Pharmacy

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    Analysis of beliefs about medicines and medication adherence in patients with chronic diseases at the Military Medical Services, Nablus, Palestine
    (2014) Raniah Majed Fares Jamous; Prof. Waleed Sweileh; Dr. Adham Abu-Taha
    Background: very few studies in the Arab world investigated patients’ behavior toward medications, particularly in those with multiple co-morbid and different chronic diseases. Furthermore, most studies in this field were carried out among patients with governmental insurance which could affect the reliability and validity of the results since medications are not always available in governmental pharmacies. Objective: to investigate how the presence of multiple chronic illnesses could affect the association between attitudes toward medicines and adherence practices in a non-governmental settings. Methodology: The Palestinian Medical Military Services in Nablus, Palestine was the main setting for the study. Presence and number of multiple chronic diseases were obtained from patients through interview setting and were confirmed by information available at the medical files. Attitudes toward medicines were evaluated by the Beliefs about Medicines Questionnaire (BMQ) while compliance / adherence behavior was evaluated by Morisky Medication Adherence Scale (MMAS-8). Results: One hundred and eighty seven patients were interviewed. Most participants (79.6%) had positive attitude that their medicines were necessary to maintain their good health status while 58.2% of the study sample were afraid and had negative attitude or concern about taking medicines on regular basis and 57.8% were afraid that they will get addicted and become dependent on their medicines. In the presence of multiple chronic diseases, demographic and clinical factors were not significantly associated with adherence practices. However, in patients with multiple chronic diseases, those who had higher positive attitudes and feeling of necessity had higher odds [1.4 (1.1 - 1.9)] of having adherence practices while those who had higher negative attitudes or concerns or fear about medicines had lower odds [0.8 (0.65 – 0.98)] of having adherence practices. Conclusions: In patients with multiple chronic diseases, positive and negative attitudes toward medicines are significant determinant of adherence practices.
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    Analytical and Dissolution Method Development and Validation for a Home Formulated Rutin Tablet
    (2015) Jumana Saleh Mohamed Mansour; Dr. Murad Abualhasan; Dr. Nidal Jaradat
    Rutin can be classified as flavone, colorant and vitamin. It is highly available in some foods, fruits, vegetables and plant-based beverages. Rutin is highly attracted to the researchers due to its variant beneficial medical effects making rutin used in the treatment of various ailments. Rutin is available in different oral dosage forms such as tablets or capsules either alone or in combination with other active ingredients. Rutin pharmaceutical preparations are widely available in international market as well as Palestinian market. In this study we formulated a 250mg rutin tablet and we developed an easy and simple validated analytical method to quantify rutin in our formulated tablet as well as the internationally marketed Rutin® tablet of Solgar. The method was validated in accordance to international guidelines of the ICH and USP. The dissolution profile of our formulated tablet was also inspected. The shelf and the accelerated stability of the locally formulate tablet was studied. The results clearly show that our developed method was a valid method with a good linearity, precision and accuracy. The validated method was sensitive with LOD and LOQ value of 4.34*10-3 and 0.013mg/ml respectively. The locally formulated rutin tablet was stable under accelerate as well as room temperature for 150 days, only with slight and tolerable drop in the %assay with no detrimental effect on the physical properties of the tablets. The dissolution profile of our locally formulated tablet show slightly better dissolution in phosphate buffer compared with the internationally marketed Rutin® tablet of Solgar. Our study encourages and helps companies that manufacture herbal products especially those present in Palestine to improve their formulated herbals and apply validation analytical methods to check their product quality. In conclusion we succeeded in developing a validated analytical method to quantify rutin in our locally formulated rutin tablet as well as the available rutin formulations present in the local and international markets. Our formulated tablet showed a slight improvement in the dissolution profile and was stable in normal as well as under stress condition
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    Antimicrobial Utilizing Pattern in a Governmental Hospital in Palestine Measured Using WHO ATC/DDD Methodology
    (2014) Marina Zeyad Bada; Dr. Adham Abu Taha; Prof. Waleed Swieleh
    BACKGROUND: Increased consumption of antimicrobial agents is related to a worldwide increased in bacterial resistance, increased costs and dispensable effects of drugs on patients. OBJECTIVES: To investigate the pattern of antimicrobial consumption data using WHO ATC/DDD methodology in a governmental hospital in Palestine, and to assess the obstacles for implementing rational use of antimicrobial agents in hospital. METHODS: Antimicrobials consumption in Rafidia hospital was retrieved prospectively. The ATC/ DDD and DU90% methodologies were used. Defined Daily Dose (DDD) per 100 Bed-Days and DDD per 1000 inhabitants per day were calculated for total systemic antimicrobial use and by antimicrobial class. RESULTS: Antimicrobials were administered to 554 patients (55.4%) out of 1000 who were hospitalized in Rafidia hospital over two months period. The total consumption of antimicrobial agents was 1656.1 DDD that corresponding to 70.55 DDD/100 Bed-Days and 3.31 DDD/1000 Inhabitants/ Day. The most highly used antimicrobial were ceftriaxone followed by cefuroxime and metronidazole. The bulk prescription (DU90%) was made up of 8 out of 22 total antimicrobial agents. And the highest rates of antimicrobial use were found in intensive care unit (ICU) 132.64 DDD/100 Bed-Days and surgical department 98.52 DDD/100 Bed-Days. CONCLUSIONS: We found that antimicrobial utilization in Rafidia hospital was relatively high, and there were a high tendency for wide-spectrum antimicrobial utilization such as third-generation cephalosporins, carbapenems and aminoglycosides. This study proved that there is an urgent demand for national antimicrobial stewardship and education programs in infection control and prevention in Palestinian hospitals. Key words: Antibiotic, Consumptions.
