Mohammed El-Khateeb

Familial Mediterranean fever in Arabs

Autoinflammatory diseases are a group of disorders characterised by seemingly unprovoked inflammation in the absence of high-titre autoantibodies or antigen-specific T cells, and include the hereditary periodic fever syndromes. Familial Mediterranean fever (FMF) is an archetypal autoinflammatory disorder, which is autosomal recessive and has a high prevalence in non-Ashkenazi Jews, Armenians, Turks, and Arabs. The classic clinical picture is recurrent acute short-lived febrile and painful attacks with variable periods of remission. In a subset of patients, the disorder is complicated by amyloidosis that leads to renal failure. The gene responsible for FMF--MEFV--has been identified and its role in inflammation is being assessed. There seems to be a distinctive clinical picture in Arab patients with FMF, and the range and distribution of MEFV mutations is different from that noted in other affected ethnic groups. Here, we discuss the clinical and molecular aspects of FMF in Arabs.

Obesity in Jordan: Prevalence, Associated Factors, Comorbidities, and Change in Prevalence over Ten Years

OBJECTIVES To determine the prevalence of obesity in northern Jordan, identify its associated factors, assess its association with selected comorbidities, and determine how the prevalence of obesity has changed in Jordan over 10 years. METHODS A total of 1121 participants aged 25 years and above were randomly selected. Sociodemographic characteristics as well as information on selected metabolic disorders and their potential risk factors were obtained. Anthropometric and biochemical characteristics were measured. Obesity was defined based on body mass index (BMI), waist circumference, and waist-to-hip ratio. RESULTS The age-standardized prevalence of obesity in northern Jordan was 28.1% (95% CI: 23.4, 32.8) for men and 53.1% (95% CI: 49.3, 57.0) for women. Irrespective of age or measure used, women always had a considerably higher prevalence of obesity than men. The prevalence of obesity varied greatly with age, generally increasing, irrespective of the measurement used. There has been a significant increase in the prevalence of obesity over a period of ten years for both men and women aged 60 years and above only. When important variables were taken into account in logistic regression analyses, obesity was significantly associated with increased odds of having all studied metabolic abnormalities. Female gender, increase in age, being married, former smoker or nonsmoker, and fewer than 12 years of education were significantly associated with increased odds of BMI-defined obesity and high waist circumference. CONCLUSIONS This study demonstrated alarming rates of obesity and of its associated comorbidities among Jordanians, especially among women.

The Prevalence of Hepatitis B, Hepatitis C and Human Immune Deficiency Virus Markers in Multi‐transfused Patients

All patients presenting with hereditary hemolytic anemia, (n = 143) over a period of 18 months were enrolled in a study to evaluate the prevalence of hepatitis B, hepatitis C and HIV in multi-transfused patients in Jordan, and to identify possible related risk factors. All patients were treated in the Thalassemia Unit at Princess Rahma Teaching Hospital. Relevant clinical data were collected. Blood specimens were taken from these patients and tested for HbsAg, HbsAb, hepatitis core IgMAb, hepatitis core IgGAb, HCVAb, and ELISA for HIV. Fifty-eight (40.5 per cent) of the specimens were HCVAb positive, while only five (3.5 per cent) of them were positive for HBsAg. None of the specimens were positive for HIV. The frequency of blood transfusion and the time of diagnosis before or after 1995, were investigated as possible risk factors for viral seropositivity. Only the time of diagnosis was a statistically significant risk factor for HCVAb positivity (OR = 4.49; p = 0.005). In conclusion, hepatitis C acquisition is a serious risk for multi-transfused patients in Jordan. Hepatitis B is relatively less common. Blood screening initiated after 1995 in Jordan has significantly reduced the risk of hepatitis C associated with blood transfusion.

Diagnosis and treatment of 106 cases of human brucellosis

During the year 1987, 106 cases of human brucellosis were studied prospectively at the Jordan University Hospital. The disease was more often diagnosed among adults (73.6%) than children (26.4%). Serious clinical complications were observed in 5.7% patients. An initial Brucella antibody titre greater than or equal to 160 proved to be reliable in confirming suspected cases of acute and subacute brucellosis. Culture of blood was found to be more sensitive (44.4%) and significant (P less than 0.02) than bone marrow culture (27.7%) for detecting Brucella melitensis. All patients treated with rifampicin plus tetracycline or co-trimoxazole were considered to be clinically cured by disappearance of all major clinical features of brucellosis. By contrast, 2/10 patients treated with rifampicin alone, as well as 1/56 patients treated with tetracycline and streptomycin, clinically relapsed. It is evident from this study that the treatment with rifampicin alone is not as effective in brucellosis as it is when given with another appropriate drug.

