HEMATOLOGICAL AND BIOCHEMICAL FINDINGS AMONG JORDANIAN PATIENT WITH END STAGE RENAL DISEASE

Chronic renal failure is a continuous decreased loss of renal function which leads to long term renal treatment including renal replacement therapy. One of the renal therapeutic options is renal haemodialysis, which acts in removing body’s waste products, including creatinine, urea and excess water. The present study was conducted to study the frequency of some hematological and chemical parameters among patients with chronic kidney disease at Royal Medical City Clinics. Study methodology implied withdrawing blood samples from study participants to carry out the following hematological and chemical parameters: hemoglobin, hematocrit, mcv, bun, creatinine, phosphorous, calcium, albumin, sodium, and potassium. Study findings showed that patients were anemic (hemoglobin 8.99). Chemical parameters indicated that renal dialysis was not able to effectively maintain chemical constituents of the body. Taken together, the current renal dialysis regimens need to be revised in terms of duration and frequency

Do People Live at Sea Level and the Dead Sea Level Have Different Patterns of Anti-Hypertensive Drugs

Background: people live at various areas of sea level may have different patterns of anti-hypertensive drugs. Such a relation has never been reported in Jordan. Study objectives: the current study investigated how the sea level will impact the prevalence of hypertension in these areas, and how will affect the pharmacological properties of such a population. Methodology: a cross-sectional study design was involved to collect data from study participants. A total of 1000 participants were randomly selected from the two study areas. 500 participants from each. Participants were matched for age and gender. Blood pressure were measured for all participants. Blood samples were withdrawn to investigate the level of angiotensin II. Data was collected through organizing a working excel sheet and was further analyzed through using SPSS version 20. Data was presented as means, standard deviations, frequencies and percentages. The relationships between variables were examined using independent T-test. Significance was measured at an alpha < 0.05. Study findings: the main findings of the present study were that the mean of SBP is significantly higher in the Dead Sea (122.42±10.53 mmHg) than the Sea level area (118.07±11.64 mmHg), (p=0.001). Another significant variable was MBP which its mean was 91.64 ± 8.90 mmHg in the Dead Sea and 89.84 ± 8.72 mm Hg. The difference in the mean was statistically significant (p=0.001). The level of angiotensin II was 8.84 ± 4.65pg/ml in the Dead Sea area and 11.21± 6.05pg/ml in the area of the Sea level. The difference in the mean of the two study areas was not statistically significant (p>0.05). Conclusions: although the level of angiotensin II was not significantly varied between the study areas, but its trend was to be higher in the Sea level area. It was surprised to have higher levels of SBP and MBP in the Dead Sea rather than the Seal level area. It can be implied that the therapeutic options of hypertensive drugs follow different patterns independent of angiotensin II pathways

SIMVASTATIN TREATMENT AMELIORATES DIABETIC TYPE 2 CONDITIONS THROUGH LOWERING THE CONCENTRATION OF PLASMA ICAM LEVELS

Diabetes type 2 is associated with other diseases including cardiovascular diseases. Obesity is a link between diabetes and cardiovascular diseases and associated with insulin resistance. Statins are used to reduce lipids and to lower the risk of cardiovascular diseases. The objective of the present study was to explore the effect of statin treatment on plasma levels of ICAM among diabetics. The study design was a prospective cohort clinical study. The study included 62 diabetic patients who were recruited from the Diabetes/Endocrine Clinics of the Prince Rashed Hospital. Data were collected from participants through a prepared questionnaire and laboratory findings of lipid profiles, glucose and ICAM levels. Study findings showed no significant variations between study and control groups at baseline level. At the end of the experiment, in study group, there were significant changes in some biochemical parameters such as ICAM level (p=0.005), cholesterol (0.019), and TG (0.025). The mean difference of study and control groups showed that significant variations were observed for the following variables ICAM (p<0.005), cholesterol (p=0.008), TG (p<0.005), and HDDL (p<0.005). Taken together, the present study showed that simvastatin therapy benefits diabetic patients even without hyperlipidemia through decreasing levels of ICAM-1, which have an inflammatory action and increase insulin resistance. It can be concluded that simvastatin is insulin sensitizer and works as anti-inflammatory agent

