Medical and Health Sciences

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    ANTIMICROBIAL RESISTANCE AND MOLECULAR CHARACTERIZATION OF AVIAN PATHOGENIC ESCHERICHIA COLI ISOLATES RECOVERED FROM BROILERS’ FARMS IN NORTHERN PALESTINE
    (An-Najah National University, 2024-10-31) Bzour, Mahmoud
    Background: Colibacillosis is a disease caused by a certain type of Escherichia coli called the avian pathogenic Escherichia coli (APEC), which leads to significant losses for the poultry sector and shows zoonotic potential and acts as a source of antibiotic resistance and virulence factors for other E. coli. Objectives: This work aimed to assess resistance phenotype, virulence genes, and phylogenetic groups in APEC isolates recovered from broilers’ farms in northern Palestine. As well as to clarify whether the virulence factors are directly associated with antibiotic resistance or, instead, dependent on a phylogenetic group distribution. Methodology: A total of the 65 APEC isolates were recovered from diseased chicken with typical colibacillosis symptoms from broilers’ farms located in the northern region of Palestine, during the period from May to July 2024. Classical and molecular techniques were used to identify these strains. The disk diffusion method was used to detect antibiotic resistance. Phylotyping and virulence genotyping of these APEC isolates were carried out by polymerase chain reaction. Results: This study revealed a high detection rate of APEC strains (100%) in chicken. The most APEC strains 56/65 (86.2%) assigned to group D. Other strains were related to groups B2 (5/65, 7.7%), B1 (3/65, 4.6%) and A (1/65, 1.5%). Antibiotic resistance ranged from 27.7% for PolymyxinsE (Colistin) to 100% for Amoxicillin. Polymyxins E (Colistin) and Fosfomycin were the most effective drugs. It was found that the most common virulence factor was iroN which was tested in 61 isolates (93.8%). While, 56 (86.2%), 42 (64.6%), 40 (61.5%), 37 (56.9%), 24 (36.9%), 23 (35.4%),16 (24.6%), 13 (20.0%), 0 (0.0%) and 0 (0.0%) isolates were positive for hlyF, iutA, Tsh, ColV, papGII, Iss, papGI, papC, papGIII and ompT genes, respectively. The APEC strains in Palestine exhibit a wide variety of resistance patterns and genetic variation. Conclusion: These results serve as an outline for development of efficient intervention plans for the management of APEC in broiler breeders and broiler farms. Controlling APEC infections is essential for public health, especially when APEC isolates can pass on virulence and resistance factors to other pathogenic bacteria such as E. coli that are particular to humans.
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    ASSESS THE EFFICACY OF INTRAVENOUS DEXAMETHASONE IN DECREASING INCIDENCE OF SPINAL ANESTHESIA INDUCED HYPOTENSION, NAUSEA AND VOMITING IN PARTURIENT UNDERGOING CESAREAN SURGERY IN LARGE TWO HOSPITAL IN PALESTINE: COHORT OBSERVATIONAL STUDY
    (An-Najah National University, 2024-10-02) Abdallah, Ayala
    Spinal anesthesia is the method most commonly used for caesarean sections because of its rapid onset and provides better analgesia, but it may lead to hypotension, nausea, and vomiting, as well as compromise maternal and fetal outcomes. The aim of this observational study was to evaluate the effectiveness of intravenous dexamethasone in preventing hypotension, nausea, and vomiting, secondary to spinal anesthesia among women undergoing cesarean section at Rafidia Palestine Hospital. Standardized procedures for administering dexamethasone to patients undergoing spinal anesthesia during cesarean section should be established and implemented. And to be included in treatment plans A total of 100 parturient were included in the study, with one group receiving a standard dose of intravenous dexamethasone prior to spinal anesthesia and the control group receiving a placebo. The primary endpoints studied were the incidence of spinal anesthesia-induced hypotension, intraoperative nausea, and vomiting associated with its use as well as after surgery The results were analyzed using SPSS v22, and to describe the sample, descriptive analysis (mean and standard deviation) was used. A parametric statistical test called Repeated measures ANOVA was applied. For multivariate analyzes of variance (MANOVA), a parametric test statistic (Wilks' lambda) was used, and in order to determine the effect size, the