Palestinian Medical and Pharmaceutical Journal (PMPJ)

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https://hdl.handle.net/20.500.11888/814

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Assemblage-Dependent Genetic Features of Giardia intestinalis in Humans
(2016) Amjad Hussein; Kentaro Nakamoto; Masaharu Tokoro; Tomoko Arai
Within a significant genetic diversity consisting of 7 genotypes of Giardia intestinalis; assemblage A and B genotypes have been suggested to have different host specificities and variable pathogenicity in humans. Assemblages are highly variable with regard to the genetic features of each genotype. A total of 89 fecal samples were collected from patients who sought medical consultation for abdominal pain in the West Bank, Palestine. Giardia positive samples were assessed microscopically and where genotyped to assemblage level by direct sequencing and subcloning for both triosephosphate isomerase and β-giardin gene markers. G. intestinalis were detected in 12 samples; 9 samples were belonging to assemblage A and 3 samples were belonging to assemblage B. A single genotype was identified from all assemblage A samples, whereas 2 to 4 subgenotypes were confirmed in each of assemblage B samples. No mixed genotypes (inter-assemblages) were found in any sample. This study revealed the contrasting genetic diversity that supports the separate-species notion for assemblage A and B genotypes; it also highlights the need to investigate assemblage B genotype more thoroughly, as has been the case for assemblage A genotype.
Community Pharmacists’ Knowledge towards the Proper Dosing Instructions and Interactions of Alendronate Therapy
(2017) Asma Radwan; Hadeel Jadallah; Haneen Zaid; Josephean Elaraj1; Masa Nour; Mohammad Ya’aqba; Raghad Salamah
Alendronate is one of the most commonly prescribed drugs for the treatment of osteoporosis and other diseases characterized by increased bone resorption. Poor compliance increases the fracture risks, and ultimately treatment failure. This study aims to evaluate Palestinian pharmacist’s knowledge of the proper administration instructions, interactions and side effects of Alendronate as this significantly affect the medical effectiveness and the development of adverse effects. Self- administered questionnaires were completed by 230 pharmacists working in community pharmacies in the northern area of the West Bank. Data were collected using a validated questionnaire consisting of 4 sections and analyzed by descriptive statistics. A scoring scheme was developed to estimate the knowledge scores of participants for the various parameters. The obtained knowledge scores were correlated with the socio-demographics characteristics of the pharmacist's. The median knowledge score of the pharmacists regarding the proper use of Alendronate was moderate i.e., 6 out of a possible maximum score of 9. The knowledge score of Alendronate interactions with food and other medications was 10.5 out of a possible maximum of 14 which is considered as a moderate score, whereas, that for side effects was 4 (0-8). Factors affecting the knowledge towards Alendronate dosing instructions, side effects, and interactions were gender, employment status, years of experience and work place. In conclusion, Palestinian pharmacists have intermediate knowledge about the proper use, drug-food interactions and side effects of Alendronate. Knowledge gaps were identified by this study. Therefore, improving pharmacist's knowledge is of great importance to achieve better efficacy and safety from the treatment.
Determinants of Poor Blood Pressure Control in Hypertensive Patients: Findings from the Baseline Survey in West Bank, Palestine
(2017) Anan Jarab; Hamzeh Al Zabadi; Hussein Hallak; Maher Khdour; Qusai Al-Shahed; Tareq Mukattash
Determinants of Poor Blood Pressure Control in Hypertensive Patients: Findings from the Baseline Survey in West Bank, Palestine
Dissolution Method Development and Validation of Rutin Tablet
(2017) Dania Yahyia; David G Watson; Murad Abu alhasan; Sana Obedat; Tasneem Qutob
Rutin is a flavonoid glycoside that has shown wide range of pharmacological applications with various beneficial medical effects. Rutin is poorly soluble in water and could limit its absorption from the gastrointestinal tract. The aim of this project was to develop and validate a simple UV analytical method for the evaluation of Rutin release from tablet dosage form. The method was developed by testing solubility of Rutin in different concentrations of sodium lauryl sulfate. The dissolution method was then validated in accordance with international guidelines. The results showed that the best dissolution was achieved in phosphate buffer pH 6.8 containing 3% SLS. The percent released was almost 100% after 55 minutes. The developed method was found to be linear, precise and accurate in the range (0.04-0.1mg/ml). The analytical method was also found to be selective for Rutin. In conclusion we successfully developed a dissolution method that is easy and feasible. The validated analytical dissolution method could be used by quality control labs and could be adopted by the official international pharmacopeias.
