Medical and Health Sciences

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    A CROSS-SECTIONAL STUDY OF SELF-REPORTED SIDE EFFECTS OF BREAST CANCER TREATMENT AND QUALITY OF LIFE IN PALESTINE
    (An-Najah National University, 2025-01-16) Breek, Karin
    Background: Breast cancer is the most common cancer among women in terms of incidence. This study aimed to determine the side effects of breast cancer treatment reported by Palestinians with breast cancer and their quality of life. Methods: This study was a cross-sectional questionnaire-based survey. The study was undertaken in Nablus. The data collection instrument was divided into two distinctive sections. Part (A) collected data covering sex, age at diagnosis, clinical symptoms, complications, treatment measures, and side effects of the treatments. While part (B) of the questionnaire involved the quality-of-life assessment tool, the current study employed the WHOQOL-BREF (Arabic version) as an assessment tool. Results: A total of 258 patients with breast cancer participated in this study. In addition to breast cancer, 207 (80.2%) patients had one or more comorbid conditions. Of the patients, 153 (59.3%) were diagnosed less than 3 years ago. With respect to disease stage, 147 (57%) patients were in Stage I, 51 (19.8%) patients were in Stage II, 54 (20.9%) patients were in Stage III, and 6 (2.3%) patients were in Stage IV. Among the patients, 207 (80.2%) received chemotherapy, 159 (61.6%) underwent lumpectomy, 156 (60.5%) received radiotherapy, and 102 (39.5%) underwent mastectomy. When screened for the adverse effects of breast cancer treatments, the patients reported adverse effects and health issues that were categorized as follows: pain, gastrointestinal, skin and hair, health issues; pain, sleep and mental health, and respiratory/mouth and throat, hematologic, genitourinary, sensory, and general health issues. Multiple linear regression showed that the overall scores were negatively associated with having comorbidities, having advanced-stage breast cancer, receiving mastectomy, and experiencing headaches, vomiting, depression, anxiety, mood swings, mouth and throat sores (mucositis), fever, and insomnia. Conclusions: The findings of this study highlighted the heavy burden of disease and therapy-related adverse effects on the quality of life of patients with breast cancer who received treatment in Palestine. A multidisciplinary holistic care plan for breast cancer patients who integrates physical and mental health support is urgently needed to improve the quality of life of these patients.
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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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    ASSESSMENT OF THE COST OF SELECTED CHEMISTRY LABORATORY TESTS USING ACTIVITY-BASED COSTING: A CASE STUDY FROM AN-NAJAH NATIONAL UNIVERSITY HOSPITAL TITLE OF THESIS AS APPROVED BY FACULTY OF GRADUATE STUDIES
    (An-Najah National University, 2025-06-29) Abo ALola, Husam Taiseer Hassan
    This study aims to assess the application of the Activity-Based Costing (ABC) system in the chemistry laboratory at An-Najah National University Hospital, with the purpose of evaluating its effectiveness in improving cost calculation accuracy and resource management. The study adopted a descriptive cross-sectional methodology, using the “Cooper” model, which consists of two main stages: cost analysis and activity identification, where indirect costs are determined and linked to the activities that drive them. Data were collected from the hospital’s financial records as well as interviews with financial managers and laboratory staff. The results showed that the ABC system provides greater accuracy and transparency in allocating costs by identifying the activities that consume resources and directly linking them to costs. This approach improved resource utilization and offered valuable insights into laboratory operations. The study further demonstrated that the ABC system contributed to enhancing financial and administrative decision-making by providing managers with a precise understanding of the costs of different laboratory activities. This enabled the identification of unnecessary activities or those consuming resources without adding value, leading to improved processes and reduced waste. However, the study also indicated that implementing the ABC system requires additional time and effort at the initial stage, particularly with respect to training financial and administrative staff to use the new system. It also necessitates the provision of appropriate information systems to facilitate the tracking of activities and their associated costs. The study recommends the wider adoption of the ABC system in other hospital departments, especially those that require high accuracy in cost allocation, such as surgical operations and intensive care. It also emphasizes the importance of updating the hospital’s accounting systems to keep pace with modern developments in financial management, as well as developing human resources and providing the necessary information systems to ensure successful implementation. In conclusion, the study indicates that the ABC system is a powerful tool for improving financial transparency and reducing unnecessary costs in the complex environment of hospitals. Although it requires additional resources initially, it provides significant long-term benefits in terms of enhancing resource management and enabling more accurate financial decision-making.
