Colorectal cancer screening barriers and facilitators among Jordanians: A cross-sectional study.

The factors affecting the adherence of Jordanians to colorectal cancer (CRC) screening remain underexplored. We examined the inhibitory and facilitating factors that influence the uptake of CRC screening among Jordanians. We conducted questionnaire interviews between April 2020 and June 2021 with 861 Jordanians aged 50-75. We analyzed the differences between proportions using the chi-square test. Binary logistic regression was conducted to determine factors associated with awareness of CRC and its screening. Of all participants, 41.7 % were aware of the necessity of screening for CRC, and 27.2 % were aware of at least one of the tests for CRC screening. However, only 17.2 % of participants underwent screening. In the multivariate analysis, participants with higher income (p-value < 0.001, odds ratio[OR] = 1.9, 95 % confidence interval [CI]: 1.4-2.7), higher level of education (p-value < 0.001, OR = 2.6, 95 % CI: 1.8-3.7), family history of colon cancer (p-value < 0.001, OR = 2.8, 95 % CI = 1.7-4.5), and those who had been screened for other cancers (p-value = 0.003, OR = 1.7, 95 % CI: 1.2-2.5) were more aware of the necessity of screening. Concerning barriers to screening, 'feeling well,' lack of physician endorsement, and difficult access to health care were the most commonly reported inhibitory factors (53.9 %, 52.3 %, and 31.9 %, respectively). The most commonly stated incentivizing factor was physician endorsement (82.3 %). Screening rates for CRC in eligible Jordanians remain low, albeit more than one-third of participants are aware of the necessity of screening. Enhanced awareness of barriers and incentivizing factors should help to prioritize national strategies to improve screening rates.

Irritable bowel syndrome and its associated factors among Jordanian medical students: A cross-sectional study.

Very scarce studies investigated the prevalence of irritable bowel syndrome (IBS) and its correlates in the Middle East, particularly in college students. We aimed to investigate the prevalence of IBS and its associated factors among Jordanian medical students. We conducted a cross-sectional study at 2 medical facilities in northern Jordan. We recruited 1135 medical students. Participants completed an anonymous questionnaire addressing sociodemographic, lifestyle, and clinical characteristics. An interview questionnaire was used to diagnose IBS according to the Rome III criteria. Comorbid anxiety and depression were diagnosed by using the Hospital Anxiety and Depression Scale. Of the 1135 completed questionnaires, 1094 (94%) had complete data. The prevalence of IBS in our sample was 30.9%. Binary logistic regression analysis of factors associated with IBS indicated having a family history of IBS as a strong predictor of the disease (odds ratio [OR]: 8.09; 95% confidence interval [CI]: 5.84-11.19). Students in the second and third years of their study had ORs of approximately 4 (95% CI: 2.20-6.54) and 3 (95% CI: 1.70-5.30) for suffering from IBS, respectively, compared with those in the first year (P = .001). Increased anxiety score (OR: 1.88; 95% CI: 1.30-2.71), poor sleep quality (OR: 1.76; 95% CI: 1.13-2.76), female sex (OR: 1.59; 95% CI: 1.14-2.20), and living in a school dormitory (OR: 1.35; 95% CI: 1.00-1.84) were significantly associated with IBS (P < .05). IBS is a highly prevalent disorder among Jordanian medical students, with several factors associated with its occurrence.

Intractable Biliary Candidiasis in Patients with Obstructive Jaundice and Regional Malignancy: A Retrospective Case Series.

BACKGROUND: Candida species are infrequently grown in bile cultures. An association between biliary candidiasis and regional malignancy may exist. The role of fungus membranes in frequent biliary stent occlusion is also presented in this case series. METHODS: We retrospectively identified patients who underwent percutaneous trans-hepatic cholangiogram (PTC) for obstructive jaundice between January 2014 and January 2019. The results of bile cultures - obtained by PTC - for all patients were analyzed, and patients with fungus growth were determined; their medical records were reviewed. RESULTS: A total of 71 patients with obstructive jaundice underwent PTC between January 2015 and January 2019. Five patients (all male; mean age 55.8 years) had candida species growth in bile cultures. Two patients were diagnosed with cholangiocarcinoma, one with adenocarcinoma of the head of the pancreas, one with gallbladder cancer, and one with locally advanced gastric adenocarcinoma. Formation of fungal balls predisposed to frequent PTC drain clogging. Eradication of Candida was achieved in 4 patients after 10 days to 3 weeks of antifungal therapy. CONCLUSION: We present a case series of biliary candidiasis in patients with obstructive jaundice and regional malignancy. We suggest that patients with obstructive jaundice and regional malignancy should be screened for biliary candidiasis. Persistent cholestasis may be caused by the recurrent formation of fungal membranes (balls).

