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Yazun Jarrar,1 Sara Abudahab,2 Ghasaq Abdul-Wahab,3 Dana Zaiter,4 Abdalla Madani,4 Sara J Abaalkhail,4 Dina Abulebdah,4 Hussam Alhawari,5 Rami Musleh,6 Su-Jun Lee7 1Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan; 2Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA; 3Department of Oral Surgery and Periodontology, College of Dentistry, Al-Mustansiriya University, Baghdad, Iraq; 4Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan; 5Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan; 6Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; 7Department of Pharmacology, Pharmacogenomics Research Center, College of Medicine, Inje University, Busan, KoreaCorrespondence: Yazun Jarrar, Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, 19117, Jordan, Email yazan.jarrar@bau.edu.joBackground: N-acetyltransferase 2 (NAT2) enzyme is a Phase II drug-metabolizing enzyme that metabolizes different compounds. Genetic variations in NAT2 can influence the enzyme’s activity and potentially lead to the development of certain diseases.Aim: This study aimed to investigate the association of NAT2 variants with the risk of Type II diabetes mellitus (T2DM) and the lipid profile among Jordanian patients.Methods: We sequenced the whole protein-coding region in NAT2 using Sanger’s method among a sample of 45 Jordanian T2DM patients and 50 control subjects. Moreover, we analyzed the lipid profiles of the patients and examined any potential associations with NAT2 variants.Results: This study revealed that the heterozygous NAT2*13 C/T genotype is significantly (P = 0.03) more common among T2DM (44%) than non-T2DM subjects (23.5%). Furthermore, the frequency of homozygous NAT2*13 T/T genotype was found to be significantly higher (P = 0.03) among T2DM patients (26.7%) compared to that of non-T2DM subjects (11%). The heterozygous NAT2*7 G/A genotype was exclusively observed in T2DM patients (11.1%) and absent in the control non-T2DM group. Moreover, among T2DM patients, those with a homozygous NAT2*11 T/T genotype exhibited significantly higher levels of triglycerides (381.50 ± 9.19 ng/dL) with a P value of 0.01 compared to those with heterozygous NAT2*11 C/T (136.23 ± 51.12 ng/dL) or wild-type NAT2*11 C/C (193.65 ± 109.89 ng/dL) genotypes. T2DM patients with homozygous NAT2*12 G/G genotype had a significantly (P = 0.04) higher triglyceride levels (275.67 ± 183.42 ng/dL) than the heterozygous NAT2*12 A/G (140.02 ± 49.53 ng/dL) and the wild NAT2*12 A/A (193.65 ± 109.89 ng/dL).Conclusion: The finding in this study suggests that the NAT2 gene is a potential biomarker for the development of T2DM and changes in triglyceride levels among Jordanians. However, it is important to note that our sample size was limited; therefore, further clinical studies with a larger cohort are necessary to validate these findings.Keywords: type II diabetes mellitus, N-acetyltransferase 2, NAT2, triglyceride, genetic variants, Jordanian population

Hussein Alhawari,1 Sameeha Alshelleh,1 Osama Alzoubi,1 Asim N Khanfar,1 Reem Akiely,1 Bayan Abdallah,1 Nada Hajjaj,1 Saja Alkhalaileh,1 Yousef Khader2 1Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan; 2Department of Public Health, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Hussein Alhawari, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan, Email h.alhawari@ju.edu.joIntroduction: Objective Structured Clinical Examinations (OSCEs) are considered an integral part of the assessment process of many schools of medicine worldwide. Close monitoring by examiners, scrutinized interactions with patients, and fear of the unknown, among other factors have been reported to cause psychological stress among students during the examinations period. In this study, we aimed to assess changes in cardiovascular parameters, anxiety scores, and lifestyle patterns of medical students during their OSCEs as compared to their baseline.Materials and Methods: We recruited healthy medical students from our institution’s medical school. General demographics, academic, and baseline lifestyle characteristics were collected 1– 2 months before the OSCE day. The Generalized Anxiety Disorder 7-item (GAD-7) scale was used to measure anxiety symptoms. Data related to coffee consumption in addition to systolic, diastolic blood pressure and heart rate measurements were collected both at baseline and on OSCE day.Results: This study included 325 students (144 (44.3%) males and 181 (55.7%) females). The mean systolic blood pressure, diastolic blood pressure, and heart rate measurements were significantly higher on OSCE day as compared to the baseline. In addition, the daily consumption of coffee increased significantly during OSCE day as compared to the baseline. Although the anxiety score increased during OSCE day compared to the baseline, the difference was not statistically significant. However, the change in anxiety score (OSCE day – baseline) was significantly higher in females compared to males.Conclusion: In our study, we observed significant increases in blood pressure, heart rate, and coffee intake on the day of the test compared to baseline measurements. These findings underscore the significance of implementing measures to reduce the harmful effects of stress on students during exam preparations and medical school assessments.Keywords: blood pressure, anxiety, stress, objective structured clinical examination, OSCE