Effects of Daily Supplementation with High Dose Ascorbic Acid on Blood Lead Levels in Broiler Chicken after Intentional Exposure to a Concentrated Source of Lead
(2016) Ahed Zyoud; Hikmat S. Hilal; Mohammad Abd-Aldaym; Omar Abubaker; Ramzi Shawahna; Sawsan Abu-Rwess; Suheir Shehadeh; Tamara Idkeidek
Lead toxicity is an important global public health issue. The present study was conducted to determine the amount of lead deposited in chicken blood after intentional exposure to a concentrated source of lead for 1 week and to determine the effect of 4 week daily supplementation with high dose ascorbic acid (AA) on the blood lead levels in broiler chicken. Clinically normal mixed-breed adult laying chickens were used in this study. Chickens received lead acetate (200 mg/kg/day) for 1 week. A group of chicken received AA (500 mg/kg/day) for 4 weeks. Another group did not receive any treatment for another 4 weeks. Blood samples were collected and analyzed for blood lead levels using a graphite furnace atomic absorption spectrophotometer. The baseline blood lead level was 47.5 ± 38.0 µg/L and increased significantly to 2755 ± 576 µg/L after 1 week of lead acetate treatment (P < 0.001). AA treatment reduced blood lead levels significantly (P < 0.05). Supplementing lead-contaminated feed with daily high doses of AA might protect from lead exposure when chickens are exposed to environmental pollution.
Evaluation of Compliance to Treatment Guidelines and Goals of Therapy among Palestinian Hemodialysis Patients
(2016) Bayan Namourah; Rowa Al-Ramahi
Patients on hemodialysis usually need management of diabetes, hypertension, dyslipidemia, anemia, and bone mineral disorder. This study was conducted to asses prescribing pattern, to evaluate compliance to treatment guidelines and goals of therapy in hemodialysis patients. This study was an observational retrospective cohort study; it was conducted at Hebron governmental hospital / Palestine. All adult patients on chronic hemodialysis were included. All information were collected from governmental electronic health record (AviCenna HIS program), and patients were asked to answer some questions. During the study period 158 patients were prescribed 1567 medication orders with a mean of 9.92±2.94. The majority of the patients (72.2%) had Hypertension. The target predialysis blood pressure was achieved in 77.2% of the patients (70.5% of the males vs 87.3% of the females; P- value =0.014), and post dialysis blood pressure was achieved in 57.6% cases. Diabetes was a comorbid disease in 36.7% patients and hemoglobin A1c (HbA1c) test was not performed for these patients. Patients with total cholesterol levels of < 200 mg/dl were 78.3% patients. Regarding triglycerides levels, 96.2% had levels of < 500 mg/dl. In the management of anemia, patients who reached goal hemoglobin (Hb) of 11-12 mg/dl according to the national kidney foundation (NKF) guidelines were 8.9% patients only. If kidney disease improving global outcome (KDIGO) guidelines are used (Hb 9-11.5 mg/dl) the patients in this range were 43.0% cases. Transferrin levels were not measured. Iron was used by 69.9% of the patients, and erythropoietin stimulating agents (ESA) by 5.1% of the patients as it was not available in the hospital. No data was available for calcium, and parathyroid hormone levels. Target phosphorus level was obtained in 12.0% of the patients according to the NKF guidelines. If serum phosphorus normal range of 2.5–4.5 mg/dl is used according to KDIGO guidelines, this target was achieved in 4.4% patients only. The results reflect a poor compliance to treatment guidelines. The target levels for treatment are not achieved in many HD patients. The medications are not prescribed optimally to the patients and many investigations and laboratory tests are not performed
Food Safety and Sanitation in Various Kinds of Restaurants Salads in Ramallah Al-Bireh Governorate, Palestine
(2016) Ansam Al-Khatib; Badrieyeh Qaimary; Issam A. Al-Khatib; Shayma’ Hijazi
food safety and sanitation is a major public health concern due to its importance to people’s lives and their health; as many diseases are avoidable whenever food consumed was clean, safe, and in a good quality free of pathogens. Our fast life enforces majority of people to consume fast foods and meals outside homes, which if not appropriate, healthy and clean, will be a source of avoidable series of illnesses. data were taken from the Central Laboratories in the Palestinian Ministry of health; oPt, from the period (Jan, 2010- Sep, 2013). As excel data file, and we recoded variables and analyzed through SPSS version 17.0. Data was collected from 1265 salad samples of various kinds of salads among Ramallah-Al-Bireh district and examined for different indicators for detection of degree of pathogenicity of eight major microorganisms. From 2010 to 2013, the number of microorganisms samples graded as acceptable decreased for Fecal Coliforms, Mould, Salmonella, Staphylococcus aureus, Total aerobic count, Total Coliforms and Yeast( N= 1265, 14.3%). All the examined samples tested negative for Listeria monocytogenes (X2=0.75, P=0.386 >0.001, df=1). Among the various kinds of salads examined, Hummus was the most contaminated kind of salad, followed by Arabic salad but luckily showed decrease in trend with time, and the kinds that were clear and free of microorganism, continued to be clean, and the microorganismal percentages also decreased with time. Healthy measurements and protocols seems to be applied, good governmental supervision, and hygienic protocols are the much possible applied among restaurants. Legislation and regulations are to be strict, clear and implemented to ensure a highest degree of food safety and quality is being provided to people. Furthermore, regular check-ups and monthly rather than yearly investigations should be done by responsible departments.
