We report a case of intrathymic parathyroid The most common cause of primary adenoma that was loc... more We report a case of intrathymic parathyroid The most common cause of primary adenoma that was localized preoperatively by hyperparathyroidism is parathyroid adenoma. Up Technetium MIBI SPECT and treated surgically to 20% of parathyroid ademomas has been via assisted Thoracoscopic surgery and reported to be in ectopic localization. Ectopic developing hungry bone syndrome after surgery. p arathyroid glands can also become ( R a w a l M e d J 2 0 1 3 ; 3 8 : 3 1 4 - 3 1 6 ) . adenamatous, causing a diagnostic dilemma Key words: Primary hyperparathyroidism, when they are difficult to localize preoperatively. parathyroid adenoma, Intrathymic.
The most common cause of primary hyperparathyroidism is parathyroid adenoma. Up to 20% of parathy... more The most common cause of primary hyperparathyroidism is parathyroid adenoma. Up to 20% of parathyroid ademomas has been reported to be in ectopic localization. Ectopic parathyroid glands can also become adenamatous, causing a diagnostic dilemma when they are difficult to localize preoperatively. We report a case of intrathymic parathyroid adenoma that was localized preoperatively by Technetium MIBI SPECT and treated surgically via assisted Thoracoscopic surgery and developing hungry bone syndrome after surgery.
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2012
To set references and evaluate the associations between the predictive powers of the anthropometr... more To set references and evaluate the associations between the predictive powers of the anthropometric indices of obesity, particularly central obesity, including body mass index (BMI), waist circumference (WC), waist to hip ratio (WHpR) and waist to height ratio (WHtR), and the risk factor accumulations of ≥ 2 of the components of the metabolic syndrome (MS) in a group of Jordanian men and women. Five hundreds subjects were randomly selected from among the visitors attending several family clinics in Amman. Obesity was assessed using BMI, WC, WHpR and WHtR anthropometric indices. MS risk factors as defined by the International Diabetes Federation were determined. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive powers and the cut off points of each index associated with increased MS risk. There were 212 men and 288 women with age ranged 20-85 years. Optimal cut off points of BMI, WC, WHpR for MS diagnosis in men were 28.4 kg/m(2), 97.8 cm and 0.89, respectively. In women, these were 30.3 kg/m(2), 95.6 cm and 0.84, respectively. WHtR was 0.61 in both genders. Area under the curve (AUC) of ROC analysis for identifying of MS (≥ 2 risk factors) was the highest for WHpR (AUC=0.71), followed by WHtR (AUC=0.67), WC (AUC=0.64) and BMI (AUC=0.59) in men; whereas in women WHpR, WHtR and WC were almost equal (AUC=0.76, 0.75 and 0.74, respectively), followed by BMI (AUC=0.67). Correlation coefficients (r) between WHpR and MS risk factors were the strongest among the other obesity indices, followed by WC and WHtR. WHpR correlated significantly with FBG (r=0.27, p<0.01), systolic blood pressure (r=0.20, p<0.01), TGs (r=0.24, p<0.01) and HDL-C (r=-0.39, p<0.01). The respective r-values between WC and WHtR and each MS risk factors were: FBG (r=0.15, p<0.001 or r=0.13, p<0.01), systolic blood pressure (r=0.16, p<0.01 or r=0.11,…
To evaluate the patterns of testicular cytology in men with primary infertility, to compare the m... more To evaluate the patterns of testicular cytology in men with primary infertility, to compare the morphologic patterns between the periods 1990-1995, immediately after Gulf War II, and 1997-2001 and to determine whether there is a correlation between hormonal profile, testicular volume and morphologic pattern. Retrospective study of men with primary infertility. History, complete physical examination, hormonal assay and testicular ultrasound were evaluated. A total of 545 patients had samples for testicular cytology obtained from both testes. The patient's consent was obtained in all cases. Smears were interpreted under light microscopy after treatment with Diff-Quik. A total of 104 healthy, fertile subjects were used for comparison of the hormonal profile and testicular volume. The mean (+/- SD) age was 28.66 +/- 4.36 years and duration of marriage 4.4 +/- 4.36 years. There were 11.2% patients with normal cytology, 55.8% with hypospermatogenesis, 28.4% with testicular atrophy, 2.9% with Sertoli cells only and 1.7% with maturation arrest. A significant increase in hypospermatogenesis and decrease in the Sertoli cell-only pattern were noted in 1997-2001 when compared with 1990-1995. The mean left testicular volume was 10.53 +/- 5.51 mL3 in the infertile group vs. 15.2 +/- 4.97 in the fertile group (p < 0.003); right testicular volume was 10.84 +/- 4.77 vs. 15.15 +/- 5.31 (p < 0.003). The hormonal profile revealed higher luteinizing hormone and follicle-stimulating hormone levels in the infertile group vs. control group (8.53 +/- 9.03 and 16.44 +/- 19.243 vs. 6.98 +/- 4.53 and 7.37 +/- 6.63, respectively [p < 0.001]). Free testosterone was higher in the fertile group (39.69 +/- 12.76 vs. 20.28 +/- 8.5 [p < 0.000]). The majority of infertile males in our cohort had hypospermatogenesis; testicular atrophy was the next most common disorder. There was no major change in overall absolute numbers since the Gulf War. Testicular cytology by fine needle aspiration is a safe and well-tolerated complementary investigation for unexplained male infertility.