Sameeha Alshelleh,1 Hussein Alhawari,1 Abdullah Alhouri,2 Bilal Abu-Hussein,3 Ashraf Oweis4 1Division of Nephrology, Department of Medicine, The University of Jordan, Amman, Jordan; 2Department of Medicine, Division of Gastroenterology, Royal Berkshire Hospital, Reading, UK; 3Department of Medicine, The University of Jordan, Amman, Jordan; 4Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Amman, JordanCorrespondence: Abdullah Alhouri, Department of Medicine, Division of Gastroenterology, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK, Email abdallahouri1995@hotmail.comBackground: Despite the growing concern worldwide regarding the quality of life (QoL) and mental well-being among chronic kidney disease (CKD), a few research has been done to address this issue. The study aims to measure depression, anxiety, and QoL prevalence among Jordanian patients with End Stage Renal Disease (ESRD) on hemodialysis and how all of these variables are correlated.Methods: This is a cross-sectional, interview-based study on patients at the Jordan University Hospital (JUH) dialysis unit. Sociodemographic factors were collected, and the prevalence of depression, anxiety disorder, and QOL was assessed using the Patient Health Questionnaire 9 (PHQ9), the Generalized Anxiety Disorder 7-item (GAD7), and the WHOQOL-BREF, respectively.Results: In a study of 66 patients, 92.4% had depression, and 83.3% had generalised anxiety disorder. Females had significantly higher depression scores than males (mean = 6.2 ± 3.77 vs 2.9 ± 2.8, p < 0.001), and single patients had significantly higher anxiety scores than married patients (mean = 6.1 ± 6 vs 2.9 ± 3.5, p = 0.03). Age was positively correlated with depression scores (rs= 0.269, p = 0.03), and QOL domains showed an indirect correlation with GAD7 and PHQ9 scores. Males had higher physical functioning scores than females (mean = 64.82 vs 58.87, p = 0.016), and patients who studied in universities had higher physical functioning scores than those with only school education (mean of College/University = 78.81 vs mean of School Education = 66.46, p = 0.046). Patients taking < 5 medications had higher scores in the environmental domain (p = 0.025).Conclusion: The high prevalence of depression, GAD, and low QOL in ESRD patients on dialysis highlights the need for caregivers to provide psychological support and counselling for these patients and their families. This can promote psychological health and prevent the onset of psychological disorders.Keywords: chronic kidney disease, end stage kidney disease, hemodialysis, quality of life, depression, generalized anxiety disorder

Hussein Alhawari,1 Sameeha AlShelleh,1 Hussam Alhawari,1 Saif Aldeen AlRyalat,2 Asim N Khanfar,1 Osama Alzoubi1 1Department of Internal Medicine, School of Medicine, the University of Jordan, Amman, Jordan; 2Department of Special Surgery, School of Medicine, the University of Jordan, Amman, JordanCorrespondence: Hussein Alhawari, Division of Nephrology, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan, Email h.alhawari@ju.edu.joIntroduction: Hypertension is an important cause of morbidity and mortality worldwide. Undiagnosed hypertension is a serious issue that leads to increased morbidity and mortality. In this study, we aim to identify the prevalence of undiagnosed hypertension in the healthy Jordanian population, as well as identify predictors of high blood pressure readings in presumably healthy Jordanians.Materials and Methods: We recruited healthy visitors accompanying patients at our Jordan University Hospital Clinics ranging from 18 to 80 years of age. We measured each participant’s systolic and diastolic blood pressure at our outpatient clinics on two different days, one week apart. We also obtained demographic data, weight, height, smoking status, and family history of hypertension and cardiovascular diseases.Results: A total of 896 participants were included in this study with a mean age of 48 years. The median of systolic blood pressure readings was 125 mmHg, and the median of diastolic blood pressure readings was 83 mmHg. 38.5% had undiagnosed stage 1 hypertension and 30.5% had undiagnosed stage 2 hypertension according to the American College of Cardiology/American Heart Association guidelines. On the other hand, 25.4% had undiagnosed grade 1 hypertension and 5.1% had undiagnosed grade 2 hypertension according to the European Society of Hypertension guidelines.Conclusion: According to the ACC/AHA guidelines, 68.5% of previously healthy Jordanians met the criteria to be diagnosed with hypertension. Predictors of high systolic blood pressure were age, BMI and family history of CAD, while female gender is associated with a lower systolic blood pressure. For diastolic blood pressure, only BMI and family history of CAD were associated with significantly higher diastolic blood pressure, while female gender and exercise were significantly associated with lower diastolic blood pressure.Keywords: blood pressure, hypertension, systolic, diastolic

Sameeha AlShelleh,1 Izzat AlAwwa,1 Ashraf Oweis,2 Saif Aldeen AlRyalat,1 Mohammad Al-Essa,1 Iyad Saeed,1 Hussein H Alhawari,1 Karem H Alzoubi31Department of Internal Medicine, The University of Jordan, Amman 11942, Jordan; 2Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JordanBackground: Several epidemiological studies have assessed various components of Metabolic Syndrome (MS) in different populations, but only a few compared the prevalence of metabolic syndrome in dialysis and transplant patients.Aim: The aim of this study is to compare the prevalence of MS in dialysis and transplant patients. Two groups of patients were included; hemodialysis patients and patients with transplanted kidneys.Methods: Demographic and clinical history, and lab data were collected. A total of 108 patients were included in this study with a mean age of 52.3 (±16.29) years. Study groups included 61 (56.5%) dialysis patients, and 47 (43.5%) patients with transplanted kidneys.Results: Upon comparing the prevalence of metabolic syndrome between the two study groups, transplant patients had significantly lower prevalence of metabolic syndrome (34%) compared to that of metabolic syndrome in patients on dialysis (55.7%; P=0.016).Conclusion: As metabolic syndrome plays an important role in the pathology of elderly patients, especially those with transplanted kidneys, such findings indicate the need for close monitoring of kidney transplant patients for the manifestations of metabolic syndrome.Keywords: metabolic syndrome, renal transplant, chronic kidney disease, elderly

