Pharmacology

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https://hdl.handle.net/20.500.11888/17721

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    UPPER GASTROINTESTINAL COMPLICATIONS AND TREATMENT AMONG PATIENTS WITH CHRONIC DISEASES: A CROSS SECTIONAL STUDY FROM PALESTINE
    (2022-10-23) Deema Mahmoud Mustafa Tumeh
    Background: Most people, older than 60, have at least one chronic disease. Therefore, these people have no choice but to use, multiple drugs. Gastrointestinal complications occur because of the harmful effects of these chronic drugs on the stomach. Objectives: The study has assessed the prevalence of patients taking chronic drugs and suffering from upper gastrointestinal complications, the severity of these symptoms, and their taking of any gastro-protective drugs or not. Methodology: This is a cross-sectional study. A questionnaire was developed and administered format outpatient clinics at a specialized hospital. Patients with chronic diseases who were taking at least one medication were included in the study. A form was used for data collection. The Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was used to evaluate the severity of the upper gastrointestinal symptoms. Statistical analysis was performed, using the Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 400 patients with chronic diseases and using multiple medications participated in the study. Of these 53.8% were females and 56% were married, 58.5% were unemployed, and 70% were non- smokers.The mean age was 54.7±17.5. The most common comorbid diseases among the patients were diabetes, hypertension, and arthritis: 44.3%, 38%, and 27.3%, respectively. Most patients used between 2 and 4 medications daily. The most commonly used medication was aspirin. It was used by 50%, followed by atorvastatin, bisoprolol, and insulin: 29.5%, 25%, and 20.3%, respectively. Among the 400 participants, 362 (90.5%) suffered from upper gastrointestinal side effects like indigestion (66%), heartburn (77.5%), nausea (49.3%), and regurgitation (52.3%). Based on SF-LDQ scoring, of the 400 respondents, 235(58.8%), 109(27.3%) and 18(4.5%) suffered from mild, moderate and severe dyspepsia, respectively. In addition, 38 (9.5%) had no dyspepsia. About 81.3% of participants were prescribed gastro-protective medications. Proton pump inhibitors were the most prescribed group for 209 (52.3%) patients. Older age, marriage health insurance, education, smoking and ≥ 5 medications were all associated with a higher possibility of having dyspepsia; (p-value <0.05). Conclusion: Upper gastrointestinal complications among patients with chronic diseases were very common. Fortunately, the symptoms were mild in most cases. The risk increased with age and with the use of high number of medications. The use of gastro-protective agents, when needed, is important. Keywords: Chronic disease; upper gastrointestinal side effects; stomach irritation; dyspepsia;Palestine
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    DOWN-REGULATION OF BETA-CATENIN IN CANCER CELLS BY SIRNA COMPLEXED WITH CARBON NANOTUBE
    (2023-03-14) Ahmad Ghareeb
    Globally, according to the World Health Organization, cancer is the second leading cause of death worldwide. In order to manage cancer, many approaches have been used, such as surgery, radiation, chemotherapy, and gene therapy. Medicine research has taken advantage of biotechnology-based therapy in the past several years, and one of the newest strategies in cancer therapy; is the utilization of small interference RNA (siRNA) to control gene expression. However, effective delivery of siRNA into cells is a challenge, particularly in vivo. Lipofectamine is currently used in vitro for this purpose, but unfortunately, the compound has demonstrated unacceptable toxicity in vivo. To deliver these types of molecules without causing significant harm, researchers are developing new technological delivery systems. The development of drug delivery systems based on carbon nanotubes (CNTs) has received a lot of attention in this respect. Our project aims to develop a new method for delivering siRNA into colon cancer cells in order to target the expression of the β-catenin protein, which is known to play a role in a variety of developmental