 for BMI, 0.85 for WHR, and 0.60 for WHtR. For men, the appropriate cut-off points were 100 cm for WC, 104 cm for HC, 27 Kg/m2 for BMI, 0.93 for WHR, and 0.57 for WHtR. CONCLUSION: WHtR performed better than other anthropometric measures in predicting diabetes and hypertension among adult population in Jordan. We recommend WHtR as a measure of choice with a cut-off value of 0.6 for women and 0.57 for men to predict diabetes and hypertension among Jordanians.

The Effect of Gonadotropin-Releasing Hormone Analogue on Final Adult Height in Children with Idiopathic Short Stature.

OBJECTIVE: To assess final adult height (FAH) in children with short stature treated with gonadotropin-releasing hormone analogue (GnRHa). METHODS: All patients with idiopathic short stature (ISS) with normally timed puberty and a Tanner stage between 2 and 3, who achieved their FAH between 2005 and 2015, were included in this clinical historical cohort study. Height gain, FAH, and mid-parental height of 28 children with ISS who received GnRHa treatment for 1.8 ± 1.0 years to delay their puberty were compared to 31 untreated children. RESULTS: The FAHs of the treated and the untreated girls were 151.3 ± 5.1 and 146.8 ± 3.8 cm (p = 0.01), respectively. The FAHs of the treated and the untreated boys were 156.4 ± 4.7 and 152.3 ± 5.7 cm (p = 0.111), respectively. The height gain in the treated and the untreated girls was 1.6 ± 7.8 and -3.6 ± 5.7 cm (p = 0.036), respectively. Height gain in the treated and the untreated boys was -5.1 ± 13.6 and -11.5 ± 8.4 cm (p = 0.171), respectively. CONCLUSION: GnRHa therapy has a modest effect in improving FAH in adolescent females with ISS but not in boys.

Clinical and biochemical features at diagnosis of type 1 diabetes in patients between 0 and 18 years of age from Jordan.

OBJECTIVE: Data regarding type 1 diabetes mellitus (T1D) in Jordan are extremely scarce. We aim to evaluate the clinical and laboratory characteristics at diagnosis of T1D in a group of children from Jordan. METHODS: The records of 437 (boys/girls: 224/213) children with type 1 diabetes followed in the years 2012 to 2016 were evaluated retrospectively. The data were assessed by sex and age subgroups (<5, 6-10, and 11-18 years). RESULTS: Mean age of children at diagnosis was 7.3 ± 3.6 years. The first peak in the number of T1D cases in terms of age at diagnosis was observed in the age group between 6 and 8 years (n = 116 [26.5%], 95% confidence interval [CI]: 22.3%-30.6%). This was followed by the age group of 3 to 5 years (n = 108 [24.7%], 95% CI: 20.6%-28.7%). Although the patients mostly presented in winter (30.0%, 95% CI: 25.6%-34.3%), no season-related significant differences were found. The frequency of ketoacidosis at diagnosis was 40.7% (95% CI: 36%-45.3%). At presentation, 22.8% (95% CI: 18.9%-26.7) of our patients had a positive history of T1D in their extended families. In addition, 61.1% (95% CI: 56.5%-65.7%) of the patients were started on premixed insulin at diagnosis. CONCLUSION: The findings possibly indicate a decreasing age of T1D onset in Jordanian patients. The high frequency of ketoacidosis at presentation is noteworthy. In addition, the initial insulin protocols are not in accordance with the recommended insulin therapy for children and adolescents with T1D.

Assessment of segmental left ventricular thickening in diabetic type II obese patients with normal myocardial perfusion scan.

OBJECTIVE: The aim of this study is to investigate whether gated single photo emission tomography (gSPET) can be used to detect subclinical left ventricular systolic dysfunction (LVSD) in obese diabetic type II patients. SUBJECTS AND METHODS: We retrospectively reviewed gSPET images of 190 patients with diabetes mellitus type II (DM II) (137 females and 53 males) with normal myocardial perfusion and normal ejection fraction (EF). Standardized twenty segment polar maps of thickening and motion were generated. Correlation between body mass index (BMI) and thickening for each segment was performed. RESULTS: Statistically significant results were reported in female patients including: negative correlation between BMI and EF (-0.19, P=0.03). End diastolic volume (EDV) also significantly increased with increasing BMI (0.25, P<0.01). There was also statistically significant negative correlation between septal thickening and BMI segment 15 (-0.19, P=0.02), segment 16 (-0.22, P=0.01), segment 18 (-0.20, P=0.01), segment 19 (-0.25, P=0.003), segment 20 (-0.2, P=0.02)]. No statistical significant correlation was found between thickening and BMI in male patients. CONCLUSION: This is the first time where thickening as measured by gSPET has been used to demonstrate subclinical LVSD in DM II obese patients. The relationship between gender and obesity on cardiovascular function and structure needs further investigations.