Influence of Corchorus Olitorius (Molokhia) Soup on the In Vivo Absorption of Ciprofloxacin from Immediate Release Tablet in Rabbits
(2016) Anwar Alheen; Asma Radwan; Josephean Elaraj1; Malak Jada'a; Mohamad Abdaldaym3; Naser Shraim; Nidal Zatar; Yasmeen Khanfar
This study was undertaken to evaluate the effect of Corchorus Olitorius (Molokhia) soup on the oral absorption of ciprofloxacin from solid dosage forms in rabbits. A single dose of ciprofloxacin tablet (125 mg) was administered to rabbits in a fasted state or with Molokhia soup. Plasma ciprofloxacin concentrations were measured by high-performance liquid chromatography. The results demonstrated a profound effect of Molokhia soup on the bioavailability of ciprofloxacin compared to the fasted state. The intake of Molokhia soup reduced the rate and extent of ciprofloxacin oral bioavailability. The geometric mean (Cmax and AUC) values of ciprofloxacin were significantly lower under fed compared to the fasted states. Administration of ciprofloxacin with Molokhia soup was associated with a delay in the time to reach peak concentration (Tmax) by about half hour. Therefore, co-administration of Molokhia soup with ciprofloxacin may have a potential negative effect on the release and oral absorption of Ciprofloxacin from tablets, This may result in serious decrease in the efficacy of this antibiotic and potential bacterial resistance.
Investigation of the Interchangeability between Cefuroxime Axetil Tablets Marketed in Palestine. Is there A Quality Reason behind the Price?
(2016) Abdelnaser Zaid; Ahlam Saleem; Naser Shraim; Nidal Jaradat; Numan Malkieh; Osama Alqaryouti; Sabreen Abdelhafez
According to Food and Drug Administration (FDA), therapeutically equivalent antibiotics is expected to have equivalent clinical efficacy and safety when used under the conditions of their labeling. However, any defect in the quality of an antibiotic may negatively affect its efficacy and safety and accordingly are considered a substandard drug. Cefuroxime is a semi-synthetic, broad-spectrum cephalosporin antibiotic intended for oral administration. Any quality defect in this product may cause inefficacy and future bacterial resistance. The aim of this study was to evaluate the quality and cost price of all commercial Cefuroxime axetil tablet products available on the Palestinian market (One brand and two generic products). A survey on the price of all commercial tablet products was conducted. To assess quality, all products were examined visually for their general appearance. They were tested for weight uniformity, friability, disintegration, and dissolution profile, and assayed for Cefuroxime content. The original brand was more expensive than the two locally produced generic products. Based on our testing procedure, all Cefuroxime tablet products were equivalent to the brand product. Although, the two generic products released more than 85% of their Cefuroxime content within 15 minutes, while the brand released only 74.5%. These results demonstrate that generic Cefuroxime tablets produced by local manufacturers are often comparable in vitro to the brand product and have lower price. Accordingly, we encourage our physician to prescribe the local product since they may be interchangeable and have same safety and efficacy profile.
Knowledge, Awareness, and Practice of Breast Self-Examination Among An-Najah National University Female Students
(2017) Besan Ahmad; Ekhlas Kokash; Hamzeh Al Zabadi; Moaed Saed; Mohammad Husean; Wala`a Kathem
Young breast cancer patients have a lower rate of survival than old age. Yet, breast self-examination makes women more "breast aware", which in turn may lead to an earlier diagnosis of breast cancer. We aimed to describe the degree of awareness, knowledge and practice regarding self-breast examination among An-Najah National University female students in Palestine. A descriptive cross-sectional design using a previously standardized and validated questionnaire was conducted. Data was collected from a convenient sample of 180 female students from An-Najah National University. Statistical Package for Social Sciences (SPSS) was used for data entry and analysis. Nearly, 63.8% of the total sample reported that they have heard about breast self examination and 96.2% reported that breast self examination is important. However, only 36% self-reported they perform the test. The most frequent reported barriers for breast self examination was lack of knowledge. Nearly, 9.2% reported that if they notice a mass in the breast, they don't know what to do. This study pointed to the insufficient knowledge, awareness and practice of university female students about breast self examination. The results should be generalized with caution. However, they provide useful baseline information that could be used to formulate health education and intervention tools aimed at increasing awareness and promote screening of breast cancer among young females at universities level in Palestine.