Our study aims to assess gender differences in blood pressure (BP) control among hypertensive patients in Jordan and identify factors influencing these differences. We conducted a cross-sectional study at Jordan University Hospital (JUH), collecting data from 601 hypertensive patients following up in JUH clinics. Patients were eligible if they were >18 years old, diagnosed with hypertension, taking anti-hypertensive medication for at least 6 months, and had no chronic kidney disease. BP control was defined as systolic BP <140 mmHg and diastolic BP <90 mmHg. Poor BP control was observed in 59.1% of females and 62.7% of males. Females demonstrated better BP control, even though they had lower incomes, lower education levels, and higher BMIs compared to males. Among females, good medication adherence (p = 0.042) was linked to improved control, while stress and a history of preeclampsia were negatively associated (p = 0.01 and p = 0.030, respectively). Among males, concurrent systemic medication use (p = 0.025) was a positive predictor of BP control, whereas smoking negatively impacted BP control (p = 0.019). Home BP monitoring was common but did not improve control in either gender. In conclusion, females showed better outcomes in BP management, largely due to treatment adherence. A history of preeclampsia and high stress was linked to poorer control in females. Both genders were aware of normal BP levels, but females were more preemptive in maintaining control. To improve hypertension care, we should consider these differences when treating patients., (© 2025 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Introduction: Von Hippel-Lindau disease (e.g. VHL) is an autosomal dominant multi-organ cancer syndrome caused by a mutation in the VHL tumour suppressor gene. In this study, we introduce a novel genetic variant found in 11 family members diagnosed initially with isolated Pheochromocytoma. Subsequent findings revealed its association with VHL syndrome and corresponds to the Type 2 C phenotype., Methods: The VHL gene was amplified through the utilisation of the polymerase chain reaction (PCR). PCR fragments were sequenced using bidirectional Sanger sequencing, using BigDye™ Terminator v3.1 Cycle Sequencing Kit, running on the 3500 genetic analyser. Results were assembled and analysed Using Software SeqA and chromas pro., Results: A heterozygous in-frame duplication of three nucleotides, specifically ATG, c.377&#95;379dup; p.Asp126dup in exon 2, was identified in all the patients tested within the pedigree., Conclusion: In this study, we disclose the identification of a novel genetic variant in a Jordanian family, affecting eleven family members with pheochromocytoma associated with VHL disease. This finding underscores the importance of screening family members and contemplating genetic testing for individuals newly diagnosed with pheochromocytoma and could enhance our comprehension of the potential adverse consequences associated with VHL germline mutations.

Hypertension is a prominent risk factor for cardiovascular and cerebrovascular diseases. Gender differences and menopausal status contribute to blood pressure changes across the lifespan which have not been completely characterized. Our study aims to explore the impact of multiple factors on blood pressure levels in previously healthy women and men. Factors of interest included gender, menopausal status, age, and body mass index. Healthy women and men were recruited through healthcare facility announcements. Detailed menopausal history was obtained from females. The authors measured each participant's systolic and diastolic blood pressure at our outpatient clinics twice on the same day, and two different days, one week apart, and the authors included the mean of the averaged two readings for each participant. The study sample consisted of 313 participants. Female gender was a significant predictor of lower systolic and diastolic blood pressure (p < .001), while age significantly correlated with higher systolic blood pressure readings (p = .004). Although systolic blood pressure levels were significantly higher in postmenopausal females (124 mmHg) compared to premenopausal females (116 mmHg), our multiple linear regression analysis revealed that postmenopausal status did not significantly predict changes in either systolic or diastolic blood pressure. Our study demonstrates significant associations between blood pressure levels and various factors such as gender and age. This could emphasize the intricate interplay of demographic and clinical factors in blood pressure variations among individuals, highlighting the importance of a holistic approach to diagnosing hypertension, which considers various individual factors, including gender and age., (© 2024 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Introduction: Hypertension is the foremost contributor to cardiovascular disease(s) and premature death worldwide. Mental health disorders have a significant impact on global public health, affecting millions of individuals with disorders including anxiety, depression, bipolar disorder, and schizophrenia. Importantly, all of these conditions are distinctly associated with hypertension. Accordingly, this study aimed to investigate the prevalence of undiagnosed hypertension among individuals diagnosed with mental health disorders in Jordan and its associated risk factors., Methods: Data from individuals 18-80 years of age, who attended the psychiatry clinic at Jordan University Hospital (Amman, Jordan), were included. The study included participants without a previous diagnosis of hypertension, diabetes, or cardiovascular disease. Systolic and diastolic blood pressure, as well as heart rate, were assessed; in addition, demographic information from each participant was collected. Assessments were performed at the clinic facilities during 2 distinct appointments scheduled at a one-week interval., Results: In total, data from 484 patients (57.2 % female, 42.8 % male) were analyzed. The prevalence of undiagnosed hypertension among those diagnosed with psychiatric disorders was significantly high (30.8 %), the majority of whom were male. Mean age, body mass index, and a positive family history of cardiovascular disease(s) were significantly higher in patients with undiagnosed hypertension. Moreover, patients undergoing treatment with serotonin and norepinephrine reuptake inhibitors (SNRIs) exhibited a significantly higher prevalence of undiagnosed hypertension than their counterparts., Conclusion: Results of the present study revealed a significant prevalence of undiagnosed hypertension among patients with psychiatric disorders (30.8 %). Factors significantly associated with a higher prevalence of undiagnosed hypertension included male sex, older age, higher BMI, family history of cardiovascular disease(s), and use of SNRIs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objective: The objective of this study was to investigate the effect of age, gender, body mass index (BMI), food intake, and smoking on serum prolactin (PRL) levels among healthy adults., Methods: In total, 100 healthy adults (46 males and 54 females) aged ≥18 years were recruited. Serum PRL levels were measured after a 9 h overnight fast, 1 h postprandially (early), and 3 h postprandially (late)., Results: Mean PRL levels were significantly higher in females than males in the fasting, early, and late postprandial states. PRL levels were suppressed significantly after food intake in both genders. Mean PRL levels were significantly higher in younger individuals (<30 years) in the fasting and the early postprandial states compared to older individuals (≥30 years) and suppressed significantly after food intake in younger individuals only. Mean PRL levels were not significantly different between individuals with a normal BMI (<25 kg/m 2 ) compared to those overweight and with obesity (BMI ≥ 25 kg/m 2 ); however, PRL levels were significantly suppressed after food intake only in subjects with a normal BMI. Mean PRL levels did not differ significantly according to smoking status. PRL levels were suppressed significantly after food intake in nonsmokers only., Conclusion: Our data suggest that age, gender, and food intake should be considered when the serum PRL level is measured in clinical practice.

