Medical and Health Sciences

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    ADHERENCE TO HEMODIALYSIS AND MEDICAL REGIMENS AMONG PATIENTS WITH END-STAGE RENAL DISEASE IN PALESTINE: A CROSS-SECTIONAL QUANTITATIVE MULTICENTER STUDY
    (An-Najah National University, 2025-06-24) Issa, Muneer
    Abstract Introduction: Chronic Kidney Disease (CKD), particularly End-Stage Renal Disease (ESRD), poses a significant public health challenge globally, with hemodialysis (HD) being a primary treatment modality. Adherence to medical regimens, dietary restrictions, and fluid management is critical for improving patient outcomes. However, adherence levels among ESRD patients vary due to multifactorial influences, including sociodemographic and health-related factors. This study aimed to assess adherence levels among Palestinian ESRD patients undergoing HD and identify associated factors. Objectives: Measure adherence rates to medications, dietary recommendations, and HD sessions among ESRD patients. Also, to identify sociodemographic and health-related factors influencing adherence. Finally, to investigate barriers to adherence, such as socioeconomic status and health literacy. Methodology: A cross-sectional quantitative study was conducted on 260 ESRD patients from three hospitals in northern West Bank, Palestine. Data were collected using the validated End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which assessed adherence to HD sessions, medications, fluid restrictions, and diet. Descriptive and analytical statistics, including Kruskal-Wallis and Mann-Whitney tests, were employed to analyze the data. Results: The majority of participants (68.5%) exhibited good adherence, with a median score of 1100 (IQR = 250). Higher adherence was significantly associated with higher educational levels (p < 0.001), ESRD due to inflammatory causes (p = 0.009), prior peritoneal dialysis (PD) (p = 0.012), and no history of kidney transplant (p = 0.033). Lower adherence correlated with higher serum potassium (r = -0.352, p < 0.001) and phosphorus levels (r = -0.330, p < 0.001). Peri-dialytic weight differences were greater among patients with higher education (p < 0.001). Conclusions: Adherence levels among Palestinian ESRD patients are influenced by educational background, disease etiology, and prior treatment modalities. Nurse-led interventions and tailored educational programs are recommended to enhance adherence, particularly for patients with lower health literacy or congenital ESRD causes. Future research should explore the impact of such interventions on long-term health outcomes. Key words: Adherence, Chronic Kidney Disease, End-Stage Renal Disease, Hemodialysis, Palestine, ESRD-AQ, Medical Regimens.
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    AN OBSERVATIONAL PROSPECTIVE ANALYSIS OF THE IMPACT OF POSTOPERATIVE PAIN AND ITS MANAGEMENT ON THE OCCURRENCE OF POSTOPERATIVE DELIRIUM: INSIGHTS FROM A STUDY CONDUCTED IN PALESTINE
    (جامعة النجاح الوطنية, 2025-12-21) Elyyan, Mohammed Abdulrahim
    Introduction: Postoperative delirium is the sudden onset of fluctuating attention and disturbance of the usual mental state during the first seven days after surgery. How pain management influences the rate of postoperative delirium (POD) is an important consideration. This study was conducted to investigate the complexity of the relationship between the rates and characteristics of postoperative delirium and postoperative pain management. Methods: This prospective cohort study used convenience sampling of 208 surgical patients at An-Najah National University Hospital and Rafidia Governmental Hospital in Nablus, Palestine. A data sheet was used as the data collection technique, and the data were collected from March 10 to September 10, 2024. The data sheet was divided into five sections: the Nursing Delirium Screening Scale (Nu-DESC), postoperative nausea and vomiting (PONV), assessment and management of postoperative pain, patient history and surgical characteristics, and sociodemographic information. SPSS was used to analyze the data while adhering strictly to ethical principles of confidentiality and anonymity Results: The mean age of the patients was 47.11 ± 15.8 years. A total of 62.5% of the patients were males. Sixty-three percent of the patients were married. Most patients complained of POP (96%), PON occurred in 75% of patients, and POV occurred in 43.7% of patients. The incidence of POD was 29.8%. The POD is influenced by education level and smoking habits, and the P values are significant (0.04 and 0.045, respectively). The type of surgery was significantly associated with POD and POP (p values =0.037 and 0.044, respectively). Additionally, our findings revealed a significant association between the occurrence of POD and surgical risk categories (p = 0.017). Furthermore, the use of rocuronium and isoflurane was significantly related to the development of POD, with p values of 0.042 and 0.03, respectively. Conclusion: The incidence of POD in our study was 29.8%. The significantly associated factors included POV, isoflurane use, preoperative anxiolytics, and postoperative controlled analgesia and steroids. Recognition of these risk factors provides opportunities for preventive strategies and better perioperative care. Keywords: POD, POP, PON, POV, Nursing Delirium Screening Scale (Nu-DESC), Rocuronium and isoflurane administration, Surgical patients, An-Najah National University Hospital, Rafidia Governmental Hospital, Nablus city, Palestine