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    Assessing Appropriate Use of Inhaler Devices among Asthmatic Patients
    (2013) Ola Adel Fawzi Salah; Prof. Waleed Sweileh; Dr. Samah Al-Jabi
    Background: Appropriate use of inhaler devices such as metered-dose inhalers (MDIs) and dry-powder inhalers (DPIs) in clinical practice is not well studied in Palestine and few were carried out in the Arab world. Objectives: The objectives of this study were to assess patients’ administration technique of inhaler devices and its association with other variables. Method: A cross sectional observational evaluation was conducted at a pulmonary clinic in Nablus, Palestine. Administration technique was evaluated based on a pre-defined checklist. Asthma control was assessed using Asthma Therapy Assessment Questionnaire (ATAQ) scale. Results: MDIs (without spacer) and DPIs (turbuhalers and aerolizers) in patients with asthma disease were studied. The study included 149 patients with mean ± standard deviation (SD) age of 47.5 ± 18.5 years. Fifty five (36.9%) of the study patients had college education and higher. Forty two (28.2%) patients were using MDIs, 38 (25.5%) were using DPIs and 69 (46.3%) were using both devices. A total of 217 inhaler devices were evaluated: 111 (51.2%) for MDI and 106 (48.8%) for DPI. Mean scores ± SD for correct inhaler technique were 61 ± 20.1, 71.4 ± 14.9 and 66.2 ± 15.7 for MDIs, turbuhalers and aerolizers respectively (p = 0.00). For MDI and DPI devices, step 3 “exhale to residual volume” was the least correctly done (22.5% and 13.2% respectively). There was a significant relationship between correct score of handling inhaler device and educational level (r = 0.187; p=0.006) where higher educated patients had higher correct scores. Among patients, ATAQ scale indicated that 22 (14.8%) patients had well controlled asthma, 56 (37.6%) patients were not well controlled and 71 (47.7%) patients were poorly controlled. There was significant difference in scores of correct inhaler device handling and asthma control category (p < 0.01) where patients had higher correct scores were with higher control for their asthma. Among patients using inhaled corticosteroids (ICS), there was a significant difference between adherence score and correct handling scores (p = 0.002) where patients with better adherence had higher correct scores. Conclusion: Correct handling of inhaler devices was not common particularly among MDI devices. Regular checking of inhalation technique and proper practical teaching of patients is crucial for optimal use of most inhaler devices.
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    Assessment of Knowledge and Practice for Safe Handling of Antineoplastic Drugs among Healthcare Providers in Oncology Departments in Palestinian Hospitals
    (جامعة النجاح الوطنية, 2021-02-06) موسى سعيد, راية
    الخلفية: بسبب زيادة الإصابة بالسرطان وإدخال نظم علاج أكثر تعقيدًا، من المتوقع أن يزداد الطلب على استخدام الأدوية المضادة للأورام (ANPDs)، مما سيؤدي إلى مزيد من التعرض المهني لهذه الأدوية بين مقدمي الرعاية الصحية (HCPs) وبالتالي فإن هذه الأدوية تتطلب احتياطات شديدة عند التعامل معها واستخدامها. الأهداف: هدفت هذه الدراسة إلى تقييم المعرفة والممارسة بين الممرضين والصيادلة ومساعدي الصيادلة حول كيفية التعامل الآمن مع الأدوية المضادة للأورام، وأيضا لتحديد ارتباط هذه المعرفة بالممارسة، ولتحديد العوائق التي تمنع مقدمي الرعاية الصحية من استخدام تدابير السلامة. المنهجية: أجريت دراسة مقطعية من آب إلى تشرين الثاني 2018 في ستة مستشفيات فلسطينية، تم جمع المعلومات عن طريق استبيان احتوى على اسئلة تساعد في جمع المعلومات الديموغرافية لمقدمي الرعاية الطبية وممارستهم حول كيفية تداول الأدوية المضادة للسرطان بشكل آمن والحواجز التي قد تمنعهم من حماية انفسهم من التعرض لمثل هذه الأدوية، تم إجراء التحليل باستخدام الإصدار 25 من برنامج الSPSS، تم اعتبار ان القيمة الاحتمالية أقل من 0.05 على انها ذات دلالة إحصائية. النتائج: اشترك 96 شخص من مقدمي الرعاية الصحية في هذه الدراسة، متوسط اعمارهم كان 31.9±8.6 سنة، تراوحت اعمارهم ما بين 22 الى 55 سنة. اغلب المشتركين كانوا ممرضين (62.5%,60)، مع أغلبية نسوية (66, 68.8%). لم يتم تدريب حوالي ثلثي المشتركين على التعامل الآمن مع الأدوية المضادة للأورام. كانت درجة معرفتهم وممارستهم تجاه التعامل الآمن مع هذه الأدوية جيدة نسبيًا، حيث كان متوسط درجات المعرفة والممارسة 84.6 ± 13.8، 74.33 ± 25.8 على التوالي. ارتبط تلقي التدريب بمستوى معرفة بدرجة متوسطة. عبء العمل الكبير، ونقص الرقابة، وعدم توفر معدات الحماية الشخصية كانت العوائق الرئيسية لعدم استخدام معدات الوقاية الشخصية كما بلغ المشتركين. الإستنتاج: بالرغم من أن معرفة مقدمي الرعاية الصحية بالتعامل الآمن مع الادوية المضادة للأورام كانت مقبولة، إلا أن توفير التدريب لهم لم يكن كافيا. يوصى بالتدريب الدوري والمستمر لمقدمي الرعاية الصحية بدعم من السياسات لاتباع المبادئ التوجيهية بهذا الشأن.
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    Assessment of Patients' Satisfaction with Pharmaceutical Services in Nablus City Hospitals: A Cross Sectional Study
    (جامعة النجاح الوطنية, 2019-07-16) زهير شريم, ريناد
    مقدمة: رضا المرضى هو أحد العوامل المهمة التي تحدد نجاح مرافق الرعاية الصحية. لذلك، هناك حاجة لتقييم نظام الرعاية الصحية فيما يتعلق برضا المرضى لضمان جودة الخدمات الرعاية الصحية. تهدف هذه الدراسة إلى قياس رضا المرضى عن الخدمات الصيدلانية في مستشفيات نابلس ، فلسطين. طريقة البحث: هذه دراسة مقطعية. تم فيها اختيار ثلاثة مستشفيات في مدينة نابلس وصمم استبيان رضا لقياس مدى رضا المريض. احتوى الاستبيان على عناصر ركزت على العوامل المؤثرة: السرعة، الموقف، وقت الانتظار، التعليم الدوائي، والجوانب الديموغرافية للمجيب. تم اختيار 90 مجيبًا لملء الاستبيان من خلال أخذ عينات ملائمة. نتائج الدراسة: بلغ إجمالي عدد المرضى الذين كانوا على استعداد لملء استبيان البحث 90. الخصائص الديموغرافية للمرضى توزعت كالتالي: كان عدد المرضى الإناث أعلى من عدد المرضى الذكور (58.9 - 41.15 ٪) وكانت الفئة العمرية المهيمنة أكثر من 30-39 سنة بنسبة 30٪. كان 58.9٪ من المرضى متزوجين. وكان مستوى تعليم غالبية المرضى في المرحلة الثانوية 44.4 ٪. ما يصل إلى 58.9 ٪ من المرضى كانوا عاطلين عن العمل. من بينهم 36.7٪ دخل الأسرة لديهم أقل من 2000 شيكل . 42.2٪ منهم كانوا يعيشون في القرية. كانت هناك فروق ذات دلالة إحصائية في الرضا عن الخدمات الصيدلانية وفقا لوقت العمل بين الفترة الصباحية والمسائية، ، وكانت قيمة P-value هي 0.009. أظهرت البيانات تأثير إيجابي لوقت الانتظار في الصيدلة على رأي المرضى ورضاهم. كان 81.1 ٪ من المرضى راضين عن وقت الانتظار في الصيدلية. في حين أن 18.9٪ من المرضى لم يكونوا راضين عنه. غالبية المشاركين 70٪ لديهم مشكلة مع الدواء في آخر زيارة بسبب عدم توفر الادوية ، 97.8٪ ليس لديهم مشاكل مع الأدوية التي لها نفس الشكل واللون. أبلغت الدراسة عن درجة معتدلة (جيدة) من رضا المرضى عن الخدمات الصيدلانية في المستشفيات الثلاثة وكان متوسط الاستجابة 3.24. المرضى عموما راضون عن خدمات الصيدلانية في المستشفيات بنسبة 64.8 %. الخلاصة كان رضا المرضى عن خدمات الرعاية الصيدلانية جيدًا. وقد انعكس ذلك على الخدمات الصيدلانية الجيدة المقدمة للمرضى والتي منها العلاقات بين الصيدلي والمريض، والاحترام الذي أبداه الصيدلي تجاه المرضى، وسرعة خدمة صرف الأدوية ورضا المرضى عن وقت الانتظار. يجب مراجعة تواصل الصيدلي مع المرضى والاستشارات الدوائية لمنع المشاكل المتعلقة بالأدوية وتحسين الخدمات الصيدلانية في مستشفيات نابلس. توصي الدراسة بمزيد من التدريب للعاملين الصحيين على الخدمات الصيدلانية وزيادة وعي المريض اتجاه الخدمات الصحية المتوقعة من قبل مقدمي الخدمات الصحية.