Vitamin B12 deficiency in Jordan: a population-based study.

BACKGROUND: Vitamin B12 deficiency is highly prevalent worldwide and has been linked to hematologic, neurologic and psychiatric diseases. There are a few studies regarding vitamin B12 deficiency in developing countries in general and in Jordan in particular. OBJECTIVES: The aims of the present study were to assess the vitamin B12 status of Jordanians at national level and to identify population groups at high risk for vitamin B12 deficiency. METHODS: Vitamin B12 status was assessed in a national sample of 5,640 subjects aged >8 years. The study involved interviews, laboratory measurements of vitamin B12 and other parameters, and physical measurements. The present report deals exclusively with subjects aged >18 years (n = 2,847). RESULTS: The percentages of subjects with low (<200 pg/ml, n = 857), borderline (201-350 pg/ml, n = 382) and normal vitamin B12 level (>350 pg/ml, n = 1,608) were 30.1, 13.4 and 56.5%, respectively. Of the 382 subjects who had borderline vitamin B12 level, 61 subjects had both increased total homocysteine (tHcy; >13 µmol/l) and low holocobalamin (<35 pmol/l). Since elevated tHcy also indicates folate deficiency, the overall prevalence of vitamin B12 deficiency reached 32.2% (31.9% among males and 32.4% among females) after adding those 61 subjects to the 857 subjects with low vitamin B12 level. CONCLUSION: In conclusion, our study showed that almost one third of Jordanian adults have vitamin B12 deficiency with no gender differences. Intake of vitamin B complex and multivitamins seems to protect from vitamin B12 deficiency. An in-depth study of the dietary and eating habits of Jordanians may be needed to explain the observed age and regional differences in vitamin B12 deficiency in the study population.

Comparison and evaluation of the 2009 and 2021 chronic kidney disease-epidemiological collaboration equations among Jordanian patients with type 2 diabetes mellitus.

AIMS: This study compared the 2009 versus 2021 chronic kidney disease (CKD) Epidemiological Collaboration (CKD-EPI) equations to calculate estimated glomerular filtration rate (eGFR) among Jordanian patients with T2DM to assess their agreement and impact on CKD staging. METHODS: This cross-sectional study included 2382 adult Jordanian patients with T2DM. The 2009 and 2021 CKD-EPI equations were used to calculate eGFR. Patients were reclassified according to kidney disease-Improving Global Outcomes (KDIGO) categories. Agreement between the equations was assessed using Bland-Altman plots and Lin's concordance correlation. RESULTS: The 2021 equation significantly increased eGFR by a median of 2.1 mL/min/1.73 m2 (interquartile range: 0.6-3.6 mL/min/1.73 m2). However, there was significant agreement between equations (Kappa: 0.99; 95% confidence interval: 0.95-1.00), independent of age, sex, and the presence of hypertension. In total, 202 patients (8.5%) were reclassified to higher KDIGO categories using the 2021 equation, with category G3 being most affected. The overall prevalence of patients in the high to highest risk categories decreased (28.0% vs. 26.5%). CONCLUSIONS: Although there was significant agreement with the 2009 equation, the 2021 equation increased eGFR and resulted in the reclassification of a subset of subjects according to KDIGO criteria. The uncertain impact of reducing high-risk category patients raises concerns about potential delays in referral and intervention, while holding the potential to enhance high-risk patient categorization, thus alleviating healthcare burden.

Risk factors for chronic kidney disease in middle eastern patients with type 2 diabetes mellitus: A cross-sectional study using the KDIGO classification.