partial eta² test (η²) was used. According to the findings, administering dexamethasone both before and after a caesarean section prevented blood pressure from dropping. The results also indicated a statistical significance for placebo at p ≤0.01 on hemodynamic markers including systolic blood pressure, DBP, and MAP during cesarean section. In contrast, there were no statistically significant effects of placebo at p ≤ 0.05 on heart rate, RR, SpO2, and body temperature during cesarean section. The size of the placebo effect on systolic blood pressure and MAP was moderate, with partial eta square values (0.60 and 0.59), respectively. Regarding DBP, SpO2 and body temperature, the effect size of placebo was small, with partial squared values (0.40, 0.22, 0.22), respectively. This study highlights the potential of dexamethasone as a beneficial adjunct in the management of spinal anesthesia-related complications, thereby improving the safety and comfort of parturient undergoing cesarean sections. future research should focus on, such as exploring different doses or comparing with other medications is recommended to confirm these findings and establish standardized protocols for the use of dexamethasone in this context.
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    ASSESSMENT OF ADHERENCE TO IRON CHELATION THERAPY AMONG PALESTINIANS WITH THALASSEMIA AT AL-WATANI GOVERNMENTAL HOSPITAL, NABLUS, PALESTINE
    (An-Najah National University, 2024-09-19) Ieran, Zein
    Introduction: Adherence to iron chelation therapy is a crucial step in reducing excess iron levels in the body, as all patients aim to decrease iron levels beyond the normal range. Factors such as age, having a sibling with thalassemia, lack of parental supervision, lower family income, infrequent blood transfusions, and psychological issues are likely to be investigated as significant predictors of nonadherence. Additionally, the relationship between disease knowledge and adherence status will be examined. It is important for healthcare providers to be aware of the high prevalence of poor adherence to iron chelation therapy among patients. Therefore, nurses should regularly assess, monitor, and encourage adherence behaviors that could impact patient outcomes. Aim: To assess different barriers to adherence patients with Beta thalassemia included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors Method: A descriptive cross-sectional design is adopted to assess the adherence for thalassemia patients of the National Thalassemia Center at the National Hospital, Nablus. The sample size of 120 thalasemia patients. Data was collected using an direct interview or by phone that composed questionnaire of three parts. The first part of the questionnaire Sociodemographic and clinical characteristics of the samples in Thalassemia center the second part of the questionnaire included Assessment of disease knowledge gaps among thalassemia patients. And the third part of the questionnaire on adherence patient to iron chelation therapy.Collected data was entered and analyzed in SPSS version 21. P value of <0.05 was taken as significant. Results: Nearly equal gender distribution (63% males, 57% females) and a predominant age range of 18 to 26 years were studied. Adherence to iron c helation therapy correlated with lower ferritin levels, indicating treatment efficacy. Notably, both adherent and non-adherent patients demonstrated a good understanding of thalassemia, suggesting sufficient disease knowledge among the participants. However, adherence positively influenced patient satisfaction with hospital treatment and medical services, highlighting the importance of patient education and support systems in enhancing treatment adherence and overall healthcare experience. Conclusion: The study concluded that many patients at the National Governmental Hospital in Nablus show adherence to iron chelation therapy. However, challenges remain, including difficulties in obtaining medication and external influences that affect adherence despite adequate knowledge. The role of health care providers is important in strengthening relationships between the patient and the service provider, providing multidisciplinary care, highlighting the importance of education and continuous support for patients, in addition to addressing the obstacles that lead to patients’ non-compliance with treatment.