Background: Recently we reported results of phase 1 pilot clinical trial of 2 consecutive intracavernous (IC) injection of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) for the first time in the treatment of diabetic patients with erectile dysfunction (DM-ED). In phase 2 of this study our aim is to evaluate long term safety and efficacy of IC injections of BM-MSC on additional eight patients with DM-ED., Results: Each patient received 2 consecutive IC injections of BM-MSC and evaluated at 1, 3, 6, 12, and 24-month time points. Primary outcome was the tolerability and safety of stem cells therapy (SCT), while the secondary outcome was improvement of erectile function (EF) as assessed using the International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS) questionnaires, and Color Duplex Doppler Ultrasound (CDDU). IC injections of BM-MSCs was safe and well-tolerated. Minor local and short-term adverse events related to the bone marrow aspiration and IC injections were observed and treated conservatively. There were significant improvement in mean IIEF-5, EHS, all over the follow-up time points in comparison to the baseline. At 24-month follow up there were significant decline in the mean IIEF-5, and EHS compared to the baseline. The mean basal and 20-min peak systolic velocity was significantly higher at 3-month after the IC injections compared to baseline., Conclusions: This phase 2 clinical trial confirmed that IC injections of BM-MSC are safe and improve EF. The decline in EF over time suggests a need for assessing repeated injections., Clinical Trial Registration: NCT02945462., (© 2024. The Author(s).)

Objectives: Diabetes mellitus (DM) is a complex chronic illness with diverse pathogenesis and associations with health complications. Genetic factors significantly contribute to DM development, and tumor necrosis factor alpha ( TNF-α ) and interleukin-10 ( IL-10 ) genes play major roles. This study aims to explore the influence of TNF-α rs1800629 and IL-10 rs1800872 genetic variants on T2DM development in Jordanian patients at Jordan University Hospital., Methods: One-hundred and 60 diabetic and 159 non-diabetic subjects were genotyped for TNF-α rs1800629 . Additionally, 181 diabetic and 191 non-diabetic subjects were genotyped for IL-10 rs1800872 using PCR-RFLP genotyping method. The demographic, lipid, and glycemic parameters of the patients were obtained from the computer records in the hospital., Results: TNF-α rs1800629 and IL-10 rs1800872 genetic variants exhibited significant different frequencies in non-T2DM subjects and T2DM patients. The difference in TNF-α rs1800629 genotype frequency between non-T2DM and T2DM participants was significant under the dominant model, while the IL-10 rs1800872 genotype frequency was significant under the recessive model. A significant association (p<0.05) was observed between TNF-α rs1800629 and total cholesterol levels, and between IL-10 rs1800872 polymorphism and glycosylated hemoglobin (HbA 1c ) and creatinine levels among T2DM patients., Conclusions: TNF-α rs1800629 and IL-10 rs1800872 are identified as genetic risk factors for T2DM. These variants also correlate with variations in cholesterol, HbA 1c , and creatinine levels among T2DM patients. Larger clinical studies are warranted to validate these findings., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Hypertension, characterized by elevated pressure, poses a significant health risk. Recent studies in Jordan highlight high hypertension rates, emphasizing the need for genetic investigations to comprehend essential hypertension determinants. The AGT gene, part of the Renin Angiotensin System, is linked to blood pressure regulation. Limited information exists on the frequency of this polymorphism among Jordanian hypertensive patients., Aims: This study explores the association between the AGT M235T polymorphism and essential hypertension in Jordan., Methods: A cross-sectional study with 435 participants (199 hypertensive, 236 non-hypertensive) was conducted at the University of Jordan Hospital. Blood pressure was measured, and genetic analysis of the AGT M235T polymorphism was completed using the PCR-RFLP technique. Chi-square and t -tests were used for comparisons using SPSS software., Results: Hypertensive patients exhibited significantly higher weight, BMI, and blood pressure. Genotyping results showed no significant difference ( p > 0.05, Chi-square ) in AGT M235T polymorphism distribution between control and patient groups. In addition, allele frequencies showed comparable patterns ( p > 0.05, Chi-square ). All genotype frequencies showed no deviation from the Hardy-Weinberg equation ( p > 0.05, Chi-square )., Conclusions: The AGT M235T genetic polymorphism is not more prevalent among hypertensive patients in Jordan, although the average weight and BMI among hypertensive patients is higher than the non-hypertensive participants. Obesity can be addressed as a potential risk factor for essential hypertension in Jordan. In addition, it is recommended to find out the influence of the AGT M235T genetic polymorphism on the response of antihypertensive drugs among hypertensive patients in Jordan.