AIMS: Chronic kidney disease (CKD) is prevalent in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate risk factors for CKD progression across the kidney disease-Improving Global Outcomes (KDIGO)categories in a Middle Eastern population beyond hyperglycemia as emphasized by KDIGO guidelines which classifying CKD by cause and severity. METHODS: This cross-sectional study targeted 1603 patients with T2DM. Risk factors for CKD progression were determined using odds ratios (ORs) and 95 % confidence intervals (CIs). RESULTS: Overall, 35.5 %, 31.7 %, and 32.8 % of patients were classified as low-risk, moderate-risk, and high-/very high-/highest-risk, respectively. Several factors were associated with high/very high/highest risk categorization, including being aged >45 years (OR: 1.85, 95 % CI: 1.36-2.49; P < 0.001), male gender (OR: 1.87, 95 % CI: 1.38-2.54; P < 0.001), hypertension (OR: 3.66, 95 % CI: 2.32-5.78; P < 0.001), and T2DM duration of ≥15 years (OR: 3.2, 95 % CI: 2.27-4.5; P < 0.001). Patients with more concurrent risk factors were notably represented in the high/very high/highest risk category. CONCLUSIONS: Male patients, older patients, and those with comorbid hypertension, longstanding T2DM, and additional concurrent risk factors have a significantly higher risk of advanced CKD. Such findings should be considered when planning management approaches for patients with CKD.

The prevalence of overactive bladder and its impact on the quality of life: A cross-sectional study.

Objective: Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors. Methodology: A total of 940 participants were categorized into non-OAB and OAB using the Overactive Bladder Symptom Score (OABSS). HRQL and symptom bother were measured using the Overactive Bladder Questionnaire - Short Form (OAB-q SF). Descriptive analyses and multivariable regression analyses were performed. Results: The prevalence of OAB among our population was 27.4%. Patients with older age (Odd ratio [OR] = 2.26, 95% confidence interval [CI]: 1.6-3), higher body mass index (BMI) (OR = 2.6, 95% CI: 1.8-3.8), comorbidities (OR = 2.6, 95% CI: 1.9-3.5) and history of recurrent urinary tract infection (UTI) s (OR = 1.9, 95% CI: 1.4-2.6) were significantly associated with increased risk of OAB (p < 0.001). The mean OAB symptom bothers score was 35.7 + 22.9 and increased significantly across OAB severity groups (p < 0.001). The mean HRQL score was 73.3 + 22 and a significant decreased across OAB severity groups (p < 0.001). All OAB symptoms showed significant positive correlation with increased symptom bother (p < 0.001) in addition to significant inverse correlation with HRQL (p < 0.001). Conclusion: OAB is a prevalent condition in our population and the associated symptoms negatively affect HRQL. In this study, the detrimental effect is not exclusive to UUI and can be attributed to the other elements in the symptom spectrum of OAB. Screening for OAB should be considered during routine clinical visits using validated and reliable measures for early detection of symptoms and possible modification of risk factors to improve the outcome.

N-acetyltransferase-2 genotypes among Jordanian patients with diabetes mellitus.

BACKGROUND: There are inconsistent reports concerning N-acetyltransferase 2 (NAT2) genotypes in diabetes mellitus (DM). OBJECTIVE: The objective of the study was to explore any association between NAT2 genotypes and Type 1 and Type 2 DM in Jordanians. METHODS: 106 Type 1 and 110 Type 2 DM patients attending the "National Center for Diabetes, Endocrinology and Genetics", Amman, Jordan, were included in the study. DNA was extracted from venous blood using a commercial DNA extraction kit. NAT2 genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The frequency of the genotype that encodes rapid acetylation (the wild-type genotype NAT2*4/4) was similar in the two types of diabetes mellitus. Those which encode intermediate acetylation (NAT2*4/5, NAT2*4/6, and NAT2*4/7) were higher in Type 2 diabetes (0.482) compared to Type 1 diabetes (0.339), while the frequency of genotypes which encode slow acetylation (NAT2*5/5, NAT2*5/6, NAT2*5/7, NAT2*6/6, NAT2*6/7, and NAT2*7/7) were higher in Type 1 diabetes (0.547) compared to Type 2 diabetes (0.418). CONCLUSION: There is excess of genotypes encoding intermediate acetylation in Type 2 DM and an excess of slow acetylator genotypes in Type 1 DM. Furthermore, NAT2*4/6 genotype (which encodes intermediate acetylation) was more prevalent in Type 2 DM. Type 1 DM behaved similar to non-diabetic controls in regard to acetylation status.