Intraperitoneal duodenal perforation secondary to early migration of biliary stent: closure with through-the-scope clip.

Endoscopic biliary stenting is a well-recognised method of palliation of malignant biliary obstruction. Distal stent migration causing duodenal perforation is an uncommon complication of this procedure and is usually delayed. Early stent migration resulting in duodenal perforation is extremely rare and can be easily overlooked. We present a case of stent migration and resultant intraperitoneal duodenal perforation that occurred 24 hours following plastic stent insertion for a malignant biliary stricture in a 63-year-old woman. The patient required emergent abdominal laparoscopy with the placement of intraperitoneal drain, followed by endoscopic extraction of the stent and closure of the defect using a through-the-scope clip. This case report addresses intraperitoneal duodenal perforation secondary to early migration of biliary stents. Special emphasis is placed on the importance of prompt diagnosis and the use of endoclips in the management of this serious complication of endoprosthesis.

Preoperative esophagogastroduodenoscopy in patients without reflux symptoms undergoing laparoscopic sleeve gastrectomy: utility or futility?

AIM: To evaluate the value of esophagogastroduodenoscopy (EGD) as a preoperative investigation in individuals without symptoms of Gastro-Esophageal Reflux Disease (GERD) who will undergo laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: After Institutional Review Board approval was obtained, patients scheduled for LSG were prospectively enrolled in the study between January 2016 and March 2018. Patients with symptoms of GERD were excluded from the study. Participants were randomly allocated to two groups: individuals who underwent EGD before the surgery as a usual routine investigation (Group A), and individuals who were scheduled without preoperative EGD (Group B). Patient demographics, endoscopic findings, endoscopic biopsy results, and histopathological findings of the resected parts of the stomach after LSG were analyzed and recorded. Additionally, operative characteristics and outcomes, and follow up findings were recorded and analyzed with appropriate statistical methods. RESULTS: A total of 219 individuals without symptoms of GERD underwent LSG were enrolled. Group A included 111 individuals (25 males and 86 females). Group B comprised 108 individuals (20 males and 88 females). The mean age and mean Body Mass Index (BMI) were similar in both groups. From Group A, 86 out of 111 individuals (77.5%) had no pathology identified on EGD, while 21 individuals (18.9%) were found to have areas of gastric erythema and biopsies showed active gastritis. All LSG operations were performed without any major complication. After one year, all individuals were assessed for the presence of symptomatic GERD and no significant difference was found between the two groups. CONCLUSION: Preoperative EGD may not be mandatory for asymptomatic GERD individuals undergoing LSG as post-operative complications and early follow up for GERD symptoms are not significantly different. Further prospective studies with longer follow up are needed to evaluate the role of EGD in individuals undergoing LSG.

Factors Associated with Colorectal Cancer Among Jordanians: a Case- Control Study

Objective: In recent years, the incidence of colorectal cancer (CRC) in Jordan has been on the rise. We aimed to determine associations with lifestyle factors, demographic and clinical variables. Methods: This case-control study included 102 patients diagnosed with CRC and 198 age and gender matched healthy subjects as controls. Cases were purposefully sampled; however, the control group were selected by simple random sampling of a cross-section of the population in Northern Jordan. Participating cases and controls completed an anonymous questionnaire inquiring about their demographic characteristics, lifestyle factors, and clinical variables. Data about the medical history and diagnosis of participating cases were obtained from the cases themselves and confirmed by reviewing their medical records. Results: In the cross tabulation analysis, the Chi square test showed that diabetes and hypertension were significantly associated with CRC (P <0.05). Additionally, regression modeling revealed that age ≥ 45 years (OR=10.93), positive family history for CRC (OR=5.53), physical inactivity (OR=7.4), cigarette smoking (OR=3.71), and having other types of cancer (OR=13.61) were all associated with increased risk of CRC. Conclusions: Physical inactivity and cigarette smoking are among the top modifiable risk factors for CRC among Jordanians. Moreover, diabetes and hypertension were found to be statistically significant risk factors in univariate, but not multivariate analysis. More effective strategies for elevating awareness and prevention are required at both national and international levels. Improving screening strategies is needed for early detection of CRC in Jordan.