Diabetic foot ulcer (DFU) is a major cause of morbidity, non-traumatic lower limb amputation in diabetic patients and a high-cost burden on the healthcare system. New therapeutic products are increasingly tested. Platelet-rich plasma (PRP) and human platelet lysate (hPL) are reported to be useful. This trial was conducted to test whether the healing effect of hPL in chronic DFU was due to plasma or platelet lysates in a prospective double-blind design. Autologous PRP was obtained from citrated blood, lysed, and used as drug 1 (active product). The platelet-poor plasma (PPP) was used as a drug 2 (placebo). Ten patients were enrolled in arm 1 and 9 in arm 2. The drugs were injected perilesionally every 2 weeks for a total of sixinjections. Adverse events were recorded until Week 14. The DFUs were scored per the Texas and Wegner systems. No patient showed any major adverse events. Some reported local pain post-injection. Wound healing was achieved in the hPL group in 9/10 of patients at a mean of 35.1 days. In the PPP group, no patient had healed by Day 84. The difference was statistically significant at P < 0.00001. We conclude that autologous hPL is safe and highly effective in healing chronic DFU and is superior to autologous PPP., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Introduction: Considering the scarcity of the literature on the association between inter-arms blood pressure difference (IABPD) and coronary artery disease (CAD)., Aim: We performed this study to investigate the prevalence of IABPD within the Jordanian population and to assess if it has an association with CAD., Methods: We sampled patients visiting the cardiology clinics at the Jordan University Hospital between October, 2019 and October 2021 into two groups. Participants were divided into two groups; patients with severe CAD and control group who had no evidence of CAD., Results: We measured the blood pressure for a total of 520 patients. Of the included patients, 289 (55.6 %) had CAD while 231 (44.4%) were labeled as controls who were normal. A total of 221 (42.5%) participants had systolic IABPD above 10 mmHg, while 140 (26.9%) had a diastolic IABPD above 10 mmHg. Univariate analysis demonstrated that patients with CAD were significantly more likely to be older (p < 0.001), of the male gender (p < 0.001), hypertensive (p < 0.001), and having dyslipidemia (p < 0.001). Moreover, they had significantly higher IABPD differences in terms of both systolic and diastolic blood pressure (p < 0.001 and p = 0.022, respectively). Multivariate analysis showed that CAD was a positive predictor of abnormal systolic IABPD., Conclusion: In our study, elevated systolic IABPD was associated with a higher prevalence of severe CAD. Patients with abnormal IABPD might be subjected to more specialist investigation as IABPD consistently predicts coronary artery disease, peripheral arterial disease or other vasculopathy throughout the literature., (© 2023. Italian Society of Hypertension.)

Background: Diabetic kidney disease (DKD) increases the risk of cardiovascular (CV) complications, kidney disease progression, and mortality. We aimed to determine the incidence and risk of these outcomes according to DKD phenotype among the Jordanian population., Methods: A total of 1172 type 2 diabetes mellitus patients with estimated glomerular filtration rates (eGFRs) of >30 ml/min/1.73 m 2 were followed-up from 2019 to 2022. At baseline, patients were classified according to the presence of albuminuria (>30 mg/g creatinine) and reduced eGFR (<60 ml/min/1.73 m 2 ) into four phenotypes: non-DKD (reference category), albuminuric DKD without decreased eGFR, non-albuminuric DKD with decreased eGFR, and albuminuric DKD with decreased eGFR., Results: Mean follow-up was 2.9 ± 0.4 years. Overall, 147 patients (12.5 %) experienced CV events, while 61 (5.2 %) demonstrated kidney disease progression (eGFR: <30 ml/min/1.73 m 2 ). The mortality rate was 4.0 %. Multivariable-adjusted risk for CV events and mortality was greatest for the albuminuric DKD with decreased eGFR group (hazard ratio [HR]: 1.45, 95 % confidence interval [CI]: 1.02-2.33 and HR: 6.36, 95 % CI: 2.98-13.59, respectively), with the risk increasing when adjusted for prior CV history (HR: 1.47, 95 % CI: 1.06-3.42 and HR: 6.70, 95 % CI: 2.70-16.60, respectively). Risk of a ≥40 % decline in eGFR was greatest for the albuminuric DKD with decreased eGFR group (HR: 3.45, 95 % CI: 1.74-6.85), followed by the albuminuric DKD without decreased eGFR group (HR: 1.6, 95 % CI: 1.06-2.75)., Conclusion: Thus, patients with albuminuric DKD and decreased eGFR were at greater risk for poor CV, renal, and mortality outcomes compared to other phenotypes., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Cytochrome 4F2 (CYP4F2) is a major arachidonic acid-metabolizing enzyme which produces 20-Hydroxyeicosatetraenoic acid (20-HETE). It is found that 20-HETE is involved in the pathophysiology of many diseases, including diabetes mellitus. The genetic variants of CYP4F2 can affect its enzymatic activity as well as the 20-HETE production., Aims: Our aim with this paper was to find out the genotype frequency of CYP4F2 rs2108622 C>T, the major functional variant in the CYP4F2 gene, among a sample of type II diabetes (TIIDM) and its effects on diabetes complications and lipid profile., Methods: The CYP4F2 rs2108622 variant was genotyped among 90 healthy volunteers and 90 TIIDM patients that attending the University of Jordan Hospital, using the DNA Sanger sequencing method. The data of lipid profile and diabetes complications were obtained from the electronic records available in the hospital., Results: We found that the frequency of CYP4F2 rs2108622C>T variant is significantly (P = 0.02) lower among TIIDM patients in comparison to healthy subjects using both co-dominant and dominant genotyping models. In addition, the CYP4F2 rs2108622 T/T genotype was significantly (P = 0.02) more frequent among TIIDM patients with retinopathy complications (OR=4.36, CI: 1.32-14.37). Lastly, the CYP4F2 rs2108622C>T variant was not associated (P > 0.05) with the glycaemic and lipid profile of patients., Conclusions: It can be concluded from this study that the frequency of CYP4F2 rs2108622 T/T genotype is lower among TIIDM, but this genotype is associated with an increased risk of retinopathy complications in patients of Jordanian origin. Further studies with a larger sample size are needed to validate the findings of this study., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Several studies suggested a higher prevalence of hypertension and depression among medical students. Patients with depression have a higher prevalence of hypertension and vice versa. In this study, we assessed the frequency of hypertension and depression in a sample of medical students and the impact of depression on hypertension., Methods: We recruited medical students from the largest medical school in Jordan. For each participant, we measured blood pressure and heart rate under standardized measurement conditions. Participants were also surveyed using the 9-item Patient Health Questionnaire (PHQ-9). We performed univariate analysis followed by linear regression analysis of factors affecting mean arterial pressure., Results: 354 medical students were included. The mean age was 21 years. 196 (55.4%) were females and 158 (44.6%) were males. 139 (70.9%) of females had normal blood pressure (BP), 7 (3.6%) had elevated BP, 44 (22.4%) had stage 1 hypertension (HTN), and 6 (3.1%) had stage 2 HTN. Within males: 60 (38.0%) had normal BP, 27 (17.1%) had elevated BP, 55 (34.8%) had stage 1 HTN, and 16 (10.1%) had stage 2 HTN. 114 participants (32.2%) had no or minimal depression, 197 (55.6%) had mild-moderate depression and 43 (12.1%) had moderately severe-severe depression. There was an association between higher depression scores and higher diastolic blood pressure., Conclusion: The frequency of hypertension and depression was notably high in our sample. There was an association between higher depression scores and higher diastolic blood pressure. We strongly believe that this association should encourage us again to screen our hypertensive patients in general for depression and vice versa. We also recommend adopting screening programs for depression and hypertension in general., Competing Interests: The authors declare no competing interests., (© 2022 The Author(s).)