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    ANTI-CD44 EXPRESSION AS A PROGNOSTIC MARKER IN DIFFERENT STAGES OF TRIPLE-NEGATIVE BREAST CANCER PATIENTS AND ITS ASSOCIATION WITH CLINICOPATHOLOGICAL FACTORS
    (An-Najah National University, 2025-12-31) Shakhsheer, Shurouq
    Background: Cancer stem cells (CSC) within tumors play a central role in tumorigenesis. Therefore, identifying these cells is essential for developing more effective cancer therapy. Triple-Negative Breast Cancer (TNBC) is an aggressive subtype of breast cancer associated with poor prognosis. The role of CD44 detected by immunohistochemistry (IHC) as a potential CSC marker in breast carcinomas, particularly in the TNBC subtype, remains unclear and has shown inconsistent results. Study Aims: This study aims to evaluate CD44 expression among TNBC cases and to investigate the relationship between CD44 overexpression and tumor aggressiveness, based on clinicopathological factors, such tumor grade, metastasis, and tumor stage. The ultimate goal is to assess the potential of CD44 as a prognostic marker for TNBC. Methodology: This retrospective cross-sectional study included 100 TNBC cases diagnosed at King Hussein Cancer Center (KHCC) between 2018 and 2022, CD44 expression was evaluated using IHC and correlated with clinicopathological parameters. Tissue sections were subjected to immunohistochemical staining using antibody against the CD44 antigen marker. The proportion and intensity of CD44 immunostaining were assessed and correlated with prognostic markers obtained from patient’s records in the KHCC archive. Results: CD44 expression was observed in 73% of the total cases. A statistically significant association was found between positive CD44 expression and tumor grade (p= 0.024), tumor recurrence (p= 0.043), tumor size (p=0.037), and toward significant with distant metastasis (p=0.06). However, no significant associations were found between CD44 expression and other clinicopathological features including OS, and DFS. Conclusion: these findings suggest that while CD44 is closely associated with tumor aggressiveness, post-therapy recurrence, and shows a trend toward association with distant metastasis, it does not independently influence survival outcomes. Therefore, CD44 may serve as a potential biomarker of treatment response and tumor biology, but not necessarily as a standalone prognostic indicator for survival in TNBC.
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    ANTIMICROBIAL PROPHYLAXIS AND THE RATE OF BLOOD STREAM INFECTIONS IN ADULT STEM CELL TRANSPLANTATION: A SINGLE CENTER RETROSPECTIVE STUDY FROM PALESTINE
    (An-Najah National University, 2025-11-13) Dwikat, Mayada Fahmi
    Introduction: Hematopoietic stem cell transplantation (HSCT), particularly autologous HSCT (auto-HSCT), has the potential to cure many hematologic cancers. However, infections continue to be a serious problem in this patient population, particularly bloodstream infections (BSIs), which are the leading cause of mortality and morbidity, primarily due to prolonged immunosuppression. Although antimicrobial prophylaxis is adopted as a standard procedure to minimize the infection risk in most HSCT centers, concern regarding antibiotic resistance and Clostridium difficile infection persists. Moreover, the burden of these infections in resource-limited settings like Palestine is insufficiently studied. Therefore, this study aims to describe the antimicrobial prophylaxis and determine the incidence rate and potential risk factors of BSI in adult patients undergoing auto-HSCT at An-Najah National University Hospital (NNUH), the only auto-HSCT center in Palestine. Methods: A retrospective observational cohort study was conducted at the bone marrow transplantation (BMT) department of NNUH between January 2018 and June 2024. The study analyzed extracted medical, laboratory, and pharmacy data from patients who underwent auto- HSCT. Descriptive statistics, univariate comparisons, and multivariate logistic regression to identify independent risk factors for BSIs and CDIs were performed using Statistical Package for Social Sciences (SPSS) version 21 software. Of the 267 candidates screened, 224 adult patients (aged ≥18 years) met the inclusion criteria and were included in the final analysis. Approval from the An-Najah National University Institutional Review Board (IRB) was obtained before initiating the study. Results: Among 224 patients, Multiple myeloma (MM) was the most commonly diagnosed malignancy, followed by Hodgkin Lymphoma (HL), accounting (50.4%,38.4%) respectively. Antimicrobial prophylaxis includes fluoroquinolones, with ciprofloxacin given to 31.3% of patients and levofloxacin administered to 69.2%. In addition, antifungal prophylaxis consisted of itraconazole (50.9%), fluconazole (48.7%), while antiviral prophylaxis with acyclovir was given to all patients. The incidence rate of BSI was 17.9% with gram-negative (GNB)and gram-positive bacteria (GPB) being the predominant isolates. Among GNB isolates, Escherichia coli was the most frequently detected organism (8 cases), while Staphylococcus epidermidis was the most common GPB, also identified in 8 cases. Extended-spectrum beta-lactamase (ESBL),and Klebsiella pneumoniae showed (100%) resistance to Ciprofloxacin. Moreover, Pseudomonas aeruginosa and Acinetobacter baumannii were classified as extensively drug-resistant bacteria (XDR) GNB. Most GPB are completely resistant to levofloxacin. Clostridioides difficile infection (CDI) occurred in 15.6% of cases, with Toxin A and Toxin B positivity in 14.3% and 10.3%, respectively. Oral