SIMVASTATIN TREATMENT AMELIORATES DIABETIC TYPE 2 CONDITIONS THROUGH LOWERING THE CONCENTRATION OF PLASMA ICAM LEVELS

Diabetes type 2 is associated with other diseases including cardiovascular diseases. Obesity is a link between diabetes and cardiovascular diseases and associated with insulin resistance. Statins are used to reduce lipids and to lower the risk of cardiovascular diseases. The objective of the present study was to explore the effect of statin treatment on plasma levels of ICAM among diabetics. The study design was a prospective cohort clinical study. The study included 62 diabetic patients who were recruited from the Diabetes/Endocrine Clinics of the Prince Rashed Hospital. Data were collected from participants through a prepared questionnaire and laboratory findings of lipid profiles, glucose and ICAM levels. Study findings showed no significant variations between study and control groups at baseline level. At the end of the experiment, in study group, there were significant changes in some biochemical parameters such as ICAM level (p=0.005), cholesterol (0.019), and TG (0.025). The mean difference of study and control groups showed that significant variations were observed for the following variables ICAM (p<0.005), cholesterol (p=0.008), TG (p<0.005), and HDDL (p<0.005). Taken together, the present study showed that simvastatin therapy benefits diabetic patients even without hyperlipidemia through decreasing levels of ICAM-1, which have an inflammatory action and increase insulin resistance. It can be concluded that simvastatin is insulin sensitizer and works as anti-inflammatory agent

FREQUENCY OF BLOOD GROUPS AMONGA SAMPLE OF PATIENTSWITH RENAL FAILURE AT ROYAL MEDICAL SERVICES

Introduction: Renal failure underlies various etiologies among which are infectious and autoimmune origins which may link directly or indirectly with blood groups. Objectives: To determine the frequency of blood groups among a sample of patients with renal failure at Royal medical services, and to investigate the association of renal function tests with blood groups. Methodology: A retrospective study design was followed to collect data from files of patients with renal failure. Files of renal patients was included if blood groups were written and kidney function tests were provided. A data sheet was made for each patient that included relevant information about renal patients. A total of 197 files were reviewed. Data were entered into excel sheet to make raw data for all patients. Data analysis was conducted using SPSS V20. Data were presented as frequencies and percentages. The relationships between blood groups and renal function tests were investigated using T-independent test. Significance was considered at alpha level < 0.05. Results: the most prevalent blood group among renal failure patients was blood group A (45.7%), blood group O (30.4%), blood group B (17.3%), and blood group AB (6.6%). When biochemical tests including renal function tests were compared between renal failure patients according their blood groups, results showed slight variations, which were not statistically significant (p>0.05), except for potassium level which was observed in its maximal level among patients with blood group A, and its minimal levels were observed among patients with blood group AB (p=0.032). Conclusions: The present study showed that renal failure patients exhibited more frequency with blood groups A and O and agreed with other studies in which blood group AB is the least associated blood group with renal failure. The level of potassium was highest in patients with blood group A and lowest in patients with blood group AB and this was statistically significant (p=0.032)

The Effect Of Controlling Hyperglycemia On The Morbidity And Mortality Of Intensive Care Unit (ICU) Patients

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes, and the risk of mortality or significant morbidity is high among those who are treated in the intensive care unit (ICU) for more than 5 days. Objective: To assess the effect of glucose management protocol on mortality and morbidity in a heterogeneous population of critically ill adult patients. Design: A randomized controlled trial. Setting: A 24-bed medical-surgical intensive care unit (ICU) for adult patients at King Hussein Medical Center, the Royal Medical Services. Methods: A total of 50 patients who were considered to need intensive care for at least three days, were randomly assigned into two groups. The intervention group subjects were to undergo a glucose control protocol with insulin infusion titrated to maintain blood glucose level in a target range of 120-160 mg/dL; except septic patients, in whom the target was higher, 160- 180 mg/dL. Patients in the second group (control group) were treated by a conventional approach with reduction of blood glucose level only if the level was markedly elevated (>200 mg/dL) to maintain blood glucose level in a target range of 180-200 mg/dL. Results: After adjustment for baseline characteristics the 2 groups of patients were well matched, for age, sex, prevalence of diabetes mellitus, HbA1c value and distribution of diagnoses; the only significant difference was in the percentage of cardiovascular dysfunction, which was higher in the intervention group (p=0.047). After institution of the protocol, the mean blood glucose levels differed significantly between the two treatment groups during the study period (143.70±12.78 mg/dL in the intervention group versus 175.56±14.07 mg/dL in the control group (p<0.001). And patients in the intervention group received a larger mean insulin dose 28.32 ±16.38 units per day, vs. 14.60±12.26 in the control group (p=0.001). The difference in mortality between the two treatment groups was not significant at 28 days (p=0.370) and at 60 days (p=0.555). No significant increase in hypoglycemia episodes was reported in our blood glucose level target. Conclusion: The glucose management protocol resulted in significantly improved glycemic control and was not associated with increased rate of death or hypoglycemia

Designing An Intervention Program To Control Glucose Level In Intensive Care Unit (ICU) In King Hussein Medical Center, Royal Medical Services