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    ASSESSMENT OF PATIENTS’ EXPERIENCE IN THE EMERGENCY DEPARTMENTS IN WEST BANK – PALESTINE: A QUANTITATIVE CROSS-SECTIONAL STUDY
    (An-Najah National University, 2024-10-23) Abdallah, Sojoud Bashar
    Introduction: The experience of patients in healthcare institutions is a complex and multifactorial, and is related to sociodemographic, cultural, and institutional factors, and their perceptions of healthcare services. This is more obvious in critical and overcrowded settings like emergency departments (EDs), in which the following study aimed to assess patients’ experience in selected Palestinian hospitals, as well as the main demographic and patient-related factors affecting the general experience level. Method: The study implemented a cross-sectional, quantitative design on a convenient sample of 405 adult patients who visited EDs in the targeted hospitals, and were asked to fill in a valid questionnaire called the Accident and Emergency Department Questionnaire (A&ED) that was translated and back-translated to Arabic language, and validated by 5 experts. Data were treated in anonymity and confidentiality and were analyzed using SPSS software. Results: The median age of patients was 28 years old (IQR = 2), with 57.8% females, 24.2% visited the ED for respiratory system indication, 27.2% care for others, and 72.8% of the questionnaires were filled in by the patient. More than half of the patients reported being treated in dignity and respect all of the time (56.0%), which was reflected by positive opinions related to waiting, communication, environment, and other domains, resulting in a satisfactory median score of overall experience (7 out of 10), which was significantly higher with age (r = 0.114, p-value = 0.022), female patients (p-value = 0.010), who did not suffer from health conditions for the last 12 months (p-value = 0.012), who do not care for others (p-value = 0.038) and when the questionnaire was filled in by the patient himself/herself (p-value < 0.001). Conclusion: The overall experience of Palestinian patients in EDs is moderate, and affected by several factors, which should be considered in continuous and evidence-based programs that enhance environmental and institutional factors and target the improvement of HCPs skills and emergency dynamics. Further longitudinal research is needed that covers more related factors. Keywords: patient, experience, perception, emergency department, emergency room
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    ASSESSMENT OF WIND ENERGY POTENTIAL IN PALESTINIAN TERRITORIES
    (An-Najah National University, 2024-06-24) Solaiman, Motasem Qasem
    The Occupied Palestinian Territories (OPT) face significant challenges due to a high dependency on imported conventional energy sources, including petroleum and approximately 90% of its electrical energy needs from Israeli companies. This dependency results in elevated energy costs and susceptibility to price fluctuations. Amidst these challenges, the energy dilemma has a vital solution in renewable energy. with wind energy representing an underutilized yet promising resource within the OPT. Despite its global significance, wind energy's potential remains largely untapped in the OPT due to a limited number of studies, professional capacity constraints, and geopolitical barriers, alongside the high costs associated with wind energy technologies. These factors have led to a palpable sense of frustration and the perception of wind energy projects as impractical within the region. This study uses exacting scientific procedures to thoroughly examine and assess the OPT's potential for wind energy. Employing the Weibull distribution method, The goal of the study is to present a thorough summary of the state of wind resource evaluations as of right now., explore existing wind energy conversion technologies suitable for the OPT, and present detailed wind characteristics for specific regions under study. Additionally, it aims to identify the most viable locations for wind turbine installations and determine the most appropriate turbine types for these areas. Through this approach, the research endeavors to offer substantive insights and recommendations to overcome the challenges facing wind energy implementation in the OPT.