vancomycin was the drug of choice for all patients diagnosed with CDI. Multivariate Logistic Regression revealed that patients with multiple myeloma had 2.7 times higher odds of developing BSI compared to those without MM. Furthermore, CHD showed a possible association with CDI (adjusted OR = 2.64, 95% CI: 0.83–8.37, p = 0.099). Despite infection risks, mortality was low (1.8%), and the average hospital stay was 24.7 ± 6.5 days. Conclusion: The use of antimicrobial prophylaxis among auto-HSCT in NNUH aligns with international guidelines. The incidence rate of BSI and CDI is consistent with studies worldwide. However, quinolone Resistance remains a significant concern in both gram-positive and gram-negative bacteria. Additionally, Multiple myeloma was identified as an independent risk factor for BSI. Finally, the emergence of multidrug-resistant organisms and CDI underscores the need for risk-adapted prophylaxis and strengthened infection control measures These findings provide valuable local data to inform clinical protocols and help reduce infection-related complications in HSCT settings, particularly in resource-limited environments
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    ASSESSING THE IMPACT OF GROUP COUNSELING CBT PLAY THERAPY FOR TREATING EMOTIONAL AND BEHAVIORAL ISSUES IN ADHD CHILDREN
    (An-Najah National University, 2025-08-31) , Mai
    This thesis investigates effectiveness of Group Counseling Cognitive Behavioral Therapy (CBT) Play Therapy on addressing emotional and behavioral issues among children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), study employed quasi-experimental design involving 60 children, divided into an experimental group receiving CBT Play Therapy intervention and control group receiving no intervention, Data were collected using Conners 3rd Edition, validated assessment tool that measures ADHD symptoms across multiple domains, including inattention, hyperactivity/impulsivity, and oppositional behavior. Pre-test and post-test scores were analyzed to evaluate intervention's impact, with findings revealing significant reductions on ADHD symptoms among experimental group compared to control group, Specifically, results indicated substantial improvements across all measured subscales, with effect sizes demonstrating intervention's effectiveness, Demographic variables such as gender, monthly income, educational background, and parental involvement were also examined to understand their influence on treatment outcomes. The study concludes that Group Counseling CBT Play Therapy is viable and effective intervention for reducing ADHD-related behavioral and emotional issues on children, findings underscore importance of integrating therapeutic play approaches on clinical settings to support developmental needs of children with ADHD, the study recommends Implementing structured Group Counseling CBT Play Therapy in schools and clinics with trained facilitators, integrate systematic parent involvement, and conduct 3–6-month follow-ups to track maintenance of gains; future research should test optimal dosage, compare against individual CBT and behavioral parent training, and examine moderators (e.g., gender, socioeconomic status, parental involvement).
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    ASSESSING THE INFLUENCE OF MANAGEMENT BY OBJECTIVES (MBO) ON MOTIVATION AMONG NURSING STAFF IN A UNIVERSITY TEACHING HOSPITAL NABLUS CITY : A CROSS-SECTIONAL STUDY
    (An-Najah National University, 2025-07-31) Tammam, Nada
    Background: Performance appraisal systems are crucial in hospitals for employee development, managerial decision-making, and organizational efficiency. Nursing, the largest workforce in healthcare, is influenced by both internal and external factors. This study investigates the relationship between Management by Objectives (MBO) and the motivation of nursing staff at a university teaching hospital in Nablus. MBO, which emphasizes goal-setting, feedback, and collaboration, is hypothesized to enhance motivation and job satisfaction among nurses. The research, grounded in self-determination theory, examines how intrinsic and extrinsic motivational factors interact within the MBO framework. Aim: This research seeks to thoroughly examine the possible impact of MBO on increased motivation among nurses in the hospital environment. Method: This research will involve a cross-sectional approach examining the impact of MBO implementation on performance metrics of the MBO system and motivation levels among nursing personnel at a university teaching hospital through a self-administered questionnaire. Result: Results indicated a positive correlation between MBO execution and employee motivation, with an R² of 0.793, which explains 79.3% of the variance in motivation levels. In addition, descriptive statistics from perceptions of MBO and motivation indicated high overall means. The sample also matched on the basis of gender, age, qualifications, and experience. Results indicated that statistically significant differences did not arise based on demographic variables, therefore showing consistent effects of MBO. Conclusion: These findings point to the fact that management by objectives is able to greatly help increase motivation among nursing staff and enhance their performance. It is advised to broaden its use to other hospitals as well to enhance the quality of health care, and increased job satisfaction can be attained in exchange. Keywords: Management by Objectives; Human Resource Management; Motivation; Nursing Staff; Performance Appraisal.