Objective: To determine the incidence of thyroid nodules found during extra-cranial carotid Doppl... more Objective: To determine the incidence of thyroid nodules found during extra-cranial carotid Doppler examination. Methods: Between March 2005 and December 2007, a total number of 791 patients (354 females and 437 males) underwent carotid Doppler examination for different causes. The study included thyroid gland examination with gray scale and color Doppler. Pati ents with incidental thyroid nodules were referred to endocrinology out-patient clinic for further evalua tion. Patients were divided according to age group and prevalence per decade. Results: Incidental thyroid nodules were found in 98 (12.3%) patient. Bilateral nodules were found in 61 and unilateral in 37 patients. Nodules equal or lar ger than one cm were found in 89 patients. Fifty ei ght nodules were solid, 24 were cystic and 16 showed mixed echogenesity. Fine needle aspiration biopsy was performed in 87 patients, and results showed 79 (91 %) benign and 8 (9%) malignant nodules. Most malignant nodules were papillary car...
Objectives: To assess the impact of age, gender, duration of diabetes and body mass index confoun... more Objectives: To assess the impact of age, gender, duration of diabetes and body mass index confounders on diabetes control among a Jordanian cohort of T2DM at the Endocrine Clinic in King Hussein Medical Center. Methods: Patients were selected over 18 months from outpatient clinic at King Hussein Medical Center in Amman-Jordan. Diabetes control assessed by mean of latest 3 HbA1c and fasting blood sugar. Patients were divided in 2 groups according to age ( 55 years), gender, duration ( 10 years) and BMI (normal, overweight, and obese according to WHO criteria). Statistical analysis is performed using SPSS11.5.Good diabetes control is assessed according to American Diabetes Association criteria Results: A total of 405 patients were selected (223 males, 182 females). 115 patients (28.4%) were having a good control with HbA1c 55 years (n=222) (29%vs.28%; p=0.812). Females in both age groups were having non statistically significant better control than males. Of those with DM duration 10 ...
OBJECTIVE To determine the lipid profile and to identify and stratify risk factors in diabetic an... more OBJECTIVE To determine the lipid profile and to identify and stratify risk factors in diabetic and non-diabetic patients with proven coronary artery disease at King Hussein Medical Center, Amman, Jordan. METHODS One hundred and ninety-two patients who were admitted to Queen Alia Heart Institute, Amman, Jordan, proving to have coronary artery disease (CAD) by angiogram, with a mean age of 54 +/- 22 years were studied. Seventy-seven patients were diabetics and 115 non-diabetics. Their lipid profiles (T-Cholesterol, high density lipoprotein level (HDL-C), low density lipoprotein level (LDL-C), triglyceride, glucose, glycosylated hemoglobin) and thyroid function test were compared to a control group of 162 individuals with no cardiac events or diabetes, mean age 48.9 +/- 18 years. Prevalence of hyperlipidemia was calculated. Patients with high thyroid stimulating hormone were excluded. RESULTS The mean (+/- standard deviation) plasma cholesterol for the group with CAD is 231.43 +/- 57.9...