Quality of care for type 2 diabetes in Jordan: A national study.

The present study aimed to describe the quality of healthcare delivered to patients with type 2 diabetes in Jordan in 2017. Another objective was to identify the factors related to glycemic control and hospital admission due to type 2 diabetes. This was a national population-based household study. Aspects of care quality were evaluated in relation to outcomes, such as glycemic control [hemoglobin A1c; glycated hemoglobin (HbA1c) level <7%] and hospital admission owing to diabetes. A total of 754 patients previously diagnosed with type 2 diabetes and aged ≥25 years were recruited. The number of annual visits was >10 for 48.5% and 1-4 for 38.2% of patients. The proportion of patients achieving glycemic control was 33.0%. In total, 4 of 5 patients reported easy access to health facilities and good health team support. Foot and eye examinations were performed for 24.9 and 55.0% of the patients, respectively. Dietary advice was delivered to 87.5% of the patients. Glycemic control exhibited a significant inverse association with the duration of diabetes and the number of annual visits. Following a specific diet for managing diabetes and the cessation of medication after an improved well-being were independently associated with a higher likelihood of glycemic control (HbA1c <7%). On the whole, the present study demonstrates that a number of indicators for the quality of diabetes care in Jordan were relatively satisfactory; however, others require improvement. The findings demonstrate that numerous patients with diabetes in Jordan require education about the treatment and management of, and complications associated with diabetes, especially those who are recently diagnosed.

Post-COVID-19 syndrome among healthcare workers in Jordan.

Background: Post-COVID-19 syndrome covers a wide range of new, recurring or ongoing health conditions, which can occur in anyone who has recovered from COVID-19. The condition may affect multiple systems and organs. Aims: To evaluate the frequency and nature of persistent COVID-19 symptoms among healthcare providers in Jordan. Methods: Post-COVID-19 syndrome refers to symptoms extending beyond 4-12 weeks. We conducted a historical cohort study among 140 healthcare staff employed at the National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan. All of them had been infected with COVID-19 virus during March 2020 to February 2022. Data were collected through face-to-face interviews using a structured questionnaire. Results: Some 59.3% of the study population reported more than 1 persisting COVID-19 symptom, and among them 97.5%, 62.6% and 40.9% reported more than 1 COVID-19 symptom at 1-3, 3-6 and 6-12 months, respectively, after the acute phase of the infection. Post-COVID-19 syndrome was more prevalent among females than males (79.5% vs 20.5%) (P = 0.006). The most frequent reported symptom was fatigue. Females scored higher on the Fatigue Assessment Scale than males [23.26, standard deviation (SD) 8.00 vs 17.53, SD 5.40] (P < 0.001). No significant cognitive impairment was detected using the Mini-Mental State Examination and the Montreal Cognitive Assessment scales. Conclusion: More than half (59.3%) of the healthcare workers in our study reported post-COVID-19 syndrome. Further studies are needed to better understand the frequency and severity of the syndrome among different population groups.

Control of diabetes, hypertension, and dyslipidemia in Jordan: a cross-sectional study.

To determine the level of glycemic, blood pressure (BP), and lipids control among patients with type 2 diabetes mellitus (DM) attending the National Center for Diabetes, Endocrinology and Genetics and to determine factors associated with poor control. Methods: A cross-sectional study of 1200 Jordanian type 2 DM patients was included in this study during the period of December 2017-December 2018. We reviewed the charts of these patients until January 2020. Data obtained from medical records included information about sociodemographic variables, anthropometric measurements, glycated hemoglobin (HbA1c), BP, low-density lipoprotein (LDL), the presence of DM complications, and treatment. Results: The percentage of subjects who had HbA1c values of less than 7% was 41.7%. BP targets (<140/90 and 130/80 mmHg) were achieved in 61.9 and 22% of our patients, respectively. LDL targets less than 100 and 70 mg/dl or less were achieved in 52.2 and 15.9% of our studied population. Only 15.4% of our patients could have simultaneous control of HbA1c less than 7%, BP less than 140/90 mmHg, and LDL less than 100 mg/dl. Factors associated with poor glycemic control were obesity [odds ratio (OR)=1.9], DM duration between 5 and 10 years or more than 10 years (OR=1.8 and 2.5, respectively), and the use of a combination of oral hypoglycemic agent plus insulin or insulin alone (OR=2.4 and 6.2, respectively). Moreover, factors associated with uncontrolled BP (≥140/90) were male gender (OR=1.4), age 50-59 years or at least 60 years (OR=3.3 and 6.6, respectively), overweight and obesity (OR=1.6 and 1.4, respectively), insulin use (OR=1.6), and LDL at least 100 mg/dl (OR=1.4). Conclusion: The overall prevalence of poor glycemic control was high and alarming. Future research should focus on capturing all variables that may impact glycemic, BP, and dyslipidemia control, with special emphasis on a healthy lifestyle that would be of great benefit in this control.