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    The Association Between Adherence and Beliefs about Medications among Patients with Ischemic Heart Disease: A Cross Sectional Study from Palestine
    (Wafaa AL-Barbarawi, 2018-07-03) AL-Barbarawi, Wafaa
    Background: optimal medication adherence in patients with ischemic heart disease (IHD) is very important to prevent cardiac events and decrease the rate of mortality. Patients' beliefs about medicines are one of the most important factors that may affect adherence. Objectives: to measure adherence to medications among Palestinian ischemic heart disease patients, and to find the effect of some patient factors and medication beliefs on their medication adherence. Methods: the study was a cross-sectional study among patients in governmental outpatient clinics, information was obtained from patients by a face to face interview and from medical files. The Morisky Medication Adherence Scale- 8 questions (MMAS-8) and Beliefs about Medicines Questionnaire (BMQ) were used to measure medication adherence and patients' beliefs about medicines respectively. Results: a total of 400 patients were included in the study, mean age ± standard deviation was 62.35± 9.30 years. Most patients 348(87.0%) had comorbid conditions. The majority 304 (76.0%) of patients were using at least 5 medicines. According to MMAS-8 score, 195 (48.8%) of participants were non adherent to their medicines (adherence score ˂ 6) and 205 (51.3%) were adherent (adherence score ≥ 6). Multivariable analysis showed that patients who had others disease (comorbid conditions) had higher odds (O.R=2.316(95%CI (1.192-4.499)) of being non-adherent. patients who had higher concerns about medicines had higher odds (O.R=1.124(95%CI (1.063-1.188)) of being non-adherent, also patients who had positive harmful beliefs of medications had higher odds (O.R=1.092(95%CI (1.018-1.171)) of being non-adherent. On the other hand, Patients who had positive beliefs of medication necessity had lower odds (O.R=0.902(95%CI (0.847-0.960)) of being non-adherent. Conclusions: Poor adherence was very common among Palestinian IHD patients. Stronger positive beliefs about necessity of treatment was associated with lower non-adherence while high concerns of long term use of medicines or harmful effects of medications were associated with higher non-adherence, which emphasizes the importance of patients' beliefs about medicines in medication adherence.
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    Attitudes, Knowledge and Practices of Health-Care Practitioners Toward Splitting or Crushing Oral Solid Dosage Forms in Palestine: Safety and Therapeutic Implications
    (2015) Yaser Mustafa Mahmood Abdallah; Prof. Dr. Abdel Naser Zaid; Dr. Saed Zyoud
    Background: Tablet splitting and crushing is a widespread practice among health-care providers and patients for different reasons, such as: (i) increasing dose flexibility, (ii) making tablet parts easier to swallow, and (iii) allowing cost savings for medications. However, this practice may be dangerous because some formulations and classes of drugs are unsuitable for crushing or splitting and may cause significant problems, especially in drugs with low therapeutic indices. Objectives: This thesis was conducted to examine the attitudes, knowledge and practice of pharmacists and nurses toward splitting or crushing oral solid dosage forms (OSDFs) in Palestine. It also aimed to determine the factors that affect health-care practitioners with regard to splitting or crushing OSDFs, in addition to determining the differences in attitudes and knowledge between nurses and pharmacists regarding this very important issue, and to determine the safety and therapeutic problems that resulted from splitting or crushing OSDFs. Methodology: This is a self-administered cross-sectional questionnaire survey involving 550 respondents and was conducted during the period May 2013 to August 2013 among pharmacists and nurses who work at community pharmacists and hospitals in the West Bank area of Palestine. Data were collected using a pretested questionnaire consisting of four sections and analysed using descriptive statistics and correlation. Results: A total of 615 questionnaires were distributed and 550 were completed. About 67.3% of the pharmacists and only 5.6% of the nurses had good knowledge. Nearly 69% of the pharmacists and 36.4% of the nurses had a good attitude. There was a positive correlation (p=0.002, r=0.18) between knowledge and attitude scores among pharmacists. There was a positive correlation (p<0.001, r = 0.24) between knowledge and attitude scores among nurses. Approximately 83.7% of the pharmacists and 41.6% of the nurses had good practices. Conclusion: This study has identified knowledge, attitude and practice gaps among health-care practitioners, especially among nurses. Therefore improving appropriate knowledge regarding splitting and crushing OSDFs is required by planning and developing programs for local health education purposes
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    Bio-Functionalization of SWCNTs with Combretastatin A4 for Targeted Cancer Therapy
    (An-Najah National University, 2017-05-25) حمد, ديمه فهيم محمد رشدي; العسالي, محي الدين
    Chemotherapy is a mainstay approach in the management of cancer. Unfortunately, it can affect not only the cancerous cells but also the healthy ones resulting in a number of severe side effects. Therefore, many researchers are keen to developing new Drug Delivery Systems (DDS) that may in one hand help reducing the used doses and on the other hand target the delivery of the chemotherapy to cancer cells. Some modern investigational DDS in this field are based on carbon nanotubes (CNTs) technology. The aim of this work is to covalently functionalize single walled carbon nanotubes (SWCNTs) with Combretastatin A4 (CA4) through click reaction in the presence of tetraethylene glycol linker to improve the solubility and dispersibility of the developed nano-drug. Moreover, in order to specifically target the cancer cells, a targeting agent folic acid was also loaded on the nano-system. The characterization of the developed nano-drug by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) showed good dispersibility of the functionalized SWCNTs with diameters of (5-15) nm. Moreover, the efficiency of functionalization was determined by thermogravometric analysis (TGA) showing 45% of functionalization in the case of CA4-SWCNTs (7) and 50% for CA4-FA-SWCNTs (13). The in vitro release profile of CA4 showed that approximately 90% of the loaded drug was released over 50 hrs at pH 7.4 and 37 ºC. MTS proliferation test was implemented to determine the suitable concentration for the CA4-SWCNTs (7), which was found to be 15 ng/ml. After that the cytotoxic activity of the nano-drug was evaluated by flow cytometry using Annexin V/Propidium iodide (PI) test. In comparison with free CA4, CA4-SWCNTs (7) treatment demonstrated a significant increase in necrotic cells (around 50%) at the expense of the proportion of the apoptotic cells. Moreover, cell cycle PI test demonstrated that free CA4 and CA4-SWCNTs (7) caused G2/M arrest. However with CA4 treatment higher proportion of cells were in the S-phase while with CA4-SWCNTs treatment greater proportion of cells appeared to be in the G1-phase. Taken together, the provided data suggest that the novel CA4-SWCNTs (7) has a significant anticancer activity that might be superior to that of free CA4. The anticancer activity of CA4-FA-SWCNTs (13) is under investigation.