Chronic kidney disease is one of the most common chronic diseases globally. Many studies have shown it is strongly associated with increased social and psychological problems such as depression and anxiety which are considered as common psychiatric disorders that occur in patients with chronic kidney disease. We investigated the prevalence of depression, anxiety and perception of quality of life in a sample of chronic kidney disease patients at the Jordan University Hospital. We aimed to see any association of the mental health in these patients; mainly depression and anxiety with their quality of life and correlation to socio-demographics or laboratory and metabolic profile of this population. 103 chronic kidney disease patients were interviewed using a questionnaire in the Nephrology outpatient clinics of the Jordan University Hospital, the questionnaire included four sections, the first sections handled socio-demographic data. Also, it contains a brief Clinical and laboratory parameter of our patients. The second part consisted of the 9-item Patient Health Questionnaire (PHQ-9) that used to measure the severity of depression. The third part included the 7-item Generalized Anxiety Disorder (GAD-7) to evaluate the severity of anxiety, the fourth part assessed participants quality of life (QOL) using The World Health Organization Quality of Life, Short Form (WHOQOL-BREF) questionnaire. More than half of the participants have depression and anxiety with a percentage of 58.3% and 50.5%, respectively. There was a negative moderate to strong correlation between depression score and quality of life domains scores (p < 0.001).Only marital status had a significant relationship with depression (p < 0.001).Weak positive correlation between Glomerular Filtration Rate and anxiety score (p = 0.04),with significant positive correlation between lipid profile and anxiety score. There was a negative correlation between anxiety score and quality of life domains scores. Females had higher anxiety score than males (p = 0.27). Patients who do not work had a lower physical functioning score compared to others (p value = 0.024).Patients with higher serum Hemoglobin had higher physical and psychological scores. Anxiety, Depression are common among our chronic kidney disease patients, more interventions are needed to improve the mental health of our patients and their quality of life perception. This kind of study allows us to gain a deeper understanding regarding the effects of chronic kidney disease on psychosocial well-being of those patients, and helps health care providers to put depression, anxiety and Quality of life into consideration when treating patients., (© 2022. The Author(s).)

Genetic polymorphisms affect lipid profiles and are associated with disease complications. Genetic variants in the vitamin D receptor (VDR) gene are associated with type 2 diabetes mellitus (T2DM). In this study, we investigated the effects of VDR genotypes on the lipid profile and disease complications of T2DM patients in a Jordanian population. Ninety T2DM patients were genotyped for four major functional VDR genetic variants, rs2228570 C > T (FokI), rs7975232 A > C (ApaI), rs731236 T > C (TaqI), and rs1544410 C > T (BsmI), using the polymerase chain reaction−restriction fragment length polymorphism method. Lipid profiles and diabetes complications were analyzed and correlated with VDR genotypes. We found that the VDR rs7975232 and rs1544410 alleles were significantly (p = 0.008−0.04) associated with high-density lipoprotein (HDL) levels and retinopathy among patients. Carriers of the rs7975232 A/A genotype exhibited higher levels (49.68 ± 15.86 mg/dL) of HDL than patients with the A/C (44.73 ± 13.38 mg/dL) and C/C (37.93 ± 9.22 mg/dL) genotypes. Moreover, carriers of the rs1544410 T/T genotype had higher levels of HDL (54.31 ± 16.45 mg/dL) than patients with the C/T (43.57 ± 13.24 mg/dL) and C/C (43.98 ± 13.17 mg/dL) genotypes. T2DM patients who carry the rs7975232 C/C genotype were at higher risk (odds ratio [OR] = 7.88) of developing retinopathy compared with carriers of the rs7975232 C/A and A/A genotypes. In addition, T2DM patients with the rs1544410 C/C genotype had a higher risk (OR = 4.21) of developing retinopathy than patients with the rs1544410 C/T and T/T genotypes. Therefore, we concluded that the VDR rs7975232 and rs1544410 alleles were associated with HDL levels and retinopathy and can be considered as potential genetic biomarkers for the lipid profile and retinopathy complication among T2DM patients in a Jordanian population of Arabic origin. Further studies with larger sample sizes are needed to confirm our findings.