Objective: The aim of the study was to explore the prevalence of peripheral neuropathy (PN) among... more Objective: The aim of the study was to explore the prevalence of peripheral neuropathy (PN) among patients with Diabetes Mellitus (DM) at King Hussein hospital. Methods: This study was done at King Hussein Hospital. Descriptive research design was used to recruit a convenience sample of 202 patients with DM who were referred to diabetes clinic. Data were collected through face-to-face interview. Data collection instrument is composed of two parts; the first part assesses the demographic characteristic, while the second part is a translated version of Michigan Neuropathy Screening Instrument (MNSI). Descriptive and inferential statistics were used for data analysis. Results: The sample consisted of 102 male and 100 female patients. Their age ranged from 16 to 88 years (M = 56.19 ± 14.31 years). The mean duration of diabetes was 10.69 ± 8.24 years. The overall prevalence of diabetic PN was (54.45 ± 49.92). The prevalence of diabetic PN was higher in women than men (55 ± 50 VS 53.92 ± ...
Patients and methods: Patients randomly selected over 18 months from outpatient clinic at KHMC in... more Patients and methods: Patients randomly selected over 18 months from outpatient clinic at KHMC in Amman-Jordan. Diabetes control assessed by mean of latest 3 HbA1c and FBS. Patients were divided in 2 groups according to age (<55 years vs >55 years), gender, duration (<10 ...
A young black Jordanian lady who has type one diabetes, chronic diabetic complication and ischemi... more A young black Jordanian lady who has type one diabetes, chronic diabetic complication and ischemic heart disease, presented with a picture of diabetic keto-acidosis, precipitated by an acute neck swelling. This was suggestive of acute suppurative thyroiditis with abscess formation causing compressive symptoms. This unfortunate patient had an eventful course despite aggressive treatment by antibiotics and surgery and then succumbed of an acute cardiac event. The operative tissue biopsy revealed an abscess in an infarcted papillary thyroid cancer. We believe this is a rare presentation of such an association with a fatal outcome.
OBJECTIVE To assess the gender differences in the prevalence of diabetes, composite cardiovascula... more OBJECTIVE To assess the gender differences in the prevalence of diabetes, composite cardiovascular disease, and the components of metabolic syndrome (MS) in a Jordanian cohort with MS. Secondly, to evaluate the impact of number of MS components on prevalence of diabetes, ischemic heart disease (IHD), and stroke. METHODS We carried out a cohort study among participants who fulfilled the National Cholesterol Education Program (Adult Treatment Panel III) criteria for MS recruited from December 2006-2007 from Endocrine Outpatient Clinics of the King Hussein Medical Centre, Amman, and Prince Rashid Military Hospital, Irbid, Jordan. Patients were divided into groups according to gender, presence, or absence of diabetes, and were evaluated for MS components, presence of IHD, and stroke. RESULTS Three hundred and fifty-seven patients 207 males and 150 females were included, type 2 diabetes was present in 226 (132 males) patients. No intergroup differences were found on waist circumference, ...
We report a case of a 62-year-old postmenopausal hypertensive lady who was treated for osteoporos... more We report a case of a 62-year-old postmenopausal hypertensive lady who was treated for osteoporosis with calcium and Vitamin D. She presented with progressive lower limb weakness and paresthesia with sensory level at T4. Investigations revealed high parathyroid hormone 1152 ng/dl, calcium 10.9 mg/dl, and low phosphorus of 2.4 mg/dl after stopping calcium supplement. Chest x-ray showed an expansile mass lesion of the right 6th rib confirmed by chest CT. Thoracic MRI showed a mass lesion extending from the T3 vertebral body and compressing the spinal cord. There were multiple lytic lesions of the scalp, ribs, femur, and pelvis suggesting metastatic lesions. A neck ultrasound and SESTA MIBI parathyroid scan confirmed a right lower parathyroid adenoma. Excision biopsy of the rib lesion confirmed a vascular lesion with features of brown tumor BT. Decompression surgery of the thoracic spine was performed, and the histopathology confirmed BT. Two weeks later the patient underwent right par...
Objective: To assess Diabetes Knowledge among patients with Diabetes mellitus at King Hussein Hos... more Objective: To assess Diabetes Knowledge among patients with Diabetes mellitus at King Hussein Hospital. Method: This study was conducted at King Hussein Hospital. Descriptive research design during the period between September 2010 to October 2010, was used to recruit a convenient sample of 100 hospitalized adult patients with Diabetes mellitus. Data was collected through face-to-face interview using the Brief Diabetes Knowledge Test (Fitzgerald et al, 1998). This test is composed of 23 multiple choice questions that assess General Knowledge and Insulin Knowledge as well as Total score for Total knowledge. Simple descriptive statistics (frequency, mean, percentage) was used to describe the study variables Results: One hundred diabetic patients participated in this study (50 men and 50 women). Their age ranged from 19 to 86 years (mean ±SD 57.8 ± 10.9 years). The majority (90%) were married. The overall scores of the total sample were low; Total knowledge was (49.8 ± 13.4); General D...