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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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    BACTERIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERNS IN HOSPITALIZED PATIENTS WITH INFECTED DIABETIC FOOT
    (An-Najah National University, 2025-08-05) Hammad, Aseel
    Background: Diabetes mellitus (DM) represents a major public health concern and has been increasingly associated with serious complications. One of the most complex and costly complications of diabetes is diabetic foot infection (DFI). Early diagnosis, promote an appropriate treatment based on pathogen identification and antibiotic susceptibility testing, is essential for achieving favorable clinical outcomes. The aim of this study is to assess the bacterial profile and antibiotic susceptibility patterns in patients with infected diabetic foot. Methodology: A retrospective design to evaluate bacterial profile and antibiotic susceptibility patterns in patients with infected diabetic foot ulcers (DFUs) was used. The study was conducted at Salfeet Governmental Hospital. The files of all type 2 diabetes mellitus patients who meet the inclusion criteria during the previous three years were included. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results The study included 211 participants, in which the majority (45.0%) aged between 50-59 years, & males comprised 66.8% of the sample. Regarding diabetes mellitus (DM) duration, most participants (87.2%) had been diagnosed for > 10 years. Neuropathy was present in 34.6%, nephropathy in 24.6%, and angiopathy in 8.5% of the study population. Among the study participants, the most common ulcer site was the forefoot (33.1%). Ulcers penetrating to the bone (Grade D) were present in 20.4% of cases, and 7.1% had ulcers with osteomyelitis or abscess (Grade E). A statistically significant association was found between nephropathy and severity of ulcer grade (p = 0.007). The most commonly isolated microorganism was Escherichia coli, detected in 26.5% of cases, followed by Staphylococcus aureus (20.9%) and Pseudomonas aeruginosa (10.9%). Among the antibiotics tested for sensitivity, Meropenem/Ertapenem showed the highest sensitivity, with 63.03%, followed by Amikacin at 47.39%, Gentamycin (40.28%), and Piperacillin+Tazobactam (39.81%). Amoxicillin + Clavulanic acid showed the lowest sensitivity, at only 3.79%, Conclusion: The microbiological profiles revealed a high prevalence of Gram-negative bacteria, notably Escherichia coli, and Pseudomonas aeruginosa, accompanied by considerable treatment resistance. Meropenem, was the most often prescribed and effective antibiotic. The results affirm the necessity for multidisciplinary management strategies that encompass early detection, prompt surgical and antimicrobial interventions to enhance clinical outcomes and reduce amputations.
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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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    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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    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.