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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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    ASSOCIATION OF HOUSEHOLD FOOD INSECURITY AND NUTRITION-RELATED KNOWLEDGE, ATTITUDES, AND PRACTICES WITH NUTRITIONAL STATUS AMONG MOTHERS AGED ? 18 IN PALESTINE: NATIONAL STUDY
    (An-Najah National University, 2025-02-17) Salahat, Eman
    Background: The global understanding of the relationship between food insecurity and maternal nutrition has improved, with researchers underlining the necessity of evaluating not just the availability of food but also the quality of food and its nutritional content. Furthermore, the need to look at food's social and cultural aspects, such as women's nutrition-related behaviors, attitudes, and knowledge, is becoming increasingly apparent. Developing successful treatments to enhance maternal nutrition and, consequently, improve child health outcomes requires consideration of these aspects. Nutrition-related knowledge and attitudes are necessary for dietary changes toward a healthier dietary pattern. For that reason, nutrition-related knowledge, attitude, and practice are some of the key factors in achieving households' food and nutritional security. Aim: to examine the association between household food insecurity and nutritional status and nutrition-related knowledge, attitudes, and practices (KAP) among mothers aged ≥ 18 years in the West Bank, Palestine. Methodology: A cross-sectional design was used in the study, which was conducted in households in West Bank/ Palestine. The target population in the households living in the West Bank is mothers aged ≥ 18 years. Stratified cluster sampling with a total sample size of 720 Households. The validated Radimer/Cornell Household Food Security questionnaire was used to assess the status of household food security status. Nutritional status (Body mass index) and dietary intake recall (24-hour dietary recalls for two days) were taken to assess the nutritional status of the mothers. Nutrition-related Knowledge, attitude, and practice (KAP) of mothers was assessed using the Food and Agriculture Organization module related to Iron deficiency anemia (Module no. 6) Result: Numerous socioeconomic characteristics were found in 720 West Bank families surveyed; the majority of household mothers were under 40, and 62.6% had a university degree. The average family size was 4.4, 33.8% of households made between 3001 and 5000 NIS per month, and only 5.6% of households received food assistance. 13.1% of households experienced food insecurity, mostly as a result of financial hardships, and 3.3% of the households had hungry children. Tiny percentages (1.5%) were underweight, whereas the majority (61.5%) were overweight or obese, indicating the need for dietary treatments. Factors such as education, income, location, and dependence on food assistance were associated with food insecurity, underscoring the need for focused assistance for disadvantaged populations. Conclusion: Food insecurity in the West Bank is complex, as this study shows, with notable socioeconomic, demographic, nutritional, and KAP differences between households. The main risk factors for food insecurity were found to be middle-aged families, lower educational attainment, geographical disparities, refugee status, and poor income.
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    CD44 EXPRESSION LEVELS AS A BIOMARKER FOR THE EARLY DETECTION OF VARIOUS CANCERS IN BIOLOGICAL SAMPLES: A CASE- CONTROL STUDY
    (An-Najah National University, 2025-02-06) Bsharat, Samah
    BACKGROUND: Cancer stem cells (CSCs) contribute to tumor progression, metastasis, and therapy resistance, with CD44 playing a key role in CSC function. As a transmembrane glycoprotein, CD44 interacts with ligands like hyaluronic acid, regulating adhesion, migration, and signaling pathways (Ras-MAPK/ERK). Its alternative splicing and modifications enhance functional diversity, promoting chemoresistance and metastasis. Elevated CD44 expression in aggressive cancers, including breast and colorectal malignancies, highlights its potential as a diagnostic biomarker and therapeutic target. Given its role in tumor progression, this study aims to evaluate soluble CD44 as a biomarker for the early detection and differentiation of breast and colorectal cancer. By analyzing its expression levels in blood and urine across different cancer stages and types, this research seeks to establish CD44’s diagnostic value and potential contribution to precision medicine in oncology. METHODS: This case-control study (2023–2024) examined CD44 expression as a biomarker for breast cancer (BC) and colorectal cancer (CRC) at three hospitals in Nablus, including 40 BC patients, 23 CRC patients, and 70 healthy controls. Blood and urine samples were analyzed for CD44 gene and soluble forms, with exosomal RNA quantified via real-time PCR (normalized to GAPDH) and soluble CD44 levels measured using ELISA. Statistical analyses (two-way ANOVA, t-tests, p ≤ 0.05) confirmed significant differences, ensuring accuracy through standardized protocols. RESULTS: The research indicates a very strong statistically significant elevation in CD44 expression in breast cancer patients when compared to healthy controls (p < 0.0001) in both fold change (gene expression) and soluble CD44 (sCD44) serum and urine concentrations. Similarly, a moderate statistically significant elevation (p < 0.01) in CD44 gene expression form and soluble form for CRC patients compared to healthy controls. Furthermore, there is a strong statistically significant difference in CD44 expression between patients with breast cancer and those with colorectal cancer (p < 0.001). CONCLUSIONS: The study identified significantly elevated sCD44 levels in serum and urine of breast and colorectal cancer patients, supporting its potential as a cancer biomarker. In contrast, αFP showed minimal diagnostic value, with negligible serum changes and absence in urine, reinforcing its association with liver-related cancers.