Objectives: Atorvastatin is commonly used medication to achieve low levels of low-density lipoproteins (LDL). Cholesteryl ester transfer protein ( CETP ) and LDL receptor ( LDLR ) genetic variants can affect the cholesterol transport and hence may affect on atorvastatin response. This study aimed to investigate the influence of LDLR AvaII , CETP TaqIb, and Rs1532624 on the efficacy of 20 mg atorvastatin among Jordanian hyperlipidemic patients., Methods: One hundred and 50 blood samples were collected from hyperlipidemic patients in the University of Jordan Hospital. Polymerase chain reaction-restriction fragment length polymorphism was used for genotyping of LDLR AvaII and CETP TaqIb genetic variants. The genotyping of CETP Rs1532624 variant was done by Sanger DNA-Sequencing., Results: LDLR AvaII and CETP TaqIb and Rs1532624 variants showed a significant (p value < 0.05) association with the baseline of the LDL at the time of diagnoses. On the other hand, none of the tested genetic variants showed a significant (p value>0.05) association with LDL reduction after atorvastatin therapy., Conclusions: Results demonstrated a significant association between the LDLR AvaII and CETP TaqIb, and Rs1532624 genetic variants with the LDL baseline level. However, the atorvastatin therapy among hyperlipidemic patients of Jordanian origin was not affected by any of the tested variants., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Objectives: Increased cholesterol levels were found to be associated with diabetes mellitus type II (DM2). The cholesterol is metabolized by cytochrome 7A1 (CYP7A1) and transported in the intestine by ATP-binding cassette G8 (ABCG8). Genetic variants in CYP7A1 and ABCG8 genes can affect the cholesterol levels. The aim of this study is to compare the frequency of CYP7A1 rs3808607 and ABCG8 rs11887534 and rs4148217 genotypes between healthy and DM2 subjects from Jordanian population., Methods: A total of 117 DM2 patients and 100 healthy controls, of Jordanian Arabic origin, were genotyped for CYP7A1 rs3808607 and ABCG8 rs11887534 and rs4148217 genetic variants using polymerase chain reaction (PCR) followed by restriction fragment length polymorphism technique., Results: The study showed that homozygosity of rs3808607 (A-204C) genotype in CYP7A1 was significantly higher in DM2 patients (ANOVA, p<0.05) with an odd ratio of 2.66, but rs11887534 (G55C) and rs4148217 (C1199A) genetic polymorphisms in ABCG8 were found in comparable frequencies in both healthy and DM2 subjects., Conclusions: The results of this study indicate that CYP7A1 rs3808607 genetic polymorphism is associated with DM2. Further clinical studies are required to confirm this finding among DM2 patients of Jordanian origin., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Objective: There is a high inter-individual variation in atorvastatin response. This study aimed to identify the influences of the CYP7A1 rs3808607 , ABCG8 rs11887534 , and ABCG8 rs4148217 genetic variants on the lipid profile and atorvastatin response among Arab Jordanian patients with type 2 II diabetes mellitus (T2DM)., Materials and Methods: 117 patients with T2DM and on atorvastatin therapy, the most common statin used at the University of Jordan Hospital, were genotyped for the CYP7A1 rs3808607 , ABCG8 rs11887534 , and ABCG8 rs4148217 genetic variants using PCR-restriction fragment length polymorphism. The baseline blood lipid and glycemic parameters were analyzed in the University of Jordan Hospital's laboratory before and after 3 months of atorvastatin administration., Results: Patients carrying the homozygote ABCG8 rs4148217 genotype have less total cholesterol (TC) (157.7 mg/dL) and low-density lipoprotein (LDL) (95.5 mg/dL) than the wild genotype (TC (192.4 mg/dL) and LDL (138.3 mg/dL)). Although these differences did not reach statistical significance (ANOVA, p-value > 0.17). There were no significant associations between the CYP7A1 rs3808607 and ABCG8 rs11887534 polymorphisms and baseline lipid and glycemic parameters (p > 0.12). Overall, no significant association was found between these polymorphisms and atorvastatin response (p > 0.13)., Conclusion: It seems that the CYP7A1 rs3808607 , ABCG8 rs11887534 , and ABCG8 rs4148217 genetic variants do not explain the inter-individual variation in atorvastatin response and lipid baseline profile among Jordanian T2DM patients of Arabic origin.

Background and Objectives: Stem cell therapy is a novel treatment with regenerative ability that can treat erectile dysfunction (ED). This phase 1/2 clinical trial (NCT02945449) using 2 consecutive intracavernous (IC) injections of allogeneic Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) was studied for the first time in the treatment of diabetic patients with ED. The primary outcome was to assess the safety and tolerability, and the secondary outcome was to assess the efficacy of 2 consecutive IC injections of allogeneic WJ-MSCs in diabetic ED., Patients and Methods: Twenty-two diabetic patients with refractory ED were included. Two consecutive IC injections of allogeneic WJ-MSCs were performed. Tolerability was assessed immediately, and at 24 h, safety was evaluated for 12 months. Efficacy was assessed using International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS), and Color Duplex Doppler Ultrasound for 12 months., Results: The procedure was well-tolerated. Minimal and transient adverse events were redness and bruising at the site of injections. There were no patient-reported serious adverse effects. There were significant improvements in IIEF-5, EHS, peak systolic velocity (PSV) basal, and 20-min PSV, all over the follow-up time points in comparison to the baseline., Conclusion: This is the first human study with proven tolerability, safety, and efficacy of IC injections of allogeneic WJ-MSCs for the treatment of diabetic patients with ED., (© 2021 S. Karger AG, Basel.)

