The efficacy and side effects of topiramate on refractory epilepsy in infants and young children: A multi-center clinical trial

SummaryObjectives:This study has been conducted to assess the efficacy and safety of topiramate in refractory epilepsies in infants and young children.Methods:A prospective clinical trial was performed in three tertiary care hospitals, on 47 children aged 6–60 months with refractory epilepsy. Topiramate was added to at least two baseline anti-epileptic drugs. The efficacy was rated according to seizure type, frequency and duration.Results:Children with refractory epilepsy were classified according to their clinical, neuro-imaging, and neurophysiological profile into infantile spasms (IS) (9 cases, 19%), Lennox–Gastaut syndrome (LGS) (25 cases, 53%) and other epilepsies (13 cases, 28%). Children were also classified into cryptogenic and symptomatic epilepsy. Topiramate was introduced as add-on therapy in a daily dose of 1mg/kg/day for 2 weeks, followed by increments of 1–3mg/kg/day at 2-week intervals, up to a maximum of 10mg/kg/day. After a minimum treatment period of 6 months, 28 (60%) of the children had a satisfactory response (completely seizure free, or more than a 50% seizure reduction). The remaining 19 children (40%) had an unsatisfactory response (50% or less reduction in seizure frequency, no change or increased seizure frequency).Topiramate appeared to be equally effective in infantile spasms, Lennox–Gastaut syndrome and children with other types of epilepsy, with no significant difference between those with a satisfactory and an unsatisfactory response (p=0.089). There was also no significant difference in response between patients with cryptogenic and symptomatic epilepsy (p=0.360).Mild to moderate adverse effects, mainly somnolence, anorexia and nervousness, were present in 25 (53%) of children. One of the children developed hypothyroidism.Conclusion:Although the long term safety and possible adverse effects of topiramate have not been fully established in infants and young children, this study has shown that it is a useful option for children with frequent seizures unresponsive to standard anti-epileptic drugs

Hypogonadism among Jordanian men with type 2 diabetes: Prevalence and associated factor

AbstractAimsPrevalence of hypogonadism is largely unknown in the general population and population of diabetics in Arab countries including Jordan. This study was conducted to determine the prevalence of hypogonadism among men with type 2 diabetes in Jordan and determine its associated factors.MethodsThis cross-sectional study included a total of 1049 consecutive men with type 2 diabetes who attended the National Center for Diabetes, Endocrinology and Genetics (NCDEG) in Amman, Jordan, in the period from August 2008 to February 2009. Data were collected from medical records and using a pre-structured questionnaire. Clinical characteristic, anthropometric measurements and laboratory measurements were obtained. Hypogonadism was defined as total testosterone <3ng/ml.ResultsOverall, 36.4% of patients with diabetes had total testosterone level <3ng/ml and 29% had symptoms of androgen deficiency. Of those with serum testosterone level <3ng/ml, 80.2% had symptoms of androgen deficiency. About 16.9% of those with serum testosterone level <3ng/ml had primary hypogonadism and 83.1% had secondary hypogonadism. Age, monthly income of less than 500JD, obesity, and neuropathy were significantly associated with low serum total testosterone level.ConclusionsThe prevalence of hypogonadism among men with type 2 diabetes in Jordan is high. This urgently calls for implementing early and universal screening programs irrespective of symptoms of androgen deficiency to detect those who have low serum total testosterone level at any early stage and to supplement testosterone accordingly

Clinical and inheritance profiles of Kallmann syndrome in Jordan

BACKGROUND: Proper management of patients with Kallmann syndrome (KS) allows them to attain a normal reproductive health. The purpose of this study is to demonstrate the presentation modalities, phenotypes and the modes of inheritance among 32 patients with Kallmann syndrome in Jordan. Recognition of the syndrome allows for prompt proper management and provision of genetic counselling. SUBJECTS: Over a period of five years (1999–2004), the clinical and inheritance profiles of 26 male and 6 female patients with Kallmann syndrome from 12 families were evaluated at the National Center for Diabetes, Endocrinology and Genetics in Jordan. RESULTS: The patients belonged to twelve Jordanian and Palestinian families and their age at presentation ranged from 4 – 46 years. Nine boys aged 4–14 years presented with cryptorchidism and microphallus, all other males presented with delayed puberty, hypogonadism and/or infertility. The main presentation among six female patients was primary amenorrhea. Intrafamilial variability in clinical phenotype was specifically evident for renal abnormalities and sensorineural hearing impairment. Familial KS was diagnosed in 27 patients belonging to five families with the X-linked mode of inheritance and two families with the autosomal recessive mode of inheritance. CONCLUSIONS: (1) the majority of cases in this study represented the X-linked form of KS, which might point to a high prevalence of Kal 1 gene in the population. (2) Genetic counselling helps these families to reach a diagnosis at an early age and to decide about their reproductive options. (3) Children presenting with cryptorchidism and microphallus in our population should be investigated for KS