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    Biological Activity of Newly Synthesized Aromatic Thio and Amino Acid Ester Derivatives
    (جامعة النجاح الوطنية, 2021-11-24) عدنان عساف, إيمان
    تم تخليق تسعة مركبات من السترات (IX-I) عن طريق تفاعل نوعين مختلفين من الكحوليات 2- (فينيل ثيو) إيثان و 2- (فينيل امينو) إيثان مع خمسة أنواع من الأحماض الكربوكسيلية المختلفة بطريقة تقليديه المعروفة باسم fisher reaction) (. تم فحص مركبات الإستر بواسطة Fourier Transform Infrared (FT-IR) ، والرنين المغناطيسي النووي البروتوني (1H-NMR) ، والرنين المغناطيسي النووي للكربون 13. تم اختبار فعاليه المركبات إذ لها نشاط كمضادة للأكسدة أو مضاد للميكروبات أو إذا كان لها مقدره على تثبيط عمل كل من إنزيم الأميليز والليباز. أظهر اختبار فحص نشاط المركبات كمضادات أكسدة أن المركبين V و IX لهما نسبة تثبيط تساوي 84.70٪ و 84.79٪ ، على التوالي ، عند تركيز 100 ميكروغرام / مل مقارنة مع ترولوكس الذي لديه قيمة تثبيط تساوي 99٪ عند نفس التركيز. بالإضافة إلى ذلك ، فإن جميع مركبات الإستر لها فعاليه لتثبيط نمو البكتيريا سواء كانت بكتيريا من النوع موجبة الجرام أو من نوع سالبة حيث تروحت قيمه التثبيط عند اقل تركيز مستخدم لتثبيط نمو البكتيريا (MIC) (7.5 - 0.47 ميكروغرام / مل). بينما أظهرت المركبات التاليه III و V و VII و VIII و IX فعاليه عاليه على تثبيط بنسبة 95٪ ضد فطريات الكانديدا حيث كانت قيمه اقل تركيز لتثبيط نشاط الفطريات يساوي ( MIC (1.875 ميكروغرام / مل) مقارنة بالعقار المضاد للفطريات فلوكونازول بقيمه تساوي (1.62 ميكروغرام / مل). أظهرت مركبات الإستر نتائج واعده كمركبات لها المقدرة على تثبيط عمل إنزيم α-amylase مقارنة مع Acarbose كمعيار. كانت نسبة تثبيط كل من المركبات IX , V و VI 99.5 ٪. 79.3٪ و 73.5٪ عند تركيز500 ميكروغرام / مل على التوالي. كانت قيمه التثبيط بالنسبة المئوية ل 5 مركبات أعلى من 50٪ عند 10 ميكروغرام / مل وهي نتيجة مهمة للغاية وكانت هذه الخمس مركبات لها IC50 أقل من IC50 للأكاربوز. قيمة IC50 للمركب III هي 0.0206 وهي أقل 3000 مرة من الأكاربوز. بالرغم من عدم وجود مجموعة أميد الوظيفية المسئولة عن نشاط إنزيم الليباز ، فإن المركبين V و IX أظهروا تثبيط 59.5٪ و 72.3٪ على التوالي عند 500 ميكروجرام / مل.
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    BIOLOGICAL ACTIVITY OF SYNTHESIZED XANTHONE AND THIOXANTHONE ANALOGS
    (جامعة النجاح الوطنية, 2022-06-05) Aqel, Samah
    Introduction: Xanthone and thioxanthone were used to synthesize a derivative of compounds to test for anticancer, anti-inflammatory, antioxidant and antimicrobial activity. In order to do this, Grignard reagent was added to xanthone and thioxanthone to give a library of tertiary alcohol of phenyl and benzyl xanthone and thioxanthones. After that, some of them were followed by coupling with cysteine to make cysteine analogous. A total of seven compounds were synthesized. The compounds were characterized using the proton and carbon NMR and IR. The synthesized structures were tested for their anticancer, antioxidant, antimicrobial and ant-inflammatory activities. Results: The test results were promising; compounds Ⅲ showed a very good activity (IC 50= 2.79 µg/ml) against Colon cancer cells (CaCo). While compound 2 showed a good inhibition activity against hepatic HEPG cells (IC 50= 49.2 µg/ml) and compound Ⅰ showed a very good inhibition activity against HeLa cells (IC 50= 60 µg/ml). Compound Ⅳ has a potent antioxidant inhibition activity (IC50= 4.22 µg/ml). Moreover, compound Ⅶ Showed a good anti-inflammatory activity with a COX2 inhibition activity (1.72 µg/ml) and also good selectivity for COX2 (3.81). However, none of the compounds showed antimicrobial activity. The future work requires further an in-vivo testing to understand its pharmacokinetic and pharmacodynamic activity in living system. Conclusion: Further future work will be carried out to better understand the SAR effects of these compounds.