Non-Covalent Functionalization of Graphene Sheets with Surfactants and their Antibacterial Activity
(2016) Adham Abu Taha; Ameera Mousa; Maha Al-ott; Maryam Faroun; Mohyeddin Assali; Pablo Romero Gomez; Saja Thiab
Graphene is a monolayer of tightly packed carbon atoms that attracted tremendous research interest in recent years, owing to its interesting physical, chemical, electrical, mechanical and optical properties and has numerous exciting applications. However, it suffers from low water solubility which limits its biological application. Therefore, the aim of this work is to functionalize the graphene sheets non covalently with various charged surfactants (cationic- Cetrimide, nonanionic-Tween 80, anionic-Sodium dodecyl sulfate) to get a highly stable conjugate soluble in water and to improve the antibacterial activity of this nano-derivative. The morphology and the size of the functionalized graphene were determined by atomic force microscopy. Moreover, the functionalized graphene was quantified by thermogravimetric analysis obtaining the maximum functionalization in the case of citrimide functionalized graphene. The antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa has been studied. The results indicate that only the functionalized graphene with citrimide has significant antibacterial activity against the two strains of bacteria S. aureus and P. aeruginosa with MIC 0.98, 7.81 mg/L respectively.
A Novel Physical Model and Mathematical Equation for Pre-process Wet granulation Endpoint Prediction
(2017) Motasim Alaqra; Tareq Jubeh
In this study we propose a mathematical formula to estimate the amount of granulating liquid needed in the wet granulation process, which saves time, money and minimizing errors during formulation. The end point of wet granulation can be defined as the uncritical granulating liquid amount that is needed to produce the intended granular size distribution. Most frequently, this end point is determined during the process of wet granulation and, until today, there are no pre-process methods for its determination. Our equation is a modification of Washburn equation, where he described the flow of liquids in powders stacked in a column. The modification of the equation depended on the wetting characterization of the powder bed and sucking saturation level. Moreover, in order to validate the equation, lactose monohydrate, corn starch and mixtures of different percentages of starch and lactose were granulated using the amount of PVP solution calculated for each case. Drop on powder test was used to measure the level of saturation of pores of the powder bed by the PVP solution. The amount of liquid used was according to the calculated porosity, or according to the amount calculated by the modified Washburn equation. The resulting granules proved to have good flow properties. The normality of the granular size distributions curves was confirmed by linear normal probability Q-Q plots, as was shown by the values of R2. The narrowness of the distribution was characterized by the mean, median, standard deviation and span for starch, lactose, and their mixtures. A narrow size distribution was obtained, indicating that the calculated volume of the granulating liquid succeeded in reaching the optimum end point. The three end points used resulted in similar granular properties, indicating the potential advantage of using the amount calculated by the modified Washburn equation. Our results indicate also the ability of this equation to take into account the effect of physicochemical properties of the inactive materials used in tableting on the amount of granulating liquid. In conclusion, this new physical model can be proposed to estimate the amount of granulating liquid depending on: the wetting characterization of the powder bed and sucking saturation level. List of abbreviations used throughout the text:I: is the height of penetrating liquid in the cylinder, r: Pore effective radius, γ: the liquid surface tension, t: is the time needed by the liquid to reach the front of the powder bed, µ: The liquid viscosity, cosθ: is the cosine of the contact angle between solid and liquid, ε: porosity, Vb: powder bulk volume , Vfp: the liquid amount calculated with considering porosity determined by liquid displacement method, Vfe: the experimental value of porosity that represents the value of liquid interring the column in the classical Washburn method ,Vfw: the value calculated by equation 15.