Degenerative lumbar changes have a statistically significant but small effect on trabecular bone score (TBS)-adjusted fracture risk (FRAX).

Trabecular bone score (TBS) assesses trabecular microarchitecture at the lumbar spine and was shown to improve fracture risk prediction compared to bone mineral density (BMD) alone. We investigated whether lumbar degenerative changes (DC) affect TBS and TBS-adjusted 10-year fracture risk assessment (tool) (FRAX) estimates. All patients who underwent BMD and TBS measurements via dual-energy X-ray absorptiometry at our institution between 1/7/2020 and 1/10/2020 were retrospectively evaluated. We identified all patients who had DC in 1 or 2 vertebrae (out of L1-L4) with a BMD T score > 1 unit higher than the remaining 2 to 3 adjacent vertebrae. TBS and BMD were compared between the vertebrae with and without DC. Change in TBS as well as FRAX estimates for major osteoporotic (MOP) and hip fractures after exclusion of the degenerative vertebrae were also determined. Of the 356 eligible patients, 94 met the inclusion criteria. The mean TBS of vertebrae without DC was not significantly different from that of L1 to L4 (1.31 ± 0.12 vs 1.32 ± 0.12, respectively, P = .11). The FRAX estimates after exclusion of the degenerative vertebrae were statistically significantly higher than for L1 to L4 for both MOP and hip fractures (P = .04 and P = .01, respectively). However, the differences were very small. The mean 10-year MOP FRAX estimate after exclusion of degenerative vertebrae was 7.67% ± 4.50% versus 7.55% ± 4.36% for L1 to L4 and the mean 10-year hip FRAX estimate after exclusion of degenerative vertebrae was 2.06% ± 2.01% versus 2.02% ± 1.98% for L1 to L4. Lumbar DC have a statistically significant but only small effect on TBS-adjusted FRAX making it unnecessary to exclude the degenerative vertebrae when computing TBS.

Pituitary abscess presenting two years after the diagnosis of a pituitary lesion in a patient with panhypopituitarism.

Pituitary abscess is a rare condition. Here, we present the case of a young male patient who was initially found to have a pituitary lesion following the diagnosis of panhypopituitarism. Two years later, he presented with severe headache and was subsequently diagnosed intraoperatively with pituitary abscess. At a follow-up of 6 years after surgery, the patient was continuing to do very well. We discuss the differential diagnosis and demonstrate the evolution of the pituitary lesion on magnetic resonance imaging at four different time points: at the time of the detection of the initial lesion; two years later at the time of the diagnosis of the pituitary abscess; at 7 weeks post operatively; and finally after six years from the pituitary surgery.

Statin Induced Myopathy Among Patients Attending the National Center for Diabetes, endocrinology, & genetics.

BACKGROUND AND OBJECTIVES: myopathy is a major side effect of statins that leads to statin intolerance and discontinuation. In this prospective cohort study, the main objective was to estimate the incidence of myopathy in patients receiving statins. In addition, we identified some risk factors associated with statin induced myopathy. METHODS: A prospective cohort study was conducted at the National Center for Diabetes, Endocrinology and Genetics [NCDEG] in Jordan from October 1, 2018 to January 31, 2021. All subjects who initiated statin therapy followed up during that period. Data was collected at time 0 (baseline), 3, 6, 9, and 12 months after enrollment. Demographic and clinical data were collected from medical records. Muscular symptoms were collected by conducting face-to-face interviews to all patients using a pre-structured questionnaire. RESULTS: The overall incidence of myopathy among patients taking statins was 27.8%, 31.4% in males and 22.6% in females, the incidence of myopathy was higher in older people, being highest in patients ≥60 years (34%). Bivariate analyses showed no significant association between myopathy and hypothyroidism, diabetes or medications that are known to interact with statins. The incidence of myopathy was highest with Simvastatin 40 mg (50%) and lowest with Fluvastatin XL 80 mg (8%) and Rosuvastatin 10 mg (10.8%). CONCLUSIONS: The overall incidence of myopathy in patients taking statins was 27.8%. Myopathy was directly related to dose and type of statin used. The use of Fluvastatin XL 80 mg and Rosuvastatin 10 mg showed less incidence of myopathy compared with other statins.