Controlling blood glucose level in ICU is one of the main priorities in ICU to decrease mortality rates and morbidity rates and to decrease the healthcare cost. The main objective of the present study is design and implement an intervention protocol in ICU. The method involved a suggested intervention protocol which was applied for 25 ICU patients and their findings were compared with 25 ICU patients in control group. Study findings showed that the intervention protocol was able to reduce mortality rates, positive blood cultures, decreased morning glucose level in the intervention group compared with control group. As a conclusion, controlling blood glucose level in ICU is considered an appropriate approach and leads to better outcome of the patients

Implementation Of Intervention Program For Controlling Glucose Level Among ICU Patients

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes, and the risk of mortality or significant morbidity is high among those who are treated in the intensive care unit (ICU) for more than 5 days. Study objectives: To assess the effect of glucose management protocol on mortality and morbidity in a heterogeneous population of critically ill adult patients. Methods and materials: Study design: A randomized controlled trial. Study setting: Intensive care unit (ICU) for adult patients at King Hussein Medical Center, the Royal Medical Services. Study sample: A total of 50 patients were included in this study and assigned randomly into two groups, control group (N=25), and intervention group (N=25). Study protocol: The intervention group subjects were to undergo a glucose control protocol with insulin infusion titrated to maintain blood glucose level in a target range of 120-160 mg/dL; except septic patients, in whom the target was higher, 160- 180 mg/dL. Patients in the second group (control group) were treated by a conventional approach with reduction of blood glucose level only if the level was markedly elevated (>200 mg/dL) to maintain blood glucose level in a target range of 180-200 mg/dL Study findings: Although the difference in mortality between the two treatment groups was not significant at 28 days (p=0.370) and at 60 days (p=0.555), but it was to be considered for further improvements. No significant increase in hypoglycemia episodes was reported in our blood glucose level target. There was no significant difference in the development of new organ failure, new renal insufficiency, number of patients undergoing transfusion of packed red blood cells, use of antibiotics for more than 10 days, length of stay in the ICU and length of stay in the hospital. It was noticed that the rates of positive blood cultures were lower in the interventional group (8%) than in the control group (32), (p=0.068). Conclusion: The glucose management protocol resulted in significantly improved glycemic control and was not associated with increased rate of death or hypoglycemia

The Variations in the Altitudes Between the Sea Level and Ajloun Impact Heart Variables, but not Angiotensin Ii

Background: hypertension affects many people worldwide and it is highly prevalent in Jordan. Living at different areas with different attitudes may have impacts in hypertension. Study objectives: to identify the prevalence of hypertension in two areas in Jordan with different attitudes and to determine the impact of attitudes in hypertension and angiotensin II to be able to determine the appropriate antihypertensive drug for such population. Methodology: a cross-sectional study design was conducted to collect data from participants. The study included 1000 participants, 500 from each area. A constructed questionnaire was used in this study. Blood samples were taken from participants to assay for angiotensin II. Blood pressure was measured for all patients. Data was analyzed using SPSS version 20. Data was presented as means, frequencies, percentages. The relationship between variables was examined using independent T-test. Significance was considered at alpha level 0.05). Conclusions: living in high altitude is associated with increased potential to have increased levels of cardiac parameters independently of the level of angiotensin II and the therapeutic options for patients with hypertension should be taken into account

The Variations in the Level of Angiotensin II Between Subjects in Ajloun City and the Dead Sea Impact Hypertension Parameters

Introduction: Jordan has a unique array of diversity among which having the deepest level in the world, the Dead Sea and an area with high attitudes in Ajloun City which gives us a great chance to study the biological effects on hypertension and possible impacts in selecting the appropriate treatment. Study objectives: to explore the impacts of variations of attitudes in hypertension and the level of beta blockers through studying the level of angiotensin II among study participants and to investigate if the patterns of anti-hypertensive treatments are impacted. Methods and subjects: a cross-sectional study design was carried out among participants from the two different areas. From each area, a total of 500 participants were recruited and surveyed through a questionnaire. Blood pressure was measured for all participants and blood samples were withdrawn to carry out the testing of angiotensin II. Data were analyzed statistically based on the appropriate software including excel and SPSS. The relationships were examined according to independent T-Test. Significance was considered according to p0.05). On the other hand, heart parameters including SBP, DBP, MBP, pulse, and PCV all of which were significantly higher in Ajloun than in the Dead Sea (p=0.001) for all selected variables. The level of angiotensin II was 12.08 ± 5.19 pg/ml in Ajloun and this was higher than that of the Dead Sea (8.84 ± 4.65 pg/ml). The difference in the mean of angiotensin II was statistically significant (p=0.039). Conclusion: the results of the present study showed that living in high altitude compared with the lowest area in the world (the Dead Sea) exposes persons for the risks of hypertension and other cardiovascular diseases. Our findings may lead to better therapeutic strategies particularly when to prescribe angiotensin II based therapies