Hypertension Prevalence, Awareness, Treatment and Control, and Associated Factors: Results from a National Survey, Jordan

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

Prevalence of dyslipidemia and its associated factors among Jordanian adults

BACKGROUND Dyslipidemia, which has been closely linked to pathophysiology of cardiovascular diseases, is a key independent modifiable risk factor for cardiovascular diseases. Estimation of the prevalence of dyslipidemia ensures proper planning of health actions for both primary and secondary prevention of cardiovascular diseases. OBJECTIVES To estimate the prevalence of various types of dyslipidemia and determine their associated factors among adults in north of Jordan. METHOD Data were analyzed from a cross-sectional study that included a random sample of 1121 Jordanians aged 25 years and older. High total cholesterol (TC) was defined as TC ≥200 mg/dL and hypertriglyceridemia as serum triglycerides level ≥150 mg/dL. Low high-density lipoprotein cholesterol (HDL-C) was defined as serum HDL-C <40 mg/dL. High low-density lipoprotein cholesterol (LDL-C) was defined as serum LDL-C ≥130 mg/dL. RESULTS Of a total of 1121 subjects, 48.8% had high TC level, 40.7% had high LDL-C, 40.1% had low HDL-C, 43.6% had high triglyceride levels, and 75.7% had at least one abnormal lipid level. Age was associated with high triglycerides, high LDL-C, and high TC. Men were more likely than women to have a high triglycerides level and low HDL-C. Compared with people with a body mass index <25, overweight and obese subjects had greater odds of having high triglycerides, high TC, and low HDL-C. Diabetes was associated with increased odds of high triglycerides only. CONCLUSION The prevalence dyslipidemia is high in Jordan, which necessitates appropriate the institution of community-based intervention strategies to prevent and manage cardiovascular risk factors.

HLA Antigens, Blood Groups and Immunoglobulin Levels in Idiopathic Thrombocytopenic Purpura

Thirty-three patients with idiopathic thrombocytopenic purpura (ITP) were tested for HLA-A, B and C antigens, platelet antibodies, immunoglobulin levels and ABO blood groups. With one exception, ITP proved not to be significantly associated with the HLA antigens studied; an increased frequency of HLA-A28 was found in chronic ITP patients (50 vs. 18.7% in the control population). An increased incidence of blood group A was found in ITP patients (64 vs. 37.98% in the control population), especially in those with acute ITP (84.7%). A significant reduction of IgG levels was noted in patients with chronic ITP, while below-normal levels of IgA were found in both chronic and acute ITP patients. There was no difference in levels of IgM. Circulating platelet isoantibodies were demonstrated in 67.6% of the ITP patients. No correlation was demonstrated between the presence of platelet antibodies, immunoglobulin levels of HLA antigens.

Anthropometric cutoff values for detecting metabolic abnormalities in Jordanian adults

Objectives To determine cutoff values for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as indicators of metabolic abnormalities in the adult Jordanian population. Methods A structured questionnaire was administered to collect relevant information. Anthropometric measurements and biochemical measurements were carried out. Receiver-operating characteristic curve analyses were used to examine the overall discriminatory power of the four anthropometric indices. Results WC cutoff values varied from 88.5 to 91.8 cm in men and from 84.5 to 88.5 cm in women. The BMI cutoff values varied from 26.2 to 27.2 kg/m2 in men and from 27.2 to 30.0 kg/m2 in women. The WHR cutoff values varied from 0.88 to 0.90 in men and from 80.0 to 0.83 in women. The WHtR cutoff values varied from 0.50 to 0.51 in men and women. Of all anthropometric indices, WHtR had the strongest association with each metabolic abnormality in men and women. Conclusion BMI, WC, WHR, and WHtR were found to be associated with cardiovascular disease risk factors, with WHtR being the better predictor. We recommend that health care professionals use WHtR, with a cutoff value of 0.5 for screening and counseling Jordanian people.

Relationship between 25-hydroxyvitamin D and metabolic syndrome among Jordanian adults

Evidence of the association between 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MeS) remains uncertain and incongruent. This study aimed to determine the association between 25(OH)D and MeS among Jordanian adults. A complex multistage sampling technique was used to select a national population-based household sample. The present report deals exclusively with adults aged > 18 years who had complete information on all components of MeS (n = 3,234). A structured questionnaire was used to collect all relevant information. Anthropometric, clinical, and laboratory measurements were obtained. MeS was defined according to the International Diabetes Federation (IDF) definition. Of the total, 42.0% had MeS and 31.7% had 25(OH)D < 30 ng/ml. In a stratified analysis, the prevalence of MeS did not differ significantly between subjects with low and normal 25(OH)D levels for men and women in all age groups. In the multivariate analysis, the odds of MeS were not significantly different between subjects with low and normal 25(OH)D levels (OR = 0.85, 95% CI: 0.70, 1.05, P-value = 0.133). The association between 25(OH)D and MeS remained non-significant when 25(OH)D was analyzed as a continuous variable (OR = 1.004, 95% CI; 1.000, 1.008, P = 0.057) and when analyzed based on quartiles. None of the individual components of MeS were significantly associated with 25(OH)D level. This study does not provide evidence to support the association between 25(OH)D level and MeS or its individual components. Prospective studies are necessary to better determine the roles of 25(OH)D levels in the etiology of MeS.

Metabolic Syndrome and Its Individual Components among Jordanian Children and Adolescents

This study aimed to determine the prevalence of metabolic syndrome (MeS) and its individual components in Jordanian children and adolescents aged 7–18 years and determine the factors that are associated with clustering of metabolic abnormalities. MeS was defined using the International Diabetes Federation (IDF) definition. The prevalence of MeS was estimated from 512 subjects who had complete information on all MeS components. The prevalence of MeS according to IDF criteria was 1.4% in subjects aged between 10 and 15.9 years and 3.6% in subjects aged between 16 and 18 years. When categorized according to body mass index (BMI), the prevalence of the MeS was 15.1% in obese subjects, compared to 0.3% in subjects with normal BMI, and 3.0% in overweight subjects. In conclusion, our results indicate that although the prevalence of MeS is low in Jordanian children and adolescents, a large proportion of them had one or two metabolic abnormalities.