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    Biological and phytochemical screening of Erodium laciniatum and Lactuca orientalis
    (An-Najah National University, 2017-01-12) Othman, Dua'a; Jaradat, Nidal
    From ancient times, various herbal remedies and various medical agents containing flavonoids, tannins and phenols have been utilized for prevention and treatment of different diseases and disorders. Currently, such groups of bioactive compounds have become the subject of many antimicrobials researches, with possessed antiviral, antifungal and antibacterial activities. Moreover, many of high quality studies assessed the relationship between flavonoid's, tannin's and phenol's chemical structures and their antibacterial activities, and also studied their mechanisms of action on the microbial growth. These investigations approved that such classes of natural compounds can possess many therapeutic properties, including oestrogenic, antiinflammatory, enzyme inhibition and antimicrobial activities. In this study we aimed to screen Erodium laciniatum and Lactuca orientalis phytoconstituents and to evaluate their total flavonoids, tannins and phenols contents. An additional aim is to evaluate their antioxidant and antimicrobial activities. Phyto-constituents, total flavonoids, phenols and tannins were screened and evaluated by using standard analytical and phytochemical methods. Antioxidant activity was evaluated by using DPPH method meanwhile antibacterial activities were examined by using several reference bacterial strains obtained from the American Type Culture Collection (ATCC) and multidrug resistant clinical isolates. The tested strains included Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (MRSA Positive), Enterococcus faecium (ATCC 700221), Shigella sonnei (ATCC 25931), Enterobacter cloacae (clinical) and Klebsiella pneumoniae (clinical). In addition to that anti-fungal activities of these extracts were also examined against two reference strains Candida albicans (ATCC 90028) and Epidermatophyton floccosum (ATCC 52066). Antibacterial and antifungal activity of all prepared Erodium laciniatum and Lactuca orientalis organic and aqueous extracts were determined by using several methods including agar diffusion well-variant method, agar diffusion disc-variant method and broth micro-dilution method. The results of the phytochemical screening showed that L. orientalis and E. laciniatum contain phenols, tannins, flavonoids, saponins, monosaccharides, reducing sugars, carbohydrates, cardiac glycosides, and steroids, while alkaloids were not detected in both of the studied species. However, proteins, starch and terpenoids were not detected in L. orientalis and detected in E. laciniatum which means that E. laciniatum had more phyto-constituents than L. orientalis. Moreover, total flavonoid, tannins and phenols content in E. laciniatum extract were higher than the L. orientalis extracts. The IC50 values of the antioxidant activity were almost the same in L. orientalis and E. laciniatum extracts. Additionally the lowest value of MIC was for organic extract of E. laciniatum against Staphylococcus aureus. The same organic extract also showed to have the largest diameter of inhibition against Enterococcus faecium. However, L. orientalis aqueous extract showed to have the largest diameter of inhibition against Staphylococcus aureus. Whereas, the antifungal activity which was tested by using agar dilution method against Epidermatophyton floccosum showed that the organic extract of E. laciniatum had the lowest MIC which was 0.391mg/ml. In conclusion, both of the studied species have a mixture of phytochemicals and rich in flavonoids, phenols and tannins and have potential antioxidant and antimicrobial activities which can be used as therapeutic agents or can be used in cosmeceutical and pharmaceutical industries.
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    Biowaiver monograph for ascorbic acid immediate release solid oral dosage forms
    (2016) Helen Najdi Naji Al-Masri; Dr. Ramzi Shawahna; Dr. Amjad Hussien
    Background: Demonstrating similarity in terms of safety and efficacy between innovator pharmaceutical products and their generic versions is a critical step in granting marketing authorizations (MAs) for generics. Similarity often proved by conducting in vivo bioequivalence (BE) studies in healthy volunteers. Health regulatory bodies issue MAs for generic versions after furnishing a proof of similarity with their innovator counterparts. BE studies are expensive, time consuming and risky studies since they are conducted in healthy volunteers. Today, the biopharmaceutical classification system (BCS) introduced by Amidon and adapted by various regulatory authorities and organizations like the US Food and Drug Administration (FDA), European Medicines Agency (EMA) and the World Health Organization (WHO) has significantly changed the processes of drug development and approval. Regulatory bodies now allow waiver of in vivo BE studies using surrogate in vitro dissolution testing for immediate release (IR) solid oral dosage forms containing high solubility and high permeability (BCS class I) drugs. Objectives: The objectives of this thesis were to systematically evaluate the possibility of granting biowaiver for immediate release (IR) formulations containing ascorbic acid as an active pharmaceutical ingredient (API). The release characteristics of two formulations containing ascorbic acid were also assessed. Methods:Solubility studies were conducted to determine the aqueous solubility of ascorbic acid at different pH points in the range of 1-7.5 at 37 ºC and to assign a correct solubility class for ascorbic acid. According to the BCS, and the FDA guidelines, a drug substance is considered highly soluble when the highest dosestrength is soluble in 250 ml or less of aqueous media over the pH range of 1–7.5. A standard shake-flask method was applied using three different aqueous media with pH values of 1.0 (maleate buffer), 4.5 (acetate buffer), and 7.5 (phosphate buffer) at 37 °C. The establishment of equilibrium was confirmed by comparing the solubility at 24 h and 48h.Drug levels in the samples were analyzed using UV spectrophotometric assay of ascorbic acid at 260nm. Dissolution experiments on two IR tablets containing ascorbic acid 500 mg were carried out. Dissolution profiles of ascorbic acid 500 mg tablets were generated in 900 ml of deionized water at pH points of 1.2, 4.5 and 6.8 adjusted using 0.1 N HCl or NaOH solutions. A paddle type dissolution apparatus was used and dissolution was tested in according to the USP type-II method. Paddles rotated at 75 rpm and the temperature of the dissolution media was maintained at 37 ± 0.5 ºC. Aliquots of 5 mL were withdrawn at predetermined time intervals of 5, 10, 15, 20, 25, 30, 45 and60 min.Samples were suitably diluted and analyzed at260 nm using UV spectrophotometer. Molecular descriptors like polar surface area (PSA), n-octanol/water partition coefficient (log P), distribution-coefficient at pH 7.4 (log D7.4), number of hydrogen bond acceptors, number of hydrogen bond donors and pKa were calculated using software packages. Literature databases were searched for solubility, permeability and dissolution related parameters. Results:The solubility measurements show that the maximum dose listed on the WHO’s EML list was soluble in less than 250 mL of water over the pH range specified by the regulatory agencies at 37 °C. The calculated dose number was in the range 0.00011 of 0.00029 in the pH range of 1.2-7.5. These results suggest that ascorbic acid should unequivocally be assigned a “high solubility” BCS class. Based on the predicted physicochemical properties and observed in vivo behavior, ascorbic acid behave like high permeability BCS class drugs. Therefore, we suggest that ascorbic acid should be assigned to BCS class I drugs. Visual as well as similarity (ƒ2) and difference (ƒ1) factors comparisons between the two IR oral formulations containing ascorbic acid(C-Tamin tablets, and Vitamin C tablets) as a single API showed the ascorbic acid was released differently in the tested dissolution media. Conclusions:Ascorbic acid is a high solubility and high permeability drug, and therefore is classified as a BCS class 1 compound. The risk of bioinequivalence is manageable as long as the use of ascorbic acid is safe. For these reasons, we consider ascorbic acid to be a good candidate for waiver of in vivo BE studies. Conducting in vitro dissolution could reveal the quality of IR oral formulations. Key words:absorption; bioavailability; bioequivalence; biopharmaceutical classification system (BCS); biowaiver; ascorbic acid; pharmacokinetics; permeability; solubility