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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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    COMMUNITY PHARMACISTS’ PERCEPTIONS AND ROLE IN THE MANAGEMENT OF COMMON DERMATOLOGICAL PROBLEMS IN PALESTINE: A CROSS-SECTIONAL STUDY
    (An-Najah National University, 2024-09-10) Salah, Zohdeya
    Background: Skin diseases are common health issues that affect 30% to 70% of the global population. This study aims to explore the perceptions and role of community pharmacists in the management of common dermatological problems in Palestine. Methods: This study was implemented in a cross-sectional design. The study was conducted in different community pharmacies that were distributed all over the different governorates of the West Bank of Palestine. The data collection instrument was a questionnaire that was developed after a search of the literature. Results: In this study, a total of 385 community pharmacists returned complete questionnaires. Of the community pharmacists, 367 (95.3%) stated that they refer patients to consult a dermatologist. The common reasons for referrals to dermatologists included being unsure of diagnosis, when a dermatologist supervision was needed, and when a prescription product was needed. The community pharmacists who were female (p = 0.043), were in practice for 10 or more years (p = 0.035), received a dedicated course on dermatology during pharmacy training (p = 0.045), and have seen 10 or more dermatological cases seen per week (p = 0.017) practiced significantly more referrals compared to the community pharmacists who were male, practice for less than 10 years, did not receive a course on dermatology, and have seen less than 10 dermatological cases per week. When the community pharmacists were asked to rate their confidence in providing education/counseling to patients with dermatological issues on a scale of 1-5, the median score was 3.0 [IQR = 2.0, 4.0]. Acne, dry skin, nail problems, fungal infections, skin rash, skin blisters, scalp problems, lip problems, sunburn, eczema/dermatitis, candidiasis, insect bites, head lice, psoriasis, and alopecia were the commonly encountered dermatological problems. Combination products containing antibiotics/antifungals/steroids, topical antibiotics, topical steroids, topical retinoids, vitamins/vitamin derivatives/pantothenic acid, topical antihistamines/anticholinergics were the most commonly dispensed dermatological products. The majority of the community pharmacists agreed or strongly agreed that they should be consulted by patients with dermatological conditions, they have a valuable role in assisting patients with dermatological conditions, they are an important source of advice/counseling/education on medications use for dermatological conditions, and the pharmacy-based dermatology services are helpful for patients with dermatological conditions. Conclusions: The findings of this study showed that community pharmacists in Palestine provided care services to patients with dermatological health issues. The findings of this study also showed that community pharmacists often referred patients with complex dermatological health issues to consult dermatologists, notably, when prescription dermatological products were required. This might suggest that community pharmacists need to be integrated with the multidisciplinary team to care for patients with dermatological health issues.