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    ASSESSMENT OF WOMEN’S KNOWLEDGE AND AWARENESS ABOUT BREAST CANCER EARLY DETECTION AND SCREENING IN WOMEN AGED BELOW 40 YEARS IN PALESTINE
    (2024-03-07) Yassmin Aladien
    Background: Palestinian Women's incidence and mortality rate of breast cancer reflects an urgent need for target intervention to a wide range of age groups to enhance awareness and early detection to improve outcomes. Research has shown the essential role of screening programs in reducing breast mortality rate; early detection is instrumental in identifying breast cancer in its initial stage, which facilitates timely intervention to enhance survival rates. This study aims to assess the level of awareness and early screening practices related to breast cancer among young women in Palestine. Methodology: In a cross-sectional study, an online questionnaire was distributed, and data were collected from 406 females below the age of 40 years from Jerusalem and the West Bank. Results: Our analysis of the response demonstrated insufficient focus on young women in breast cancer awareness projects as shown in their attitudes regarding breast cancer, where 91.38% never visited a breast cancer center, and 76.85% never did a self-check, from a particular perspective that they are not within the target age group of breast cancer as it also was the main barrier of not seeking medical help. Conclusions: We conclude that young women are less likely to be aware of breast cancer symptoms and the importance of local breast cancer clinics to expand the target group to reach the most significant number of women of all ages. This research proposes innovative ideas that hold significant potential for contributing to public health. Recommendations: To maximize the impact of this research, we recommend establishing a comprehensive online database aggregating information from various sources, including associations, doctors, campaigns, and screening centers; ensuring the database is regularly updated with the latest information on breast cancer, covering prevention, early detection, treatment options, and support resources. Keywords: Breast Cancer; Awareness; Early Detection; Screening; Women; Under 40; Palestine.
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    CAN A FAILURE-TO-RESCUE PREVENTION PROGRAM ENHANCE WARD NURSES' KNOWLEDGE AND PRACTICE IN EARLY DETECTION OF DETERIORATING PATIENT?
    (An-Najah National University, 2025-11-06) Zandeeq, Ward
    Background: Failure to rescue (FTR), marked out as death next to treatable complications, it’s a crucial index of hospitals quality and patients’ safety. Ward nurses play a critical role in early recognizing deterioration; however. Knowledge and practice deficit can delay actions and rise the mortality rates. Objectives: This thesis aimed to assess the effectiveness of FTR prevention educational program in increase ward nurses’ knowledge, practice and self-competence. Methodology: a quasi-experimental one group pre and post design was established at An-Najah National University Hospital across emergency, medical, specialized surgeries, day care, bone marrow transplant, out clinic, intermediate cardiac care unit and surgical departments. A total of 57 nurses recruited through G-Power sample size estimation. Data collection between December 2024 and April 2025 using a tool consists of: Questionnaire 10 MCQs, practice questionnaire 10 case based MCQs, and self-competence scale 12 Likert type items. Content validity confirmed by seven experts (S-CVI/Ave≥ 0.87), along with internal consistency supported by (Cronbach’s α = 0.70–0.83). data analysis done using descriptive statistics and paired t-test at a significant level of p ≤ 0.05. Results: knowledge achieved scores increased from pre-intervention 58.2% to 98.2% post-intervention (P= 0.000). practice scours improvement from 58.8% to 95.3% (P= 0.000). self-assessment enhanced from 69.7% to 83%. the results demonstrate significant improvements along with all domains after the program.
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    CHEMICAL COMPOSITION, CYTOTOXIC EFFECT, ANTIMICROBIAL ACTIVITY, AND MODE OF ACTION OF COMBINED ESSENTIAL OILS FROM CITRUS PARADISE, CITRUS SINENSIS, AND CITRUS MAYERI LEAVES
    (An-Najah National University, 2024-10-17) Hamdan, Mahmoud Sapti
    Background: Plants are the most abundant primary source of active phytochemicals, which are essential for the medical treatment of diverse diseases. Objectives: The current study aims to investigate the chemical composition, antimicrobial activity, and mode of action of combined Essential Oils (EOs) from Citrus paradise, Citrus sinensis, and Citrus meyeri leaves, and to evaluate their cytotoxicity. Methodology: Gas chromatography-mass spectrometry identified the chemical composition, while the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] assay measured the EOs' cytotoxicity against HeLa, HepG2, Caco-2, and LX-2 cells. Antimicrobial activities were assessed by broth microdilution assay against one fungal and six bacterial strains. The antibacterial mechanisms of EOs from C. paradise, C. sinensis, and C. meyeri and their combinations were investigated by evaluating their effects on microbial cell constituents at MIC and 2X MIC levels, using crystal violet assays to assess biofilm formation inhibition, and performing real-time PCR to measure bacterial lysis-related gene expression. Results: The EOs of C. meyeri, C. paradise, and C. sinensis contain 27, 20, and 32 compounds, respectively. Limonene (43.2%), β-pinene (44.5%), and sabinene (55.9%) are the most abundant compounds in these EOs, namely C. meyeri, C. paradise, and C. sinensis, respectively. The EOs showed variable antimicrobial activity, with combinations displaying synergistic effects against pathogens like Escherichia coli, Candida albicans, and Proteus vulgaris. C. meyeri EO exhibited robust anticancer activity when compared with other Citrus species studied against HeLa, HepG2, and CaCo-2 cancer cell lines. The study found that Citrus EOs and their combinations had varying effectiveness in releasing cellular constituents from microbial isolates. In the other side, the results demonstrate significant inhibition of biofilm formation, ranging from 15% to 80%, with the strongest effects observed against S. aureus and C. albicans. Citrus EOs inhibited the expression of several genes associated with bacterial energy metabolism, the tricarboxylic acid cycle, cell membrane proteins, and DNA metabolism. Certain genes were significantly upregulated, whereas others remained relatively unchanged. Conclusion: Collectively, the achieved results support the possible therapeutic applications of the EOs from C. meyeri, C. paradise, and C. sinensis, and their combinations to be used as antimicrobial or anticancer agents.