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    CANCER-RELATED POST-TREATMENT PAIN AND ITS IMPACT ON TREATMENT SATISFACTION WITH MEDICATION IN BREAST CANCER PATIENTS: A CROSS-SECTIONAL STUDY FROM PALESTINE
    (جامعة النجاح الوطنية, 2022-03-27) Daifallah, Aiman Hussein Mohammed
    Background: Pain after therapy is an important clinical problem in breast cancer patients. Unfortunately, patients with cancer have a lower quality of life due to undertreatment of post-treatment pain; therefore, improving medication management plans and palliative care became one of the most important targets of cancer therapy. Objectives: The current study aimed to examine the impact of posttreatment pain (pain severity and interference) on medication satisfaction in patients with various stages of breast cancer in Palestine. Methods: A correlational cross-sectional study was conducted at Al-Watani Hospital and An-Najah National University Hospital in the Nablus area. Using the Brief Pain Inventory (BPI), the intensity and interference of pain will be evaluated. Patients’ satisfaction with cancer management medications will be measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). Results: Two hundred and fifty-four patients were included in this study. All were women, with a mean ± SD age of 53.1 ± 10.7 years. Patient satisfaction with medication reported was measured using the median scores of 4 domains (Effectiveness satisfaction 61.0 [50.0-72.2], Side effects satisfaction 59.4 [31.3-100.0], Convenience satisfaction 66.7 [61.1-77.8] and Global satisfaction 64.3 [50.0-78.6]). There were significant negative correlations (p < 0.05) between pain severity and effectiveness interference (r = -0.258, -0.319, respectively), side effects (r = -0.414, -0.514, respectively), convenience (r = -0.274, -0.307, respectively), and global satisfaction domain scores (r = -0.293, -0.287, respectively). The regression analysis results indicated an independent association between chemotherapy use and a higher global satisfaction score (p = 0.011). Also, lower pain interference score (p = 0.01) and patients without side effects (p = 0.47) were independently associated with higher Effectiveness satisfaction scores. Finally, lower pain interference scores (p < 0.001), patients without post-treatment pain (p = 0.034), and patients without side effects were independently associated with higher side effects satisfaction scores. There were significant positive correlations indicated between global satisfaction score and the use of cyclophosphamide (p =0.018), between effectiveness satisfaction score and the use of (p = 0.035), and between convenience satiasfaction score and the use of tamoxifen (p = 0.038). There were significant negative correlations between convenience satisfaction score and the use of adriamycin (p = 0.005), docetaxel (p = 0.008), capeciatabine (p = 0.022), gemcitabine (p = 0.026), and trastuzumab (p = 0.002). Conclusions: Patients with posttreatment pain, side effects, and greater pain interference with their functioning had lower satisfaction scores. Therefore, better management of their treatment medications, side effects, and pain medications is recommended to enhance their satisfaction and quality of life.
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    Chemical composition and pharmacological screening of Micromeria fruticosa serpyllifolia volatile oils collected from West Bank-Palestine
    (An-Najah National University, 2018-02-26) سلامه, نهاية محمد يوسف; شريم, نصر
    Background and Objectives Micromeria fruticosa subspecies serpyllifolia (M. Bieb.) is one of the Medicinal Aromatic Plants (MAP) which are dominated in the eastern Mediterranean regions including Palestine, has pleasant minty fragrance, in hot summer provide sensation of coolness. The objective of the current work was to screen and compare the chemical constituents and potential pharmacological properties of Micromeria fruticosa serpyllifolia volatile oils collected from three different regions in the West Bank -Palestine. Methods The volatile oils of three samples of Micromeria fruticosa serpyllifolia were extracted using Microwave - ultrasonic apparatus method. The volatile oils samples were analyzed for chemical constituents using GC-MS. The antioxidant activity of the volatile oils of the three samples were screened by the inhibition of 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical. The antilipase activity was evaluated using porcine pancreatic lipase (PL) and p-nitrophenyl butyrate (PNPB). The anti amylase activity was assessed using porcine pancreatic α- amylase, starch and 3,5-dinitrosalicylic (DNSA). The antimicrobial activity was examined using broth microdiltution method separate for antibacterial and then for antifungal and agar dilution method for fungal assessment. Nine bacterial strains were used four Gram-positive: Staphylococcus aureus, Staphylococcal enterotoxin B (SEB), Enterococcus faecium, "methicillin"-resistant Staphylococcus aureus (MRSA), and five Gram-negative strains; Proteus mirabilis, Pseudomonas aeruginosa, Escherichia coli, Shigella sonnie, Klebsilla pneumoniae and one fungus Epidermophyton floccosum and one yeast Candida albicans. Results Plant extracts yield range was (0.67 to 0.99%) (w/w%). GC-MS analysis showed the high percentages of oxygenetated components with the range of (86.1-89.88%), non oxygenated components in the range of (4.38-4.71%), the total identified compounds range was (90.48-94.44%). Seven components were observed, pulegone was the most abundant components in the three samples in the range of (74.43-86.04%), isomenthone was the second abundant components with the range of (3.16-14.41%).The sample from Ramallah (middle region) showed the potent antioxidant agent with IC50 0.45 µg/mL, the sample from Hebron (southern region) was the potent antilipase agent with IC50 85.00 µg/mL. The sample from Nablus (northern region) was the potent antiamylase agent with IC50 3.00 µg/mL. The three samples exhibited broad antimicrobial activity; the three samples showed potent antifungal activity at minimum inhibitory concentration (MIC) with the range of (0.206 to 0.781 mg/mL). The sample from Hebron (southern region) showed the highest potency against Shigella sonnie with lowest reported MIC value (1.56 mg/mL), the sample of Nablus (northern region) demonstrated the least potency against Staphylococcal enterotoxin B (SEB) and 'methicillin" resistance Staphylococcus Aureus (MRSA) with highest MIC value (6.250 mg/mL). However, the three samples showed broadspectrum antibactreial activity with MIC value (3.125 mg/mL). Conclusion The study showed that Micromeria fruticosa serpyllifolia volatile oils samples from different regions in Palestine contained different proportions of phytochemicals which provided different potential biological activities such as: antioxidant, antiobesity, antidiabetes and antimicrobial activities that were in line with traditional uses of the plant extracts. The plant extracts showed higher antioxidant, antilipase and antiamylase potency higher than that of the relative references and there were significant differences in these activities compared to each other. Further in vivo studies are required to evaluate the potential pharmacological activities, safety and toxicity of plant extract. Also further studies are needed to isolate, identify and characterize the main components responsible for potential pharmacological activities..