Struma ovarii is a rare ovarian teratoma that may produce hyperthyroidism. The association with H... more Struma ovarii is a rare ovarian teratoma that may produce hyperthyroidism. The association with Hashimoto thyroiditis HT, however is rare and has been reported in only one case. We report a case of HT following the resection of struma ovarii tumor, after which the patient became frankly, hypothyroid with elevated thyroid stimulating hormone and low thyroxin levels. Her thyroid peroxidase antibodies were positive. She improved after initiation of levothyroxine replacement therapy. We believe her euthyroid status preoperatively was due to thyroid hormone secretion by struma ovarii itself.
Thyroid nodules are frequently found in association with Graves' disease. Papillary carcinoma... more Thyroid nodules are frequently found in association with Graves' disease. Papillary carcinoma can arise from these nodules. We report a 65-year-old gentleman who presented with classical features of Graves disease. Technetium 99 scintigraphy revealed diffuse goiter with a cold nodule over the isthmus. Papillary thyroid cancer was suggested by the enlarging thyroid gland, and by the presence of cold nodule, and was proven by fine needle aspiration biopsy of this nodule. The diagnosis was confirmed by histopathology of thyroid specimen after total thyroidectomy, which also showed local invasion; metastatic work up revealed pulmonary and liver metastasis. Despite treatment by total thyroidectomy, twice radioactive iodine I131 ablation and levothyroxine replacement in a thyroid stimulating hormone suppressive dose, he still harbors metastases with elevated thyroglobulin level. This case should raise the index of suspicion of the treating physician to consider similar association, an...
Objective: To determine the frequency of erectile dysfunction in a referral diabetic clinic and t... more Objective: To determine the frequency of erectile dysfunction in a referral diabetic clinic and the rate of self-reporting in relation to age and duration of diabetes. Methods: A group of 258 males were interviewed in the diabetic clinic in the first half of 2001. Mean age (± standard deviation) was 52.3±10.62 (range 35-75 years) with mean duration of diabetes of 9.8±6.8 years. About 6% of the sample had type 1 diabetes and 94% had type 2 diabetes. Results: The duration of erectile dysfunction was 33.8±27.6 months (1.5-120 months). Erectile dysfunction was found in 67.4 % (n=174) of the interviewed patients. Only 40.2% (n= 70) of patients reported erectile dysfunction, which was directly proportionate to age. Higher frequency of erectile dysfunction was found in patients with duration of >10 years but with a lower self-report rate. Conclusion: The frequency of self-reporting is, however, low. Erectile dysfunction should be looked for routinely as part of the follow-up in the diab...
We report a 25-year-old female with florid hypothyroidism, subtle hypogonadism, with pituitary ma... more We report a 25-year-old female with florid hypothyroidism, subtle hypogonadism, with pituitary mass with suprasellar extension encroaching the optic chiasma and lymphocytic hypophysitis in association of type 1 diabetes mellitus. (Rawal Med J 2010;35: ).
We report a case of glucagonoma in a 60-year old diabetic lady who was seen by a dermatologist fo... more We report a case of glucagonoma in a 60-year old diabetic lady who was seen by a dermatologist for a superficial erythematous skin eruption with flaccid bullae over both legs of recent onset. These findings warranted further investigations that revealed a pancreatic mass lesion involving the distal body and tail with three metastatic deposits within the right lobe of the liver. Distal pancreatectomy and splenectomy were performed and histological examination of the excised specimen confirmed the diagnosis of pancreatic glucagonoma with liver metastasis. Blood sugar levels became more controlled postoperatively. The skin lesion disappeared completely six months after surgery. The lady enjoys fairly good health, and is maintained on Somatostatin analogues for control of metastasis that are stable after 18 months of follow up.
Methods: Hyperthyroid patients who opted RAI as a primary therapy and those who had relapse after... more Methods: Hyperthyroid patients who opted RAI as a primary therapy and those who had relapse after treatment with antithyroid drugs (ATD) or had significant side effects. All patients were advised to stop ATD 35 days before RAI dose and special precautions to avoid contact with ...