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    CHEMICAL DERIVATIZATION OF NORETHINDRONE BASED ON CLICK REACTION FOR NOVEL ANALYTICAL METHOD DEVELOPMENT
    (2023-06-25) Rawan Saymeh
    Abstract Norethindrone is a synthetic progestin, which mimics female natural progesterone's effects but with a greater potency. Norethindrone-only progestin pill is mainly used as birth control pills by increasing uterine lining thinning and cervical mucus thickening. It is also used as hormonal replacement therapy alongside other steroidal hormones in treating conditions caused by abnormal hormonal levels. Norethindrone has significant dose-limiting properties, resulting in a small therapeutic window. Consequently, there is a need for analytical methods that allow for effective and reliable measurements of norethindrone. The adapted analytical methods must have enough sensitivity, selectivity, or both in order to evaluate different chemical processes more easily and accurately. One of the adaptive strategies utilized in chemical derivatization involves converting functional groups within a molecule. In this thesis, we made a proposal to create a novel analytical technique for norethindrone’s chemical derivatization. This was accomplished by using a click reaction with an azide-conjugated alkyne, which produced a five-membered heterocycle ring (1,2,3-triazole) and an extended conjugation. Our goal was to create a sensitive and selective analytical method. The analytical method has been created using HPLC with a UV/Vis detector and validated using parameters like accuracy, linearity, range, precision, Limit of detection, and Limit of quantitation in accordance with the ICH and the FDA's guidelines. The developed method adapted λmax= 245 nm for the measurement of the derivatized norethindrone. The method used HPLC using mobile phase MeOH-Water 60:40 v/v. The eluted peak of the derivatized norethindrone was separated from other used derivatization reagents. The analytical method was then validated, and validation parameters were found to be within the permitted limits. The developed method proved to be linear (R2 = 0.9995), precise (RSD = 1.07), and accurate (% recovery = 106.5%). Moreover, the developed method was sensitive to LOD (2*10-6 mg/ml) and LOQ (2*10-4 mg/ml). Therefore, the developed method is simple and practical and has excellent sensitivity and selectivity. Norethindrone may be analyzed in a variety of dosage forms and raw materials, including active pharmaceutical components. The good sensitivity values of our developed method suggest that it may be applied to analyze norethindrone in biological systems. Keywords: click chemistry, chemical derivatization, norethindrone, analytical method development, high-performance liquid chromatography.
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    CHEMICAL DERIVATIZATION OF ZIDOVUDINE BASED ON CLICK REACTION FOR NOVEL ANALYTICAL METHOD DEVELOPMENT
    (2023-03-19) Kyan Bransi
    ABSTRACT Zidovudine is a drug used for the treatment of patients that are infected with the human immunodeficiency virus. It inhibits HIV-reverse transcriptase. Zidovudine has significant dose-limiting toxicities drug-specific, resulting in a small therapeutic window between the minimum and the maximum effective and tolerated doses, respectively. Serious adverse effects among them include hepatic abnormalities, myopathy, and bone marrow toxicity. Hence, a demand exists for analytical technologies that enable efficient and accurate measurements of Zidovudine. The adapted analytical techniques must have sufficient sensitivity, selectivity, or both in order to have more manageable and accurate measurements of various chemical procedures. Converting functional groups within a molecule is one of the adaptive techniques used in chemical derivatization. In this study, the development of a new analytical method for the chemical derivatization of Zidovudine was proposed. To that end, a click reaction with azide-conjugated alkyne was employed, resulting in a five-membered heterocycle (1,2,3-triazole) and an extended conjugation. The aim is to develop a sensitive and selective analytical method. The proposed analytical method has been developed using HPLC with UV/Vis detector and validated according to the International Conference of Harmonization and the Food and Drug Administration guidelines and with the use of the parameters such as accuracy, linearity, range, precision, limit of detection, and limit of quantitation. The developed method adapted max=260 nm for the measurement of the derivatized Zidovudine. The method used HPLC using mobile phase Water-ACN 70:30 v/v. The eluted peak of the derivatized Zidovudine was separated from other used derivatization reagents. The analytical method was then validated, and validation parameters were found to be within the accepted limits. The developed method was found to be linear (R2 = 0.994), precise (RSD = 0.59), and accurate (% recovery = 101.17). Moreover, the developed method was sensitive to LOD (4*10-8 mg/ml) and LOQ (4*10-7 mg/ml). Therefore, the developed method is simple and feasible with high sensitivity and selectivity. Zidovudine may be analyzed in a variety of dosage forms and raw materials, including active pharmaceutical components. This line of research may be pursued further in the future, and the technique that has been established may be adopted in the testing of Zidovudine in biological systems. Keywords: Zidovudine; Click Reaction; HPLC; Derivatization.