Background: Endothelial nitric oxide synthase (eNOS) plays a major role in the response of anti-hypercholesterol statin drugs. Genetic polymorphisms in the eNOS gene affect the activity of eNOS thereby modulating the statin response., Objective: This study investigated the influence of major functional eNOS gene polymorphisms (rs2070744, rs1799983, and rs61722009) on the lipid profile of type 2 diabetes mellitus (T2DM) Jordanian patients treated with atorvastatin., Methods: The sample comprised 103 T2DM patients who attended the diabetes clinic of Jordan University Hospital. The T2DM patients had regularly been taking 20 mg atorvastatin. The atorvastatin response was calculated by measuring the lipid profile before and after three months of atorvastatin treatment. The eNOS genotypes of the subjects were analyzed using polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) assay., Results: No significant association was found between eNOS genetic polymorphisms and the response to atorvastatin (ANOVA, p > 0.05). In addition, no significant difference in the frequency of eNOS genotypes was found between T2DM patients and healthy subjects. However, patients with eNOS rs1799983, 4a/4a, and rs61722009 G/G genotypes showed significantly lower levels of baseline total cholesterol (TC) and low density lipoprotein (LDL) than did patients carrying the rs1799983 4b/4b or rs61722009 T/T genotype (p < 0.05). The eNOS rs1799983 and rs61722009 polymorphisms were in complete linkage disequilibrium (D' = 1)., Conclusion: Although no association was found between eNOS genetic polymorphisms and atorvastatin response, there was a significant association between the rs1799983 and rs61722009 genotypes and baselines levels of TC and LDL in Jordanian T2DM patients. These genetic variants affect cholesterol levels and may play a role in the susceptibility to cardiovascular diseases in T2DM patients. Further studies are needed to validate these findings., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Atorvastatin is commonly used among type 2 diabetic (DM2) patients at the University of Jordan Hospital to prevent cardiovascular complication. However, we noticed that there is a wide inter-individual variation in the efficacy and toxicity of atorvastatin. This study aimed to find out the effects of major genetic variants in 3-Hydroxy-3-Methylglutaryl-CoA Reductase (HMGCR), Apolipoprotein E (APOE), and Solute Carrier Organic Anion (SLCO1B1) genes on atorvastatin response among DM2 patients. A sample of 139 DM2 patients on 20 mg of atorvastatin was included in this study. The lipid and glycemic profile and the levels of hepatic enzymes alanine aminotransferase (ALT) and aspartate transaminase were recorded before and after 3 months of atorvastatin treatment. Additionally, the genetic variants HMGCR rs17244841, APOE rs7412 and rs429357, and SLCO1B1 rs2306283 and rs11045818 were genotyped using an Applied Biosystems DNA sequencing method (ABI3730×1). We found that atorvastatin reduced total cholesterol and low-density lipoprotein (LDL) more significantly ( p -value < 0.05) in patients with wild genotype than variant alleles APOE rs7412C > T and SLCO1B1 rs2306283A > G . Furthermore, the ALT level was elevated significantly ( p -value < 0.05) by 27% in patients with heterozygous SLCO1B1 rs11045818 G/A genotype, while it was not elevated among wild genotype carriers. Additionally, atorvastatin reduced total cholesterol more significantly ( p -value < 0.05) in patients with SLCO1B1 rs2306283A and rs11045818G haplotypes and increased ALT levels by 27% ( p -value < 0.05) in patients with SLCO1B1 rs2306283G and rs11045818A haplotypes. In conclusion, it was found in this study that APOE rs7412, SLCO1B1 rs2306283, and rs11045818 genotypes can be considered as potential genetic biomarkers of atorvastatin response among DM2 patients of Jordanian Arabic origin. Further clinical studies with larger sample numbers are needed to confirm these findings.

Objective: To determine whether a pregnancy-adapted clinical and D-dimer-based algorithm, termed the "YEARS algorithm," can reduce the need for radiological imaging, including lung scintigraphy in pregnant women with suspected pulmonary embolism (PE)., Patients and Methods: This retrospective study included all pregnant women with suspected PE between January 2014 and September 2019 who have undergone D-dimer testing and radiological imaging (computed tomography pulmonary angiography or lung perfusion scans) at presentation. Three criteria from the YEARS algorithm were assessed: clinical signs of deep vein thrombosis, haemoptysis, and whether PE was clinically considered as the most likely diagnosis. Patients who did not have to undergo imaging per the YEARS algorithm were defined as those with no YEARS criteria and a D-dimer of <1μg/mL (group 1) and those with 1-3 YEARS criteria and a D-dimer of <0.5μg/mL (group 2). Patients who had to undergo imaging were those with no YEARS criteria and a D-dimer ≥1μg/mL (group 3) and those with 1-3 YEARS criteria and a D-dimer ≥0.5μg/mL (group 4). Women with symptoms of deep-vein thrombosis had to undergo Doppler ultrasound: If positive, they were anticoagulated and excluded from this analysis, and if negative, they were evaluated further for the need of imaging based on other YEARS criteria and D-dimer level., Results: Of 117 pregnant women with suspected PE analyzed according to the YEARS algorithm five had confirmed deep-vein thrombosis by Doppler ultrasound, were anticoagulated and excluded from the analysis. Of the remaining 112 women (mean age; 30.4±5.7 years), 50 underwent computed tomography pulmonary angiography (CTPA), 54 lung perfusion or ventilation-perfusion (V/Q) scan and eight both; PE was diagnosed in 7 (6.25%), two by CTPA, two by lung perfusion or V/Q scan and three by both. Thirty-three of the 112 women (29.5%) were in groups 1+2 and could, therefore, have avoided CTPA or lung perfusion scans per the YEARS algorithm. None of those 33 women had PE by CTPA or lung perfusion scans vs. 7/79 patients (8.9%) who required CTPA or lung perfusion scans per the YEARS algorithm., Conclusion: The pregnancy-adapted YEARS algorithm can safely rule out PE in about one-third of pregnant women with suspected PE without the need for radiological imaging.

Objectives: This open label, phase I clinical trial (NCT02945462) using 2 consecutive intracavernous autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) for the first time in the treatment of diabetic patients with erectile dysfunction (ED). The primary outcome is to assess the safety and tolerability of intracavernous autologous BM-MSCs, the secondary outcome is to assess efficacy of the procedure., Patients and Methods: Four diabetic patients with refractory ED were included. Two consecutive intracavernous autologous BM-MSC injections were performed. Tolerability was assessed immediately and at 24 h, safety was evaluated for 2 years. Efficacy was assessed using International Index of Erectile Function-15 (IIEF-15) and Erection Hardness Score (EHS) for 12 months., Results: procedure was well tolerated and no patients reported significant adverse effects. There was significant improvement of IIEF-15 and EHS; IIEF-15 (p = 0.04), Erectile Function (p = 0.03), Sexual Desire (p = 0.04), Intercourse Satisfaction (p = 0.04), and Overall Satisfaction (p = 0.04)., Conclusion: This is the first human study with proven tolerability, safety and efficacy of intracavernous autologous BM-MSC injections for treatment of diabetic patients with ED., (© 2018 S. Karger AG, Basel.)