We report a case of intrathymic parathyroid The most common cause of primary adenoma that was loc... more We report a case of intrathymic parathyroid The most common cause of primary adenoma that was localized preoperatively by hyperparathyroidism is parathyroid adenoma. Up Technetium MIBI SPECT and treated surgically to 20% of parathyroid ademomas has been via assisted Thoracoscopic surgery and reported to be in ectopic localization. Ectopic developing hungry bone syndrome after surgery. p arathyroid glands can also become ( R a w a l M e d J 2 0 1 3 ; 3 8 : 3 1 4 - 3 1 6 ) . adenamatous, causing a diagnostic dilemma Key words: Primary hyperparathyroidism, when they are difficult to localize preoperatively. parathyroid adenoma, Intrathymic.
The most common cause of primary hyperparathyroidism is parathyroid adenoma. Up to 20% of parathy... more The most common cause of primary hyperparathyroidism is parathyroid adenoma. Up to 20% of parathyroid ademomas has been reported to be in ectopic localization. Ectopic parathyroid glands can also become adenamatous, causing a diagnostic dilemma when they are difficult to localize preoperatively. We report a case of intrathymic parathyroid adenoma that was localized preoperatively by Technetium MIBI SPECT and treated surgically via assisted Thoracoscopic surgery and developing hungry bone syndrome after surgery.
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2012
To set references and evaluate the associations between the predictive powers of the anthropometr... more To set references and evaluate the associations between the predictive powers of the anthropometric indices of obesity, particularly central obesity, including body mass index (BMI), waist circumference (WC), waist to hip ratio (WHpR) and waist to height ratio (WHtR), and the risk factor accumulations of ≥ 2 of the components of the metabolic syndrome (MS) in a group of Jordanian men and women. Five hundreds subjects were randomly selected from among the visitors attending several family clinics in Amman. Obesity was assessed using BMI, WC, WHpR and WHtR anthropometric indices. MS risk factors as defined by the International Diabetes Federation were determined. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive powers and the cut off points of each index associated with increased MS risk. There were 212 men and 288 women with age ranged 20-85 years. Optimal cut off points of BMI, WC, WHpR for MS diagnosis in men were 28.4 kg/m(2), 97.8 cm and 0.89, respectively. In women, these were 30.3 kg/m(2), 95.6 cm and 0.84, respectively. WHtR was 0.61 in both genders. Area under the curve (AUC) of ROC analysis for identifying of MS (≥ 2 risk factors) was the highest for WHpR (AUC=0.71), followed by WHtR (AUC=0.67), WC (AUC=0.64) and BMI (AUC=0.59) in men; whereas in women WHpR, WHtR and WC were almost equal (AUC=0.76, 0.75 and 0.74, respectively), followed by BMI (AUC=0.67). Correlation coefficients (r) between WHpR and MS risk factors were the strongest among the other obesity indices, followed by WC and WHtR. WHpR correlated significantly with FBG (r=0.27, p<0.01), systolic blood pressure (r=0.20, p<0.01), TGs (r=0.24, p<0.01) and HDL-C (r=-0.39, p<0.01). The respective r-values between WC and WHtR and each MS risk factors were: FBG (r=0.15, p<0.001 or r=0.13, p<0.01), systolic blood pressure (r=0.16, p<0.01 or r=0.11,…
To evaluate the patterns of testicular cytology in men with primary infertility, to compare the m... more To evaluate the patterns of testicular cytology in men with primary infertility, to compare the morphologic patterns between the periods 1990-1995, immediately after Gulf War II, and 1997-2001 and to determine whether there is a correlation between hormonal profile, testicular volume and morphologic pattern. Retrospective study of men with primary infertility. History, complete physical examination, hormonal assay and testicular ultrasound were evaluated. A total of 545 patients had samples for testicular cytology obtained from both testes. The patient's consent was obtained in all cases. Smears were interpreted under light microscopy after treatment with Diff-Quik. A total of 104 healthy, fertile subjects were used for comparison of the hormonal profile and testicular volume. The mean (+/- SD) age was 28.66 +/- 4.36 years and duration of marriage 4.4 +/- 4.36 years. There were 11.2% patients with normal cytology, 55.8% with hypospermatogenesis, 28.4% with testicular atrophy, 2.9% with Sertoli cells only and 1.7% with maturation arrest. A significant increase in hypospermatogenesis and decrease in the Sertoli cell-only pattern were noted in 1997-2001 when compared with 1990-1995. The mean left testicular volume was 10.53 +/- 5.51 mL3 in the infertile group vs. 15.2 +/- 4.97 in the fertile group (p < 0.003); right testicular volume was 10.84 +/- 4.77 vs. 15.15 +/- 5.31 (p < 0.003). The hormonal profile revealed higher luteinizing hormone and follicle-stimulating hormone levels in the infertile group vs. control group (8.53 +/- 9.03 and 16.44 +/- 19.243 vs. 6.98 +/- 4.53 and 7.37 +/- 6.63, respectively [p < 0.001]). Free testosterone was higher in the fertile group (39.69 +/- 12.76 vs. 20.28 +/- 8.5 [p < 0.000]). The majority of infertile males in our cohort had hypospermatogenesis; testicular atrophy was the next most common disorder. There was no major change in overall absolute numbers since the Gulf War. Testicular cytology by fine needle aspiration is a safe and well-tolerated complementary investigation for unexplained male infertility.