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    DEVELOPMENT OF NON-COVALENTLY FUNCTIONALIZED MULTIWALLED CARBON NANOTUBES BASED-SUBSTRATE FOR SUPPORTING IN VITRO NEURONAL GROWTH
    (2023-06-22) Rama Sahem Hendawi
    Abstract Background: Nerve injuries are considered the first leading cause of disabilities and one of the leading causes of deaths globally, which add a huge burden on socioeconomics. Many interventions have been developed to treat nerve injures, the golden standards are neurorrhaphy when suturing is possible, and autologous nerve transplantation, although promising results were obtained, functional recovery from chronic injuries remains a challenge. As a result, nerve tissue engineering emerged to find innovative solutions. In this study, the researcher aimed to develop neuronal growth by enhancing multiwall carbon nanotubes (MWCNT) dispersion and use it as a substrate. Objectives: This study aimed to test the effect of CNT substrate on neuronal functions and morphology, by first enhancing the MWCNT dispersion and form a substrate allows neuronal growth. Methods: in order to enhance MWCNT dispersion, the researcher functionalized it with poly-l-lysine (PLL) and chitosan by sonication, the cells were primary isolated from cortical rat embryo and seeded on PDMS polymer, and then we analyzed the substrate was analyzed by Raman spectra and scanning electronic microscope (SEM). Then we tested neuronal synchronicity was tested by calcium dye staining florescence, the recorded videos were further analyzed by SyincAnalysis software, the cellular viability, and synchronicity percentages were statistically analyzed by student T test. The neuronal morphology was analyzed by staining actin and tubulin, the main cytoskeletal filaments engaged in neuritogenesis, the recorded images were further analyzed by special software, and the results were statistically analyzed by one way ANOVA. Results and conclusions: PLL enhanced MWCNT dispersion better than chitosan, with 0.05% PLL-MWCNT as our working concentration. For neuronal synchronicity the researcher tested the substrate against PLL-ECM as a control, and it was that there is found no significant difference between active cell number percentage and synchronicity cell percentage which indicates the substrate ability to sustain neuronal activity. Furthermore, we tested neurite branching against PLL and PLL-ECM as controls, and we found significant difference between PLL-MWCNT and others, we hypothesized this increase due to nanoscale topography that are in the favorable size for focal adhesion attachment, and that PLL-MWCNT increased substrate stiffness. Keywords: Carbon nanotubes; poly-l-lysine; chitosan; synchronization; neuritogensis; nerve tissue engineering; substrate.
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    DEXMEDETOMIDINE AS A BLOCKING AGENT FOR INTERCOSTAL BLOCKS IN PATIENTS WHO UNDERGO VIDEO -ASSISTED THORACOSCOPIC SURGERY
    (2022-06-29) Mousa Mohammed Mousa Ma’rouf
    Background: Local or regional anesthesia is one major fields in anesthesia. One technique to apply regional anesthesia is intercostal block, a type of regional anesthesia used in thoracic and upper abdominal surgeries to provide analgesia and to relieve pain due to rib-fracture, cancer, thoracic procedures and lung surgeries. Video -assisted Thoracoscopic Surgeries (VATS) has been began the late 20th century. They have now become one of the most common preferred procedures for lung surgeries. Applying intercostal blocks in these surgeries yield good outcome on pain level post operatively. Many anesthetic blocking agents are used in regional anesthesia such as lidocaine and Marcaine. Dexmedetomidine is an alpha-2 adrenergic antagonist that works on the smooth muscles of viscera and has unique effect on pain control and sedation. Adding 1 microgram per kilogram of Dexmedetomidine for the formula has a strong effect on controlling level of pain. Objectives: This study has assessed the effect of Dexmedetomidine as intercostal block agent on the level of pain, analgesia requirements, stability of hemodynamics and nausea and vomiting. Methodology: randomized control clinical trial double-blinded design was used to assess 30 patients with a category of anesthesia (ASA 1, ASA 2 and ASA 3) who underwent VATS in referral center in Palestine. These patients were divided into two groups: intervention (experimental) and control. The control group (15 patients) was given Marcaine 1 mg/kg while, the intervention group was given 1 microgram/kg Dexmedetomidine with 1 mg/kg Marcaine on intercostal space. Results: According to the results, there was an effect on the level of pain in the 3rd (p-value=0.04) 5th (p-value=0.01) 15th (p-value=0.1) minute post operation and after 24 hours of the procedure (p-value=0.01). Conclusion: Using Dexmedetomidine as adjunct in intercostal block deceased the intensity of pain, conserved the vital signs (hemodynamics) on the normal lower limits for patient, and needed less analgesic requirement post-operatively. There was also no incidence of nausea and vomiting for patients who were administered Dexmedetomidine with Marcaine. Keywords: Dexmedetomidine, intercostal block, regional anesthesia, pain, analgesia, hemodynamics.