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    Clinical Pharmacokinetics: Perceptions of Hospital Pharmacists in Palestine about how it is Taught and Applied
    (جامعة النجاح الوطنية, 2020-12-02) Aqel, Rafeef
    Background: The American society of health-system pharmacists (ASHP) defined clinical pharmacokinetic (CPK) as "the application of pharmacokinetic (PK) principles to the safe and effective therapeutic management of drugs in an individual patient". Where the main aims of CPK are optimizing efficacy and reducing toxicity. CPK is one of the main courses in pharmacy curriculum, as graduating pharmacists will be responsible of initiating and adjusting drug doses and making decisions about drugs that need therapeutic drug monitoring (TDM) when they go to their work places. Application of TDM in many studies showed improvement in patient outcomes including achieving drug levels within a fewer number of days, shortening length of hospitalization, reducing mortality and morbidity, shortening febrile period and increasing medication safety. In this study we looked at pharmacist's perceptions and training background in PK courses contents they received during their undergraduate pharmacy programs. We also aimed to determine the barriers experienced by the pharmacists when applying PK principles in their current practice and explore the influence of the respondents’ characteristics on their perception about clinical PK. Method: This is a descriptive cross sectional self-administered questionnaire that targeted licensed hospital pharmacists in most hospitals under the umbrella of the Ministry of Health (MOH) in Palestine, in addition to pharmacists working in most private hospitals in the West Bank (WB) and Jerusalem. The questionnaire was prepared to obtain the relevant answers that contribute to the final results. The data was collected between August and November of 2018. Results: In this study a total of 145 questionnaires were distributed among hospital pharmacists in Palestine. Most of the participants were female (78.6%) and the vast majority of participants (71.7%) had taken their first pharmacy degree from Palestine. PK courses were taught in 74.5% of the undergraduate programs with most of the courses (57.9%) covering basic PK principles. In addition 88.3% of participants hadn't received any PK related courses after graduation. While rating the degree to which various barriers hindered the application of PK principles in current practice, we found that the lack of PK related continuing education topics was the highest in importance category (55.2%). Furthermore, we had an agreement between more than half of pharmacists about adequacy, importance and relevance of PK courses in their undergraduate programs to current practice. Pharmacists who took their pharmacy degree from foreign countries other than Palestine were more agreed about adequacy, efficacy and way of teaching of CPK courses with significant association as (p < 0.05). Conclusions: Improving the depth and methods by which PK courses are taught, in addition to providing continuous education learning (CEL) for hospital pharmacists in PK will improve pharmacist's perception about PK courses and their application in clinical practice as only 11.7% of pharmacists had taken any related former courses after graduation, also having a CEL for other health care professionals will improve application of clinical pharmsicts role as poor understanding of PK by the health care professionals where one of the barriers that faced pharmacists in application PK.
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    Community Pharmacists' Medication Knowledge: A Nation-wide Study in Palestine
    (2012) Enass Majed Abd Alrahman Abu Arah; Prof. Waleed Sweileh; Dr. Adham Abu-Taha
    Background: Community Pharmacists are easily accessible to the public. They have an important role and responsibility in monitoring the safety of medicines dispensed with or without a prescription. Objective: This study aims to assess medication knowledge of Palestinian community pharmacists. In specific, knowledge of community pharmacists about safety of medicines during pregnancy and evidence based therapy of herbal products will be assessed. Methodology: This is a cross-sectional survey study on community pharmacists. The medication knowledge was assessed by a set of questions specifically designed for this purpose. Scores of the test were presented as percentage from a total of 100. The internal consistency of each test was acceptable with a Cronbach alpha ≥ 0.6. Results: Approximately one third of chief community pharmacist in West-Bank, Palestine took part in the study. The sample consisted of 173 (50.6%) females and 169 (49.6%) males. The majority of the participants (303; 89.2%) had a B.Sc. degree in pharmacy while 37 (10.8%) had an M.S degree. Community pharmacists have the following median (Q1-Q3) scores: [70% (60-80)]; [40% (30-50)]; and [50% (40-70)] for the general knowledge, safety of medicines during pregnancy and in evidence based herbal therapy tests respectively. The total score was significantly and negatively correlated with the number of years since graduation (r= - 0.2; P<0.01). Female pharmacists had significantly better score than male pharmacists in all tests (general pharmacy, herbal pharmacotherapy, total parts) but not for drug safety during pregnancy (P values = 0.16, 0.008, 0.046) respectively.. Conclusion: Good proportion of the study sample lack adequate knowledge in certain important aspects of pharmacy practice such as medication safety during pregnancy, evidence based indication of herbal products, and herbal-drug interactions. This might negatively affect the role of Community pharmacists in patient counseling and education. Authorities need to improve the community pharmacists' role in healthcare system by providing continuous and up-to-date education for community pharmacists. Practice Implications: Professional development should be mandatory in Palestine. Inclusion of a course about drugs during pregnancy into pharmacy curriculum is recommended. Key Words: Community Pharmacist, Medication Knowledge, Pregnancy, Herbal Product, Palestine.