Objective: To determine the incidence of thyroid nodules found during extra-cranial carotid Doppl... more Objective: To determine the incidence of thyroid nodules found during extra-cranial carotid Doppler examination. Methods: Between March 2005 and December 2007, a total number of 791 patients (354 females and 437 males) underwent carotid Doppler examination for different causes. The study included thyroid gland examination with gray scale and color Doppler. Pati ents with incidental thyroid nodules were referred to endocrinology out-patient clinic for further evalua tion. Patients were divided according to age group and prevalence per decade. Results: Incidental thyroid nodules were found in 98 (12.3%) patient. Bilateral nodules were found in 61 and unilateral in 37 patients. Nodules equal or lar ger than one cm were found in 89 patients. Fifty ei ght nodules were solid, 24 were cystic and 16 showed mixed echogenesity. Fine needle aspiration biopsy was performed in 87 patients, and results showed 79 (91 %) benign and 8 (9%) malignant nodules. Most malignant nodules were papillary car...
Objectives: To assess the impact of age, gender, duration of diabetes and body mass index confoun... more Objectives: To assess the impact of age, gender, duration of diabetes and body mass index confounders on diabetes control among a Jordanian cohort of T2DM at the Endocrine Clinic in King Hussein Medical Center. Methods: Patients were selected over 18 months from outpatient clinic at King Hussein Medical Center in Amman-Jordan. Diabetes control assessed by mean of latest 3 HbA1c and fasting blood sugar. Patients were divided in 2 groups according to age ( 55 years), gender, duration ( 10 years) and BMI (normal, overweight, and obese according to WHO criteria). Statistical analysis is performed using SPSS11.5.Good diabetes control is assessed according to American Diabetes Association criteria Results: A total of 405 patients were selected (223 males, 182 females). 115 patients (28.4%) were having a good control with HbA1c 55 years (n=222) (29%vs.28%; p=0.812). Females in both age groups were having non statistically significant better control than males. Of those with DM duration 10 ...
OBJECTIVE To determine the lipid profile and to identify and stratify risk factors in diabetic an... more OBJECTIVE To determine the lipid profile and to identify and stratify risk factors in diabetic and non-diabetic patients with proven coronary artery disease at King Hussein Medical Center, Amman, Jordan. METHODS One hundred and ninety-two patients who were admitted to Queen Alia Heart Institute, Amman, Jordan, proving to have coronary artery disease (CAD) by angiogram, with a mean age of 54 +/- 22 years were studied. Seventy-seven patients were diabetics and 115 non-diabetics. Their lipid profiles (T-Cholesterol, high density lipoprotein level (HDL-C), low density lipoprotein level (LDL-C), triglyceride, glucose, glycosylated hemoglobin) and thyroid function test were compared to a control group of 162 individuals with no cardiac events or diabetes, mean age 48.9 +/- 18 years. Prevalence of hyperlipidemia was calculated. Patients with high thyroid stimulating hormone were excluded. RESULTS The mean (+/- standard deviation) plasma cholesterol for the group with CAD is 231.43 +/- 57.9...
