Ciprofloxacin Versus Levofloxacin Prophylaxis in Hematopoietic Stem Cell Transplantation: A Randomized Trial.

OBJECTIVES: We aimed to assess whether there is a difference between ciprofloxacin and levofloxacin as prophylaxis in hematopoietic stem cell transplant (SCT) recipients. METHODS: This is a prospective, randomized trial in patients receiving SCT at Henry Ford Health in the United States of America. We randomly assigned patients (1:1) to receive ciprofloxacin or levofloxacin. The primary outcome was incidence of bloodstream bacterial infections (BSI) up to day 60 after SCT. RESULTS: Between June 4, 2018, and May 23, 2022, we randomly assigned 308 consecutive patients to receive ciprofloxacin (154 patients) or levofloxacin (154 patients). BSI was similar in both the ciprofloxacin and levofloxacin groups (18 [11.7%] vs 18 [11.7%]). Pneumonia was more frequent in the ciprofloxacin group compared to the levofloxacin group (18 [18%] vs 7 [23%]; relative risk 2.57, 95% CI 1.11-5.98; p = 0.028). There were no differences in neutrophil engraftment, fever, Clostridium difficile infection, relapse incidence, overall survival, non-relapse mortality, length of stay post-SCT, or intensive care unit admission. CONCLUSIONS: Although both prophylaxis regimens demonstrated the same efficacy in SCT recipients, levofloxacin prophylaxis led to less pneumonia in the first 60 days post-SCT. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov, NCT03850379.

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.

Fusarium-Induced Cellulitis in an Immunocompetent Patient With Sickle Cell Disease: A Case Report.

Fungal infections due to Fusarium species are mostly present in immunocompromised and patients with poorly controlled diabetes mellitus. We report a case of lower extremity skin infection caused by Fusarium species in a 61-year-old woman diagnosed with sickle cell disease. Single skin ulceration caused by Fusarium species can result from fungal inoculation into damaged tissue, so any condition that damages the skin can be considered as a risk factor for inoculation. Long-standing sickle cell disease may develop vaso-occlusion in the skin that can produce lower extremity ulcers and myofascial syndromes. The mechanism is not completely characterized, but compromised blood flow, endothelial dysfunction, thrombosis, inflammation, and delayed healing are thought to contribute to locally compromised tissue that may eventually lead to opportunistic infection such as in our case. Other factors contribute to the pathophysiology of lower extremity ulcers such as diabetes mellitus, with the resulting peripheral vascular ischemia causing poor circulation to the lower extremity, and peripheral neuropathy, which can make patients with diabetes unaware of minor trauma leading to the development of skin infections.

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.