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    COMPARISON BETWEEN PROPOFOL VS LIDOCAINE PRETREATMENT FOR PROPOFOL INJECTION PAIN AMONG PATIENTS UNDERGOING GENERAL ANESTHESIA
    (2023-10-21) Sahar Jinat
    Abstract Background: A common general anesthesia that is quick and efficient is propofol. However, anesthesiologists who rate clinical anesthesia outcomes still rank discomfort following propofol administration as a 7-33 clinical issue. Methodology: A quantitative research approach, true experimental) RCT) study of 100 patients whose ages (18-60) years who were subjected to the criteria of the study general anesthesia for elective surgery was included in this study. Patients were classified into two groups: the first group (study), in which 50 patients were injected with propofol only 3mg / kg,As for the second group (the control group) 40 ml of lidocaine was given pretreatment to propofol and given to 50 patients. Results: The effect of propofol after injection was to reduce (SBP, DBP, HR, and RR), and increase OSL, as the percentages of change for these variables were (-15.94%, -19.01). %, -5.22%, 1.89%, and -9.52%) respectively. The study also indicated that there were statistically significant differences at p ≤ 0.01 between the experimental and control groups in favor of the experimental group, and no statistically significant differences were observed between the two groups in HR, OLS, and RR. This means that propofol reduced blood pressure to a greater extent than propofol with lidocaine 40 mg in healthy adult patients undergoing general anesthesia. The trial group experienced significantly less discomfort from propofol injections than the control group (90% of patients did not feel pain from propofol injection and only 10% of patient felt mild pain). The study also showed that only in the control group, the patient's vital signs change following a propofol infusion. Conclusions: The use of intravenous lidocaine as a pre-treatment in adult patients lessens the discomfort of propofol injections. This method is simple to use, doesn't waste time, and doesn't cost extra money. keywords: Propofol, Injection, Pain, Lidocaine, anesthesia and hospital.
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    COMPARISON OF NON-INTENSIVE CARE UNIT (ICU) VERSUS ICU NURSES’ PERCEPTIONS AND SATISFACTION WITH THE USE OF THE SITUATION, BACKGROUND, HOSPITAL ASSESSMENT, AND RECOMMENDATION (SBAR) TOOL: A MULTICENTER RESEARCH
    (2023-07-06) Rasheed Darawsheh
    Abstract Background: Patient safety is crucial for the delivery of effective, high-quality healthcare, and poor communication is found in many different healthcare settings, including handovers, shift exchanges, rounds, and team meetings. The SBAR tool was used for effective communication between nurses and between nurses and other HCPs. Therefore, the purpose of this study was to examine perception, satisfaction, and perceived barriers among Palestinian nurses working in the ICU regarding the use of the SBAR tool for effective communication. Methods: This cross-sectional study was conducted in Palestinian hospitals. Data were collected from 208 participants through a questionnaire that was adopted from previous studies in this field. Data were collected by convenience sampling. The nurses answered a questionnaire covering social demographics, satisfaction, perception and perceived barriers. IBM-SPSS software was used for all analyses, and median utility indices used a Bloom cut-off point for positive satisfaction and satisfied perceptions were equal or high. Results: Overall, 208 nurses completed the study questionnaires. The median age of the study participants was 27 years, with an IQR of 25.0-29.0. The median satisfaction score was 95, with an interquartile range of 89.0 to 102.0. Approximately fifty percent (n = 106) of the respondents scored 95 (median). The median perception score was 36.0, with an interquartile range of 33.0 to 39.0. A total of 55.3% (n = 115) of the respondents scored 36 (median). The 25-29 age group showed better satisfaction than the other age groups, with a median satisfaction of 97 (p < 0.001). Additionally, nurses with 3 to 5 years in the field showed good satisfaction, with a mean satisfaction of 98 (p < 0.001). Additionally, participants did not share any direct barriers to SBAR, but approximately 42.3% did not know when asked about time constraints. Additionally, 41.8% were unaware of the physician's delay in response. Conclusions: Our study revealed that participants of the SBAR framework as a communication tool had negative satisfaction and unsatisfied perceptions. Future research should provide more evidence of its viability and effectiveness compared to conventional handover tools and in other healthcare scenarios. Keywords: SBAR; perceptions; nurses; satisfaction; perceived barriers; safety; patient safety.