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    Dual functionalization of single-walled carbon nanotubes for targeted cancer therapy
    (An-Najah National University, 2018-05-07) نعيم كتانة, محي الدين العسالي
    Chemotherapy is a mainstay strategy in the management of cancer. Regrettably, they suffer from serious side effects due to their effect on healthy cells besides cancerous cells. Therefore, many researchers are eager to develop new drug delivery systems that may help to decrease the side effects and the effective dose of the drug in addition to target delivery of the chemotherapy to cancer cells. One of the epochal drug delivery systems in this field are based on carbon nanotubes technology. The aim of this work is the covalent functionalization of single walled carbon nanotubes with Doxorubicin in the presence of tetraethylene glycol linker to improve the solubility and dispersibility of the developed nano-drug. Moreover, in order to target the cancer cells, a targeting agent mannose was also loaded on the nano-system. The characterization of the developed nano-drug by transmission electron microscopy showed good dispersibility of the functionalized single walled carbon nanotubes with diameters (6-10) nm. Moreover, the percentage of functionalization was determined by thermogravometric analysis showing 25% of functionalization in the case of Dox-SWCNTs (7) and 51% for Dox-mannose-SWCNTs (11). The in vitro release profile of Dox from Dox-SWCNTs (7) showed 45% of the loaded drug was released over 18 hr at pH 7.4 and almost complete release at pH 5.5 at 37 ºC. However, the in vitro release profile of Dox from Dox-mannose-SWCNTs (11) showed 75% of the loaded drug was released over 5hr at pH 5.5 at 37 ºC. The cytotoxity effect of the compounds was studied at different concentrations and different pH conditions and compared with Dox alone. The maximum cytotoxity effect was observed at 4μg/ml and at pH 6.5. After that, the pre-incubation with any of the tested concentrations of mannose reduced the cytotoxicity of Dox-mannose-SWCNT by approximately 40-57%, suggesting that the entry of this complex might be dependent on mannose receptors, which imparts this complex a kind of selectivity for cancer cells that overexpress this type of receptors.  
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    Effects of self-care and self-efficacy on glycemic control in patients with type 2 diabetes: A cross sectional study from Palestine
    (An-Najah National University, 2018-12-12) أبو بكر, ربا عباس سليم
    Background: Type 2 diabetes mellitus has become a significant public health problem in many countries including Palestine where it is considered the fourth cause of death. Self-care/self-efficacy has been shown to have strong correlation with glycemic control among patients with type 2 diabetes. However, such evidence is lacking in Palestinian primary health care centers. Objectives: To examine if there is any significant relationship between self-efficacy/self-care and blood glucose control, to determine factors associated with self-efficacy and self-care behavior, to determine factors associated with glycemic control, and to estimate the prevalence of glycemic control among diabetic patients. Method: This cross-sectional study involved 380 type 2 diabetes patients attending Al-Makhfeyyeh primary health care center in Nablus/Palestine during July to September, 2017. Patients were assessed for self-care/self-efficacy behaviors, and glycemic control (HbA1c). Results: of the total 380 patients, 82.4% had a poor glycemic control, as was indicated by HbA1c levels of > 6.5%. SES8C scale analysis revealed that high education level is a strong predictor for good type 2 diabetes self-efficacy behaviors (p value= 0.001). PEPPI scale analysis revealed positive direct effect between self-efficacy score with married participants (p-value was 0.034) and with high educated participants (p-value was <0.001). Significant correlation between participants in daily activities score was shown in participants <65years old (p-value <0.001), single or divorced (p-value 0.043), low educated (p-value 0.008), using monotherapy (p-value 0.034), using insulin injection (p-value <0.001), having ≥ 3 chronic diseases (p-value <0.001), and having high blood pressure (p-value 0.001). Physical activity shows positive correlation with young age, males, married, educated participants, not using insulin injection, and not suffering from any chronic diseases. No significant association was found between self-care/self-efficacy with glycemic control (p-values > 0.05). About half of the participants using insulin injection (48.7%). Only 12% of patients prepare a list of questions to ask their doctors about their illness and about 42% never discuss any personal problems that may related to their illness with their physicians. Conclusion: This study has found that higher self-efficacy behaviors were among high educated patients, and married participants. No relation between self-care/self-efficacy and glycemic control was found. Healthcare providers should encourage patients to increase their daily physical activity, having regular feet-care examination, and measure their blood glucose level regularly. Also patients should trust their physicians more and communicate with them to increase their knowledge about their illness and treatment.
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    Evaluation of anemia management among hemodialysis patients in Palestine: associated factors and clinical outcomes
    (Nada Sadek Rajabi, 2020-01-23) Rajabi, Nada
    Background: Anemia is a frequent complication in patients on maintaining hemodialysis (HD). Appropriate management involves the administration of iron supplementation and erythropoietin stimulating agents (ESA) therapy besides monitoring the response. Poor health related quality of life (HRQOL) is also a common impairment in HD patients results from the dialysis procedure it-self or its related comorbidity. This study aimed to evaluate anemia management in HD patients from Palestine, determine the associated demographic and clinical characteristics with it, describe patients HRQOL and its association with appropriate anemia treatment. Methods: The study was a cross sectional observational study; patients were included from three dialysis centers from West Bank - Palestine during the period of 24-June to 5-September 2018. The data filled by interviewing the enrolled patients and getting access to patient’s health profiles. The data collection form consisted from two portions, the initial contains demographic and clinical information about the patients while the latest consists of the European Quality of Life 5- Dimensions scale (EQ-5D-5L) that represents the descriptive system and the EQ visual analogue scale (EQ-VAS) which represents the health status of patient in their own judgment. Results: 226 patients included. Their mean age (± SD) was 57 ± 13.9 years. The mean hemoglobin (Hb) level (± SD) was 10.63 ± 1.71 g/dl, 34.1% of patients had Hb level 10-11.5 g/dl. Only 72.1% and 81.9% of patients recorded for serum ferritin and transferrin saturation (TSAT) respectively. 33.1% of patients had serum ferritin ≥ 500ng/ml and 50.3% had TSAT ≥ 30%. All patients who received iron supplementation received it by intravenous route and dose of 100mg of iron sucrose. Almost 86.7% of patients received Darbepoetin by intravenous route and weekly dose of 0.45 mcg/kg, 24% of them had Hb >11.5g/dl. On the other hand, 2.4% of patients had Hb < 10g/dl and did not received ESA therapy. Regarding EQ-5D-5L 22.6%, 54.9%, 32.3%, 29.6% and 25.2% of patients had level of “no problem” across the dimension of quality of life; mobility, self-care, usual activity, pain/ discomfort and anxiety respectively. Only 0.9% of patients had the highest degree of difficulty in the five dimensions. There was a significant association between Hb level, number of years the patients received HD and HRQOL. Conclusion: Our study found a significant association between Hb level and patients HRQOL, therefore the appropriate management of anemia in HD patients by adherence to NKF-KDOQI guideline recommendations provides an improvement in their quality of life in addition to obtain the optimal therapy. Key word: Anemia, Hemodialysis, Hemoglobin, Iron status, Erythropoietin stimulating agent, Health related quality of life.