Effect of Insulin Injection Techniques on Glycemic Control Among Patients with Diabetes.

Objective: Previous studies have shown that healthcare professionals rarely instruct patients about proper insulin injection techniques. This study aimed to assess the practices of insulin injection techniques among patients with diabetes treated and assess the effect of these practices on glycemic control. Patients and Methods: This cross-sectional study was conducted between November 2020 and February 2021. A random systematic sampling technique was used to recruit study subjects at specialist outpatient clinics. Subjects with type 1 or 2 diabetes mellitus who had been using insulin injections for at least a year were included in this study. Results: A total of 298 subjects with type 1 diabetes and 553 with type 2 diabetes participated in this study. The mean age of patients with type 1 diabetes was 20.1 ± 10.4 years. The mean age of patients with type 2 diabetes was 58.6 ± 9.5 years. The median type 1 diabetes duration was 6.0 years, and median type 2 diabetes duration was 15.0 years. About 66.8% of patients with type 1 diabetes and 69.4% of patients with type 2 diabetes were rotating insulin injection sites. Almost 36.6% of patients with type 1 diabetes and 50.5% of patients with type 2 diabetes reported using the same insulin needle more than three times. The prevalence of lipohypertrophy was 57.0% among patients with type 1 diabetes and 55.5% among patients with type 2 diabetes. The absence of lipohypertrophy, rotation of insulin injection site, and total daily insulin dose ≤50 units were all independently significantly associated with better glycemic control. Conclusion: Insulin injection techniques were suboptimal among significant proportion of patients with diabetes in Jordan. Improper insulin injection technique, especially the rotation of injection sites and lipohypertrophy formation, was associated with uncontrolled blood glucose levels. Educational interventions that focus on insulin injection techniques among Jordanian patients with diabetes are strongly recommended.

The prevalence of hypertension and its progression among patients with type 2 diabetes in Jordan.

BACKGROUND: Assessing the prevalence and progression of hypertension among diabetics is crucial for designing appropriate strategies for successfully managing hypertension and its life-threatening complications. This study aimed to assess the prevalence of hypertension, its progression, and its determinants among type 2 diabetes mellitus (T2DM) patients in Jordan. MATERIALS AND METHODS: A cross-sectional study was conducted among 1382 Jordanian patients with T2DM in the period from January 2019 to January 2020. Blood pressure (BP) was followed and measured every 2-3 months using standardized automated sphygmomanometer during patients' routine visits for a total of 12 months. Data were obtained from medical records that included sociodemographic variables, anthropometric measurements, HbA1c, lipid profile, presence of T2DM complications and treatment. RESULTS: The prevalence of hypertension among T2DM patients at the baseline was 74.6% (95% CI: 72.2%, 76.9%). The one-year incidence of hypertension among T2DM patients who were free of hypertension at the baseline was 26.2% (95% CI: 21.7%, 31.1%). In the multiple logistics regression analysis, patients older than 60 years (OR = 1.3 (95% CI: 1.01, 1.7); p-value 0.045) and those with positive family history of hypertension (OR = 4.2 (95% CI: 1.2, 8.2); p-value 0.026) were more likely to have uncontrolled hypertension. Patients who were using insulin only were less likely (OR = 0.5 (95% CI: 0.2, 0.9); p-value 0.026) to have uncontrolled hypertension compared to those who were on oral hypoglycemic agents only. CONCLUSION: The prevalence of hypertension among Jordanian patients with T2DM is alarmingly high. Healthcare providers should be committed to policies or preventive strategies targeting the modifiable risk factors associated with hypertension.