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    COMPARISON OF THE NEUROLOGICAL ADVERSE EVENTS AND CHANGES IN ELECTROLYTES LEVELS BETWEEN PANTOPRAZOLE AND FAMOTIDINE: A PROSPECTIVE OBSERVATIONAL STUDY
    (2023-06-13) A'mer Nawwaf Zidan
    Abstract Background: Proton-pump inhibitors (PPIs) have recently become more commonly used in patients with functional gastrointestinal illnesses or for primary prophylaxis of drug-related gastro duodenal damage, despite the fact that their benefits for those conditions have not been thoroughly confirmed. In a few studies, significant acute neurological symptoms related to PPI-induced hypomagnesemia have been observed; and histamine-2 Receptor Antagonist (H2RAs) are more strongly associated with increased delirium than PPIs. However, severe hypomagnesaemia has not been linked to usage of H2RAs. Aim: The study aim was to compare the effects of Pantoprazole (Proton pump inhibitor) and Famotidine (histamine-2 Receptor Antagonist) on electrolytes disturbances and other neurological adverse events among critically ill patients. Method: A prospective observational study was conducted between August 2022 and December 2022 included 100 critically ill patients in intensive and cardiac care units of Al- Watani Hospital. The response rate was 91.75%. The data sheet consisted of several sections, including sociodemographic data, health information, data about administration of Pantoprazole and Famotidine, clinical outcomes, neurological complications including delirium degree. Results: The highest age group for the total participants was over 60 years old (60%), and more than half of the total participants were male (57.0%). The findings pointed out that the percentage of Acute Kidney Injury was higher in Pantoprazole compared with Famotidine (38% vs. 10%, respectively). The results also showed that the blood urea nitrogen was significantly higher in Pantoprazole group compared to Famotidine group (40.0±29.6 vs. 27.8±24.3 mg/dl; P < 0.05). Similarly, creatinine was significantly higher in Pantoprazole group compared to Famotidine group (2.2±2.0 vs. 1.5±1.5 mg/dl; P < 0.05). In contrast, the average albumin in Pantoprazole group were significantly lower than that in Famotidine group (2.8±0.5 vs. 3.1±0.6 g/dl; P < 0.05). The Mean±SD of serum Magnesium (2.0±0.3 mg/dl in Pantoprazole vs. 2.1±0.2 mg/dl in Famotidine; P > 0.05). The results pointed out that the percentages of neurological complication among Pantoprazole group compared to Famotidine were agitation (12% vs. 24%, P=0.118), hallucinations (10% vs. 4%, P=0.24), dizziness (4% vs. 6%, P=0.646), nausea (4% vs. 4%, P=1.000), vomiting (2% vs. 2%, P=1.000), numbness (2% vs. 2%, P=1.000), muscle spasms (2% vs. 0%, P=0.315), seizures (0% vs. 2%, P=0.315), convulsions (2% vs. 0%, P=0.315), however, nobody has loss of consciousness, death, tetany, and tremors. Conclusion: There was no significant association between patients who were treated by Pantoprazole and who were treated by Famotidine with regards to serum magnesium level, occurrence of neurological complications, and mean delirium degree. But the Pantoprazole group were associated with elevated levels of creatinine and blood urea nitrogen, and lower levels of albumin and hematocrit compared to Famotidine group. Keywords: Pantoprazole; Famotidine; electrolytes; neurological adverse events.
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    DETECTING THE CONSTRUCT VALIDATION OF SOME DEPRESSION SCALES IN THE PALESTINIAN CONTEXT
    (An-Najah National University, 2025-07-24) Massarwa, Remaa
    This study aimes to evaluate the construct validity of three globally recognized depression assessment the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HDRS), and the Montgomery-Asberg Depression Rating Scale (MADRS), and examine their relevance within the unique sociocultural and psychological context of Palestine, where mental health struggles are intensified by ongoing adversity and war. To achieve this, the study adopted a quantitative research approach, utilizing both descriptive statistics and factor analysis. Specifically, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to thoroughly assess the structure of each instrument. The research sample included 860 participants aged 15-60, drawn from the West Bank, Jerusalem, and the 1948-occupied territories. EFA was carried out on subgroup of 280 participant, while CFA was performed on a larger group of 580 participant. Data were collected through an online questionnaire, with participants selected using a convenience sampling technique. The results revealed that the 17-item version of Beck Depression Inventory exhibited the strongest psychometric prosperities, including high validity and reliability, making it particularly effective tool for depression screening with the Palestinian context. In contrast, the 20 item Hamilton Depression Rating Scale (HDRS-20) failed to meet acceptable model fit criteria, rendering it ineffective without substantial modification. The MADRS-10 scale, after minor modifications, achieved acceptable validity and reliability, suggesting its applicability in this context. Additionally, the PDS-22 scale created in this research showed considerable validity and consistency. Considering previous results, current recommend the following: 1. Embracing the BDI-17 as the most valid measure for evaluating depression in mental health facilities within Palestine. 2. Continuing to enhance the PDS-22 should be further improved for wider use, including in clinical setting and research endeavours.
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    DETERMINANTS AND OUTCOME INDICATORS FOR PATIENT SAFETY CULTURE AMONG HEALTHCARE WORKERS AT AN-NAJAH NATIONAL UNIVERSITY HOSPITAL, NABLUS, PALESTINE: A CROSS-SECTIONAL STUDY
    (An-Najah National University, 2025-04-16) Kharof, Hamza
    Background: Globally, patient safety culture (PSC) is key to improving healthcare efficiency. In Palestine, PSC enhances patient trust, reduces medical errors, and raises care standards. Despite challenges, organizations aim to improve healthcare sustainability by implementing efficient reporting and training systems. This study aimed to assess the PSC among healthcare staff at An-Najah National University Hospital (NNUH), the only accredited academic medical center in the West Bank. Methods: A convenience sample of 232 healthcare providers, excluding part-time, new staff with less than six months of experience, and contracted services, participated between June 25, 2023, and July 8, 2023. Data collection utilized an online platform (SurveyMonkey) and the Arabic-translated version of the Hospital Survey on Patient Safety Culture (HSOPSC 2.0) to Results: This study assessed patient safety culture (PSC) at An-Najah National University Hospital, revealing positive evaluations, with teamwork and continuous improvement as strengths. Response to error and staffing were areas for improvement. Conclusion: adopting proactive strategies is crucial to build a strong PSC organization; these findings are essential for hospital leadership to support staff and formulate effective patient safety programs. Keywords: Patient Safety, Perception, HSOPSC, Healthcare Providers.