Budd-Chiari syndrome associated with coeliac disease: case report and literature review.

We report a case of Budd-Chiari syndrome occurring in a patient with coeliac disease, who presented with symptoms of increased abdominal girth, right upper quadrant pain and shortness of breath for three weeks prior to admission. Initial assessment revealed the presence of moderate ascites, hepatosplenomegaly and right-sided pleural effusion. Further diagnostic work-up established a diagnosis of chronic Budd-Chiari syndrome. Interestingly, complete screening for pro-thrombotic factors was negative. A review of the literature on this association disclosed only 28 similar cases, with the majority of them describing individuals of North African origin. Interestingly, in the majority of cases no specific thrombotic factor could be identified, suggesting that coeliac disease may play a role in this thrombotic disorder.

Protozoan parasites in irritable bowel syndrome: A case-control study.

AIM: To investigate the putative role of protozoan parasites in the development of irritable bowel syndrome (IBS). METHODS: The study included 109 IBS consecutive adult patients fulfilling the Rome III criteria and 100 healthy control subjects. All study subjects filled a structured questionnaire, which covered demographic information and clinical data. Fresh stool samples were collected from patients and control subjects and processed within less than 2 h of collection. Iodine wet mounts and Trichrome stained smears prepared from fresh stool and sediment concentrate were microscopically examined for parasites. Blastocystis DNA was detected by polymerase chain reaction, and Cryptosporidium antigens were detected by ELISA. RESULTS: A total of 109 IBS patients (31 males, 78 females) with a mean age ± SD of 27.25 ± 11.58 years (range: 16 -60 years) were enrolled in the study. The main IBS subtype based on the symptoms of these patients was constipation-predominant (88.7% of patients). A hundred healthy subjects (30 males, 70 females) with a mean ± SD age of 25.0 ± 9.13 years (range 18-66 years) were recruited as controls. In the IBS patients, Blastocystis DNA was detected in 25.7%, Cryptosporidium oocysts were observed in 9.2%, and Giardia cysts were observed in 11%. In the control subjects, Blastocystis, Cryptosporidium and Giardia were detected in 9%, 0%, and 1%, respectively. The difference in the presence of Blastocystis (P = 0.0034), Cryptosporidium (P = 0.0003), and Giardia (P = 0.0029) between IBS patients and controls was statistically significant by all methods used in this study. CONCLUSION: Prevalence of Blastocystis, Cryptosporidium and Giardia is higher in IBS patients than in controls. These parasites are likely to have a role in the pathogenesis of IBS.

Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature.

Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.

Constipation-predominant irritable bowel syndrome: a review of current and emerging drug therapies.

Irritable bowel syndrome (IBS) is a highly prevalent medical condition that adversely affects patient quality of life and constitutes a significant economic burden on healthcare resources. A large proportion of patients suffer from the constipation subtype of IBS (IBS-C), most commonly afflicting older individuals and those with a lower socioeconomic status. Conventional pharmacologic and nonpharmacologic treatment options have limited efficacies and/or significant adverse events, which lead to increased long-term health care expenditures. Failure to effectively treat IBS-C patients over the past decades has largely been due to a poor understanding of disease pathophysiology, lack of a global view of the patient, and an inappropriate selection of patients and treatment endpoints in clinical trials. In recent years, however, more effective and safer drugs have been developed for the treatment of IBS-C. The advancement in the area of pharmacologic treatment is based on new knowledge of the pathophysiologic basis of IBS-C and the development of drugs with increased selectivity within pharmacologic classes with recognized efficacies. This narrative review covers the spectrum of available drugs and their mechanisms of action, as well as the efficacy and safety profiles of each as determined in relevant clinical trials that have investigated treatment options for IBS-C and chronic constipation. A brief summary of laxative-based treatment options is presented, followed by up-to-date assessments for three classes of drugs: prokinetics, prosecretory agents, and bile acid modulators.

Prevalence of temporomandibular disorders in patients with gastroesophageal reflux disease: a case-controlled study.