Pharmacovigilance and Adverse Drug Reactions Reporting Process in West-Bank, Palestine
(2016) Anan Jarab; Hussein Hallak; Maher Khdour; Mohammad Dweib; Nima Yaghmour; Qusai Al-Shahed
Active national pharmacovigilance programmes are needed to monitor adverse drug reaction (ADR) data in local populations. The objective of this study was to describe the knowledge, experiences, attitudes and perceived barriers to reporting of suspected ADRs by community and hospital pharmacists in West Bank, Palestine. Between December 2014 and March 2015 we conducted a survey about the knowledge and attitude of pharmacists (n = 270) using a face-to-face questionnaire. The questionnaire consisted of questions about the sociodemographic characteristics of the pharmacists, their knowledge of pharmacovigilance and their attitudes towards ADR reporting. Main outcomes measured: The majority of the pharmacists (62.6%) worked in the community pharmacies and more females responded to the questionnaire than males (59% vs 41%). only 11.9% could conceptually or actually define ‘pharmacovigilance’ correctly while one quarter of the respondent pharmacist (24.9%) could define ADR correctly. The hospital clinical pharmacists defined ‘pharmacovigilance’ correctly with higher significance (P<0.001) when compared with community pharmacists. Only 12.2% had ever reported an ADR. The majority of these reports (85%) done by the hospital pharmacists (p<0.0001). The main reasons that discourage the pharmacists from reporting ADRs were ‘‘no enough information available from the patient (76.7%)’’, and ‘‘they did not know how to report (66.7%)’’. The majority of the respondents (92.0%) felt that reporting ADR was their duty and (82%) participants were interested in participating in the National Pharmacovigilance Programme in Palestine. The results show that Palestinian pharmacists have poor knowledge about pharmacovigilance. There is an urgent need for educational programs to train them about pharmacovigilance and ADR reporting scheme.
Phytochemical and Antibacterial Assessment of Rhagadiolus Stellatus Plant in Jerusalem Area - Palestine
(2017) Alaa Nasser Eldin; Bassam Abu Shanab; Fatima Hussein; Mohammad Qneibi; Momen Khawaja; Motasem Al-Masri; Nidal Jaradat; Tariq Yassin
In Palestine, many edible wild plants serve as food and medicine in the folk traditions. Now days, contemporary people, cultures, and traditions are increasingly losing their close connection with nature. Preliminary phytochemical screening including estimation of total phenols and flavonoids contents, as well as antioxidant and antibacterial properties, were evaluated for Rhagadiolus stellatus plant using standard phytochemical and biological methods. Evaluation of antibacterial activities of the aqueous extract was performed using the broth micro-dilution method. Antibacterial activities were examined against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa ATCC’s and MRSA. The methanolic plant extract contains a mixture of phytochemical compounds such as flavonoids, glycosides, saponins, phenols, alkaloids, phytosterols and volatile oil. Total flavonoids and phenols contents were 18.35±1.11 mg QUE/g and 38.55±0.95 mg GAE/g of the plant extract, respectively. The methanolic extract also had potential antioxidant properties, while the aqueous extract has significant antibacterial properties. This study has provided initial data that justify the importance of Rh. stellatus in traditional folkloric food and medicine. The studied species can be used in the prevention and treatment of various infectious diseases. The tested extract not only exhibited antioxidant properties, but also contained bioactive constituents. It can also be utilized as natural food preservatives, nutritional supplements and in pharmaceutical industries.
The Present and Future of Pharmaceutical Care in Palestine: A Survey among Pharmacists
(2016) Ala' Abed Alkhaleq; Anwar Malawani; Karama Laboom; Rowa' Al-Ramahi; Sana' Rajab; Sujood Kittani
The aims of this study were to evaluate community pharmacists’ views about their current role, main barriers to pharmaceutical care practice and their attitudes towards continuing education and providing some services. The study was a questionnaire based cross- sectional study that was conducted among community pharmacists in the West Bank between July 2013 and March 2014. Key findings: The questionnaire was completed by 295 out of the 300 pharmacists approached giving a response rate of (98.3%). The majority of pharmacists (205; 69.5%) stated that the community pharmacists do not practice the pharmaceutical care as it should be. All of the pharmacists said that they dispense medications and write instructions of use, 224 (76.0%) claimed that they ask about allergies, 218 (74.0%) confirmed that they review the appropriateness of the doses, 200 (68.0%) said that they take medical and disease history. The majority of the pharmacists 275 (93.2%) were willing to participate in pharmaceutical care practice. The main reported barriers to practice pharmaceutical care were the poor cooperation from the patients (215; 73%), and physicians (180; 61%), having no enough time (177; 60%), and low salaries (153; 52%). The majority 92.5% (273 pharmacists) were willing to participate in continuing education activities. The majority of community pharmacists believe that they do not do their role in Palestine as it should be. Dispensing of prescriptions is the primary focus of community pharmacists. The community pharmacists have positive attitude towards pharmaceutical care and continuing education. Efforts are needed to overcome barriers.

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