Objective: The aim of the study was to explore the prevalence of peripheral neuropathy (PN) among... more Objective: The aim of the study was to explore the prevalence of peripheral neuropathy (PN) among patients with Diabetes Mellitus (DM) at King Hussein hospital. Methods: This study was done at King Hussein Hospital. Descriptive research design was used to recruit a convenience sample of 202 patients with DM who were referred to diabetes clinic. Data were collected through face-to-face interview. Data collection instrument is composed of two parts; the first part assesses the demographic characteristic, while the second part is a translated version of Michigan Neuropathy Screening Instrument (MNSI). Descriptive and inferential statistics were used for data analysis. Results: The sample consisted of 102 male and 100 female patients. Their age ranged from 16 to 88 years (M = 56.19 ± 14.31 years). The mean duration of diabetes was 10.69 ± 8.24 years. The overall prevalence of diabetic PN was (54.45 ± 49.92). The prevalence of diabetic PN was higher in women than men (55 ± 50 VS 53.92 ± ...
Patients and methods: Patients randomly selected over 18 months from outpatient clinic at KHMC in... more Patients and methods: Patients randomly selected over 18 months from outpatient clinic at KHMC in Amman-Jordan. Diabetes control assessed by mean of latest 3 HbA1c and FBS. Patients were divided in 2 groups according to age (<55 years vs >55 years), gender, duration (<10 ...
A young black Jordanian lady who has type one diabetes, chronic diabetic complication and ischemi... more A young black Jordanian lady who has type one diabetes, chronic diabetic complication and ischemic heart disease, presented with a picture of diabetic keto-acidosis, precipitated by an acute neck swelling. This was suggestive of acute suppurative thyroiditis with abscess formation causing compressive symptoms. This unfortunate patient had an eventful course despite aggressive treatment by antibiotics and surgery and then succumbed of an acute cardiac event. The operative tissue biopsy revealed an abscess in an infarcted papillary thyroid cancer. We believe this is a rare presentation of such an association with a fatal outcome.
OBJECTIVE To assess the gender differences in the prevalence of diabetes, composite cardiovascula... more OBJECTIVE To assess the gender differences in the prevalence of diabetes, composite cardiovascular disease, and the components of metabolic syndrome (MS) in a Jordanian cohort with MS. Secondly, to evaluate the impact of number of MS components on prevalence of diabetes, ischemic heart disease (IHD), and stroke. METHODS We carried out a cohort study among participants who fulfilled the National Cholesterol Education Program (Adult Treatment Panel III) criteria for MS recruited from December 2006-2007 from Endocrine Outpatient Clinics of the King Hussein Medical Centre, Amman, and Prince Rashid Military Hospital, Irbid, Jordan. Patients were divided into groups according to gender, presence, or absence of diabetes, and were evaluated for MS components, presence of IHD, and stroke. RESULTS Three hundred and fifty-seven patients 207 males and 150 females were included, type 2 diabetes was present in 226 (132 males) patients. No intergroup differences were found on waist circumference, ...
We report a case of a 62-year-old postmenopausal hypertensive lady who was treated for osteoporos... more We report a case of a 62-year-old postmenopausal hypertensive lady who was treated for osteoporosis with calcium and Vitamin D. She presented with progressive lower limb weakness and paresthesia with sensory level at T4. Investigations revealed high parathyroid hormone 1152 ng/dl, calcium 10.9 mg/dl, and low phosphorus of 2.4 mg/dl after stopping calcium supplement. Chest x-ray showed an expansile mass lesion of the right 6th rib confirmed by chest CT. Thoracic MRI showed a mass lesion extending from the T3 vertebral body and compressing the spinal cord. There were multiple lytic lesions of the scalp, ribs, femur, and pelvis suggesting metastatic lesions. A neck ultrasound and SESTA MIBI parathyroid scan confirmed a right lower parathyroid adenoma. Excision biopsy of the rib lesion confirmed a vascular lesion with features of brown tumor BT. Decompression surgery of the thoracic spine was performed, and the histopathology confirmed BT. Two weeks later the patient underwent right par...
Objective: To assess Diabetes Knowledge among patients with Diabetes mellitus at King Hussein Hos... more Objective: To assess Diabetes Knowledge among patients with Diabetes mellitus at King Hussein Hospital. Method: This study was conducted at King Hussein Hospital. Descriptive research design during the period between September 2010 to October 2010, was used to recruit a convenient sample of 100 hospitalized adult patients with Diabetes mellitus. Data was collected through face-to-face interview using the Brief Diabetes Knowledge Test (Fitzgerald et al, 1998). This test is composed of 23 multiple choice questions that assess General Knowledge and Insulin Knowledge as well as Total score for Total knowledge. Simple descriptive statistics (frequency, mean, percentage) was used to describe the study variables Results: One hundred diabetic patients participated in this study (50 men and 50 women). Their age ranged from 19 to 86 years (mean ±SD 57.8 ± 10.9 years). The majority (90%) were married. The overall scores of the total sample were low; Total knowledge was (49.8 ± 13.4); General D...