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    DEVELOPMENT AND EVALUATION OF THE ANTICANCER, ANTIOXIDANT, AND ANTIMICROBIAL ACTIVITIES OF CYPRESS OIL NANOEMULGEL
    (An-Najah National University, 2024-07-01) Shahin, Aya
    Background: Cypress oil is a potent essential oil known for its wide range of therapeutic activities. Objectives: This study aimed to incorporate cypress oil into nanoemulgels to overcome their low solubility and high volatility. Methodology: Gas chromatography-mass spectrometry identified the chemical composition. The cypress oil nanoemulsion was optimized, and then it was incorporated with Carbopol hydrogel to produce cypress oil nanoemulgel. DPPH scavenger technique measured the cypress oil and its nanoemulgel antioxidant activity. Then, the droplet size, PDI, zeta potential, rheology, antimicrobial, anticancer, and anti-inflammatory activities were evaluated utilizing reference methods. Results: The chemical composition of cypress oil is predominantly composed of monoterpene hydrocarbons, with α-pinene as the major component (50.72%), followed by 3-b-carene (27.57%). The ternary phase diagram revealed that the nanoemulsion containing 40% Tween, 10% Span, and 50% cypress oil had an optimized droplet size of 105.28 ±2.12 nm and a PDI of 0.112 ±0.016 nm. The cypress nanoemulgel formulation showed no significant change in droplet size or PDI, while it has a zeta potential of -33 mV. Moreover, the antioxidant efficiency of cypress oil was IC50 = 14.7 ±0.3 μg/mL, while it was reduced to more than half for nanoemulgel with IC50=6.6 ±0.13 µg/ml. Potent antibacterial activity was reported against several gram-positive and gram-negative bacteria, with inhibition zones in the 11–36 mm range. Also, effective antifungal activity was noticed against different species of Candida albicans in the range of 16–24 mm. The formulated nanoemulgel had better activity compared to the oil alone. Furthermore, it was more potent than the oil as an anticancer agent against Hep-G2 cells, with an IC50 of 39.81 µg/ml, followed by 58.88 and 61.65 µg/ml for MCF-7 and HeLa cell line. It also demonstrated an anti-fibrotic effect with an IC50 of 63.09 µg/ml against LX-2 cell line. The cypress oil nanoemulgel was more selective for COX-2 than COX-1. In addition, the IC50 of the nanoemulgel toward COX-2 (13.96 µg/ml) was almost half the value for the oil (28.78 µg/ml). Conclusion: The overall findings suggest that cypress oil nanoemulgel holds promise to counteract several skin infections and cancer cell lines. However, further in vivo studies are needed.
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    DEVELOPMENT OF AN OPTIMIZED SCAFFOLD FOR TISSUE ENGINEERING BASED ON THE NON-COVALENT FUNCTIONALIZATION OF CARBON NANOMATERIALS
    (2022-12-29) Salsabeel Mamon Odeh
    One of the main approaches for tissue engineering for therapeutic purposes involves the utilization of primary cells that are cultured on a biocompatible scaffold with appropriate characteristics. Such tissues aim to maintain and/or restore normal tissue functions. Over the past few years, significant attention has been given to carbon nanomaterials, like carbon nanotubes (CNTs), and their potential applications in generating tissue scaffolds as they tune some of the tissue's physical characteristics such as flexibility, elasticity, and porosity. A major obstacle to the employment of CNTs in biological applications was the poor limited water dispersibility and cytotoxicity, however, it was found that the functionalization of CNTs adequately with polar functional groups can solve this problem and improve their biocompatibility. Similar benefits could be achieved by coating the CNTs with chitosan, which is biodegradable, biocompatible, and can form porous structures that are appropriate for cell growth. Therefore, in our project, we aimed to investigate the characteristics of an engineered connective tissue (ECTs) that is composed of primary dermal fibroblasts and collagen hydrogel that is enriched by varying concentrations of noncovalently functionalization multiwall CNTs (MWCNTs) with pyrene moiety and coated with chitosan. The tested concentrations were 0.025%, 0.05%, and 0.1%. Our data demonstrated that the enrichment of the ECTs with the functionalized MWCNTs significantly increased the electrical conductivity of the tissues in a kind and concentration-dependent manner. Furthermore, the conductivity enhancement was greater with MWCNTs- COOH compared to MWCNTs-NH2, the concentration of 0.025% of MWCNT-COOH was enough to sufficiently enhance the electrical conductivity of the tissue compared to the control tissue. however, this concentration was still associated with some cytotoxicity where it reduces the cell viability by around (20-30) % relative to the control, while there was no significant reduction in viability when adding chitosan to 0.025%MWCNT-COOH, which indicates that chitosan might have a cytoprotective effect against CNT-induced toxicity, in addition to electrical conductivity enhancement. Keywords: carbon nanomaterials, tissue engineering, chitosan, MWCNT, primary fibroblast.