PURPOSE: The present study estimated the prevalence of temporomandibular disorders (TMDs) in patients with gastroesophageal reflux disease (GERD). PATIENTS AND METHODS: A study group consisting of 60 adult patients (34 women and 26 men) diagnosed with GERD was matched by age and gender to a control group of 60 patients without any signs or symptoms of GERD. The diagnosis of TMD was established using the Research Diagnostic Criteria for Temporomandibular Disorders. RESULTS: Of the 60 patients in the study group, 22 (36.6%) had TMD compared with 11 (18.3%) in the control group (P = .025). Most patients with TMD in both groups were diagnosed with myofascial pain: 19 (31.7%) in the study group versus 9 (15%) in the control group (P = .031). CONCLUSIONS: The increased TMD prevalence in patients with GERD should be explored further to better characterize the association between TMD and GERD. The physicians treating the 2 disorders should consider the clinical implications of this association.

Celiac disease in patients with presumed irritable bowel syndrome: a case-finding study.

AIM: To estimate the prevalence of celiac disease (CD) in adult patients with presumed irritable bowel syndrome (IBS). METHODS: Between March 2005 and December 2008, 742 consecutive patients (293 male, median age 43 years, range 18-69 years) fulfilling the Rome II criteria for IBS were prospectively enrolled in the study. IBS was diagnosed via self-completed Rome II modular questionnaires. Anti-tissue transglutaminase (anti-tTG) serology was checked to initially recognize possible CD cases. Patients with a positive test were offered endoscopic duodenal biopsy to confirm the diagnosis of CD. RESULTS: Thirty two patients (15 male, median age 41 years, range 19-59 years) were found to have organic diseases other than CD. Twenty four patients tested positive for anti-tTG antibodies, and duodenal biopsies confirmed the diagnosis in all of them. Thus, in this patient population with presumed IBS, 3.23% actually had CD. CONCLUSION: CD is common in patients with presumed IBS. Routine screening for CD in patients with symptoms of IBS is recommended.

Awareness, attitude and practice of evidence-based medicine among primary health care doctors in Jordan.

OBJECTIVES: To assess the awareness, attitude and knowledge towards evidence-based medicine (EBM) among primary health care doctors in Jordan and to identify the perceived barriers for practising EBM. METHODS: A simple random sample of 34 comprehensive primary health care centres was selected from a list of 64 centres in Jordan using random number table. A family doctor visited all selected centres and invited the available doctors to participate in the study. Participants were asked to fill the self-administrated questionnaire that was designed to assess beliefs and attitude of doctors towards EBM. RESULTS: Of the total 220 clinicians approached, 202 (91.8%) completed the questionnaire. About 80.7% welcomed promotion of EBM and 91.1% agreed on that research findings are helpful in daily management of patients. About 85.1% stated that practising EBM improves patient care, 68.3% stated that EBM reduces health care costs, 74.8% stated that EBM improves quick knowledge update, 93.6% reported that the doctor-patient relationship is affected positively by practising EBM. About 60.9% reported that they know the concept of EBM and 56.1% reported that they ever used the EBM. Patient overload, limited resources and facilities, and the absence of an effective computer system were the most commonly reported barriers to the implementation of EBM. CONCLUSIONS: In spite of the positive attitude towards EBM, this study demonstrated numerous personal, interpersonal and institutional barriers towards implementing EBM which necessitate prompt action to formulate a national plan to overcome such barriers.

Evidence-based medicine among hospital doctors in Jordan: awareness, attitude and practice.

OBJECTIVES: The aim of this cross-sectional study was to determine the awareness and attitude of hospital doctors towards evidence-based medicine (EBM) and their related educational needs. METHODS: A questionnaire study was performed on a randomly selected sample of 386 hospital doctors from both a teaching hospital and the Ministry of Health general hospitals in Jordan. Attitude towards EBM, best method of moving from opinion-based medicine to EBM, accessing and interpreting evidence and perceived barriers to practise EBM among participants were the main outcome measures. RESULTS: Participants welcomed promotion of EBM and 91.2% agreed that research findings are helpful in daily management of patients. About one-third of respondents (32.7%) thought that the most appropriate way to move towards EBM was by seeking and applying EBM summaries. About one half of participants (47.9%) were unaware of Cochrane database and only 5% used it to help in clinical decision making. More than half (53.7%) reported that they had access to the Internet at their office. Only minority understand the technical terms used in EBM. The major barriers to practising EBM were threat to clinical freedom/judgement, limited resources and facilities, patient overload absence of library in the locally and lack of personal time. CONCLUSIONS: Although there is a high support among doctors for the promotion of EBM, there is a deficit in knowledge and skills of EBM. Hence, the time appears ripe for planning and implementing an effective EBM educational programme for both undergraduate and postgraduate doctors.