Struma ovarii is a rare ovarian teratoma that may produce hyperthyroidism. The association with H... more Struma ovarii is a rare ovarian teratoma that may produce hyperthyroidism. The association with Hashimoto thyroiditis HT, however is rare and has been reported in only one case. We report a case of HT following the resection of struma ovarii tumor, after which the patient became frankly, hypothyroid with elevated thyroid stimulating hormone and low thyroxin levels. Her thyroid peroxidase antibodies were positive. She improved after initiation of levothyroxine replacement therapy. We believe her euthyroid status preoperatively was due to thyroid hormone secretion by struma ovarii itself.
Thyroid nodules are frequently found in association with Graves' disease. Papillary carcinoma... more Thyroid nodules are frequently found in association with Graves' disease. Papillary carcinoma can arise from these nodules. We report a 65-year-old gentleman who presented with classical features of Graves disease. Technetium 99 scintigraphy revealed diffuse goiter with a cold nodule over the isthmus. Papillary thyroid cancer was suggested by the enlarging thyroid gland, and by the presence of cold nodule, and was proven by fine needle aspiration biopsy of this nodule. The diagnosis was confirmed by histopathology of thyroid specimen after total thyroidectomy, which also showed local invasion; metastatic work up revealed pulmonary and liver metastasis. Despite treatment by total thyroidectomy, twice radioactive iodine I131 ablation and levothyroxine replacement in a thyroid stimulating hormone suppressive dose, he still harbors metastases with elevated thyroglobulin level. This case should raise the index of suspicion of the treating physician to consider similar association, an...
Objective: To determine the frequency of erectile dysfunction in a referral diabetic clinic and t... more Objective: To determine the frequency of erectile dysfunction in a referral diabetic clinic and the rate of self-reporting in relation to age and duration of diabetes. Methods: A group of 258 males were interviewed in the diabetic clinic in the first half of 2001. Mean age (± standard deviation) was 52.3±10.62 (range 35-75 years) with mean duration of diabetes of 9.8±6.8 years. About 6% of the sample had type 1 diabetes and 94% had type 2 diabetes. Results: The duration of erectile dysfunction was 33.8±27.6 months (1.5-120 months). Erectile dysfunction was found in 67.4 % (n=174) of the interviewed patients. Only 40.2% (n= 70) of patients reported erectile dysfunction, which was directly proportionate to age. Higher frequency of erectile dysfunction was found in patients with duration of >10 years but with a lower self-report rate. Conclusion: The frequency of self-reporting is, however, low. Erectile dysfunction should be looked for routinely as part of the follow-up in the diab...
We report a 25-year-old female with florid hypothyroidism, subtle hypogonadism, with pituitary ma... more We report a 25-year-old female with florid hypothyroidism, subtle hypogonadism, with pituitary mass with suprasellar extension encroaching the optic chiasma and lymphocytic hypophysitis in association of type 1 diabetes mellitus. (Rawal Med J 2010;35: ).
We report a case of glucagonoma in a 60-year old diabetic lady who was seen by a dermatologist fo... more We report a case of glucagonoma in a 60-year old diabetic lady who was seen by a dermatologist for a superficial erythematous skin eruption with flaccid bullae over both legs of recent onset. These findings warranted further investigations that revealed a pancreatic mass lesion involving the distal body and tail with three metastatic deposits within the right lobe of the liver. Distal pancreatectomy and splenectomy were performed and histological examination of the excised specimen confirmed the diagnosis of pancreatic glucagonoma with liver metastasis. Blood sugar levels became more controlled postoperatively. The skin lesion disappeared completely six months after surgery. The lady enjoys fairly good health, and is maintained on Somatostatin analogues for control of metastasis that are stable after 18 months of follow up.
Methods: Hyperthyroid patients who opted RAI as a primary therapy and those who had relapse after... more Methods: Hyperthyroid patients who opted RAI as a primary therapy and those who had relapse after treatment with antithyroid drugs (ATD) or had significant side effects. All patients were advised to stop ATD 35 days before RAI dose and special precautions to avoid contact with ...
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Papers by Fares H Haddad