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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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    COMPARISON OF THE OUTCOMES BETWEEN PERCUTANEOUS CORONARY INTERVENTION ALONE AND PHARMACOINVASIVE CORONARY INTERVENTION AMONG ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS
    (An-Najah National University, 2025-02-03) Ma’ali, Basel Khairy Ali
    Background: Myocardial infarction is among the most diagnosed cardiological diseases in the whole world and in Palestine, and is managed mainly by invasive interventions to control or treat coronary artery occlusion, while some centers add tissue plasminogen activator to the plan in what so called pharmacoinvasive approach. The incidence of postoperative complications is inevitable, and therefore, the aim of the current study is to identify the most common complications compared between two myocardial infarction management approaches (percutaneous and pharmacoinvasive coronary interventions) in two tertiary centers in Ramallah and Nablus, and determine the most common risk factors associated with the differences between them. Methodology: The study utilized retrospective cohort design on a randomized sample of 160 adult (30 – 75 years old) patients who were admitted to intensive care cardiology departments of Palestine Medical complex (for pharmacoinvasive approach) and An-Najah National University Hospital (for percutaneous coronary intervention approach). The researcher used a data sheet that was developed based on previous literature, and data were analyzed using software. Results: Patients who underwent percutaneous coronary intervention (n = 82, 51.2%) were significantly older (mean = 59.8 ± 9.7 vs 56.2 ± 12.7) than pharmacoinvasive (n = 78, 48.8%). Catheter insertion site was mostly radial in percutaneous coronary intervention patients (95.1%) compared to pharmacoinvasive (15.4%), with no significant difference in MI location. Patients with percutaneous coronary intervention patients showed more significant decrease in white blood cells, low-density lipoprotein, high-density lipoprotein, triglyceride and heart rate, with more significant increase in troponin-I, and less increase in sodium, compared to pharmacoinvasive patients (p-value < 0.05) between pre- and post-operative phases. All postoperative complications, except for upper gastrointestinal bleeding, and mortality rate were significantly higher among pharmacoinvasive patients (p-value < 0.05). Lastly, significantly more postoperative complications were found among patients with dyslipidemia, valve regurgitation and cardiac hypokinesia. Conclusion: Patients who were treated with pharmacoinvasive approach showed higher postoperative complications and 30-day mortality rate. More research is needed in this area of cardiology management in Palestine. A prospective design is also recommended to be conducted for this topic in the future research.
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    CONTINUOUS TRAUMATIC STRESS RESPONSE AND COPING STRATEGIES AMONG ADULTS EXPOSED TO POLITICAL VIOLENCE IN THE NORTH OF THE PALESTINIAN TERRITORIES: A MIXED METHOD STUDY
    (An-Najah National University, 2024-10-02) Ghannam, Maram
    Background: Prolonged exposure to political violence, such that which occurred during the Israeli-Palestinian occupation, has caused serious physical and mental distress for Palestinian civilians. It is crucial to examine that people experience anxiety, dread, and sense of perceived threat during continuous traumatic stress are directly affect coping strategies.  The aim of the study :  To assess the level of Continuous Traumatic Stress Response and coping strategies among Palestinian adults exposed to political violence. Method: A mixed method of quantitative and qualitative research study design was adopted in this study. A purposive sampling method of adults who are from Jenin and Nablus camps and Nablus Old City. Out of 407 participants were included in this study. The Politically Violent Events Scale, continues traumatic stress response scale and the Jalowiec Coping Scale were used.Ten participants were included in this study in qualitative study for in depth interviews. Results: The findings indicated that the participants' greatest exposure (76.7%) was to their home being searched by the military. In terms of the event's severe impact, curfews or being prohibited from leaving one's home or city was ranked as the most severe influences. Participants feels fear and helplessness (63.6%), followed by feeling of exhausted and detachment (62.61%), and finally feeling of rage and betrayed(59.35%). the focus on concentrating their efforts on doing something about the situation  was the highest among the approach coping method and their ‏trying to find comfort in religion was the highest among the avoidant coping method among the study participants. In the qualitative findings, Six themes were emerged: Military occupation as a source of danger,  terror, sabotage, deprivation of freedom and rights. a source of psychological and physical diseases, loss of loved ones. And the “Challenging the occupation as a source of hope” theme . Conclusion: Enhanced comprehension of the psychological ramifications of possibly traumatic incidents can eventually result in better CTSR prevention and treatment strategies. The promotion of mental health and well-being among people impacted by stress and trauma connected to conflict requires standardized instruments, family support, and cultural sensitivity.
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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.