Holding solution pH and composition consistently improve vase life of rose, lily and gerbera

We assessed the influence of postharvest pulsing solutions pH and composition on cut flower quality of rose (Rosa hybrida cvs. Avalanche and Black Magic), gerbera (Gerbera jamesonii cv. Beaudine) and lily (Lilium × elegans cv. Fangio) under room (20±2 °C) and cold storage (4±1 °C) conditions. Cut flowers were placed in different acidic (pH, 3.5 - 4) or basic (pH, 7.0 - 7.5) preservative solutions containing water, sugar 5% (flower food), 100 mg/L silver nitrate (AgNO3 act as a bactericide), or a commercial product (2% sugar + bactericide and fungicide). Acidic solutions had higher or similar (never lower) vase life at both room and cold storage conditions and across species. In addition, vase life was 3-4 times longer in cold storage when compared to room conditions. Leaf chlorophyll concentrations for rose and lily were inconsistent or not significant across the species at both conditions (room and cold storage). The commercial preservative solution consistently and significantly had higher vase life than water for all tested cut flower species and under both room and cold storage environments. AgNO3 ranked second in terms of vase life enhancement. Overall, the use of only flower food (sugar) or bactericide (AgNO3) had a positive impact on vase life but only the combined use of a preservative substance (specifically at pH, 3.5 - 4.0) consistently guaranteed a high cut flower quality across flower species

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

Sexual Dysfunction in Jordanian Diabetic Women

OBJECTIVE—To estimate the prevalence of female sexual dysfunction (FSD) in diabetic and nondiabetic Jordanian women

Randomized controlled trial of live lactobacillus acidophilus plus bifidobacterium bifidum in prophylaxis of diarrhea during radiotherapy in cervical cancer patients

<p>Abstract</p> <p>Background</p> <p>Radiation-induced diarrhea is frequently observed during pelvic radiotherapy. This study was performed to determine the ability of a probiotic containing live lactobacillus acidophilus plus bifidobacterium bifidum to reduce the incidence of radiation-induced diarrhea in locally advanced cervical cancer patients.</p> <p>Methods</p> <p>Patients who were undergoing pelvic radiotherapy concurrent with weekly cisplatin were randomly assigned to a study drug or placebo, in a double-blind study. Diarrhea was graded weekly according the Common Toxicity Criteria (CTC) system. Stool consistency and white and red blood cell count in stool were also assessed. The primary endpoint was to reduce the incidence of diarrhea, defined by a CTC grade 2 or more, and the need for anti-diarrheal medication.</p> <p>Results</p> <p>A total of 63 patients were enrolled. Grade 2 -3 diarrhea was observed in 45% of the placebo group (n = 31) and 9% of the study drug group (n = 32) (p = 0.002). Anti-diarrheal medication use was significantly reduced in the placebo group (p = 0.03). The patients in the study drug group had a significantly improved stool consistency (p < 0.001).</p> <p>Conclusions</p> <p>Live lactobacillus acidophilus plus bifidobacterium bifidum reduced the incidence of radiation-induced diarrhea and the need for anti-diarrheal medication and had a significant benefits on stool consistency.</p

Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention

Introduction Hypoglycaemia is one of the most serious adverse effects of diabetes treatment. Older adults are at the highest risk to develop hypoglycaemia. Several studies have established the important positive role of educational interventions on achieving glycaemic control and other clinical outcomes, however, there is still a lack in studies that evaluate the impact of such type of interventions on hypoglycaemia risk in elderly patients with type 2 diabetes. The purpose of this research is to evaluate the effectiveness of pharmacist-led patient counselling on reducing hypoglycaemic attacks in older adults with type 2 diabetes mellitus. Methods and analysis: This study is an open-label, parallel controlled randomised trial, which will be conducted in the outpatient clinics at the largest referral hospital in the north of Jordan. Participants who are elderly (age ≥ 65 years), diagnosed with type 2 diabetes mellitus, and taking insulin, sulfonylurea, or any three anti-diabetic medications will be randomly assigned to intervention (SUGAR Handshake) and control (usual care) groups. The SUGAR Handshake participants will have an interactive, individualised, medications-focused counselling session reinforced with a pictogram and a phone call at week six of enrolment. The primary outcome measure is the frequency of total hypoglycaemic events within 12 weeks of follow up. Secondary outcomes include the frequency of asymptomatic, symptomatic, and severe hypoglycaemic events, hypoglycaemia incidence, and time to the first hypoglycaemic attack. We will also conduct a nested qualitative study for process evaluation