processes; such as cell growth and proliferation, embryonic patterning, cell differentiation, and other cellular functions. The new approach is based on the synthesis of a new nano-system of multi-walled carbon nanotubes (MWCNTs) functionalized with a tetra-amine linker and mannose sugar as a targeting agent to increase the nano-system`s uptake and selectivity. We successfully functionalized MWCNTs with tetra-amine groups (f-MWCNTs (8)), which were then functionalized with mannose molecules (f-MWCNTs (12)), confirmed by atomic force microscopy. In addition, the amount of amine in f-MWCNTs (8) was 12.7 x 103 nmol/mg and 40 x 103 nmol/mg in f-MWCNTs (12), while the amount of loaded mannose in f-MWCNTs (12) was 20.02 μg/mg as confirmed by the anthrone method. The N/P ratio required to trap β-catenin siRNA starts at 5:1 for f -MWCNTs (8) and 15:1 for f -MWCNTs (12), as determined by agarose gel. Western blot analysis revealed that our compounds significantly reduced β-catenin protein expression (p > 0.05). The knockdown percentage was 20% in f-MWCNTs (8) and 50% of f-MWCNTs (12). We hypothesized that the possible up-regulation of mannose receptors on the surface of caco-2 cells may increase the transfection efficacy of f-MWCNTs (12) compared with f-MWCNTs (8). The MTS results showed that the down-regulation of β-catenin protein can restrict cancer cell growth and prevent cell proliferation which was shown significantly in both transfection approaches with an IC50 equal to 66.48 for f-MWCNTs (8)-siRNA slightly lower than control (IC50 = 70.01μg/ml) while 19.32 μg/ml for f-MWCNT (12)-siRNA. Also, this effect can increase the efficacy of 5-FU in colon cancer significantly compared with control. Therefore, we propose that our approach could be implemented in the setting of colon cancer therapy. Keyword: Beta-catenin; Colorectal Cancer; Multi-walled Carbon Nanotubes.
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    PHYSICIAN’S ADHERENCE TO INTERNATIONAL TREATMENT GUIDELINES FOR MAJOR PSYCHIATRIC DISORDERS: A DESCRIPTIVE STUDY FROM PALESTINE
    (2022-11-03) Huda Said Shebli
    Background: Psychiatric disorders are progressively considered among the common health disorders affecting people worldwide. Data from Western countries show that psychiatric disorders are relatively prevalent. Objectives: In this study, we aimed to assess the Palestinian psychiatrist’s adherence to the international treatment guidelines in treating common psychiatric disorders. In addition, we aimed to explore the factors associated with non-adherence to the treatment guidelines. Methodology: A retrospective study was conducted to examine psychiatrist’s adherence to treatment guidelines and the factors associated with the non-adherence of patients diagnosed with schizophrenia, depression, anxiety, bipolar disorder, and schizoaffective disorders, which was obtained from the period May 2021 to September 2021 in an outpatient psychiatric clinic in the north of West Bank, Palestine. Results: A total of 1070 prescriptions were examined. Most patients were aged between 36 and 55 years (47.8%), and two-thirds were males (63.8%). Most of the patients were diagnosed with schizophrenia (46%), while the rest were diagnosed with depression, bipolar disorder, schizoaffective, and anxiety (22.7%, 18.2%, 9.1%, and 4%, respectively). In general, the most commonly prescribed drugs were typical anti-psychotics (47%), followed by atypical antipsychotics, SSRIs, TCAs, BZD, anti-convulsants, and lithium (39.9%, 22.7%, 20.7%, 15.3%, 14.3%, and 3.6%, respectively). Moreover, the study showed that the majority of psychiatric prescriptions (76.8%) were non-adherent to treatment guidelines and 64.7% of them were for males while 47.5% of non-adherent prescriptions were for adult patients aged 36-55 years old. The non-adherent prescriptions were significantly higher among patients diagnosed with schizophrenia (50.73%) (p-value=0.000). In addition, the study found that the majority of non-adherent prescriptions (37%) were due to the drug’s unavailability in the psychiatric clinic. Conclusions: The pharmacotherapy of the major psychiatric disorders in Palestine was not in line with the international treatment guidelines. The most common factors which were associated with the non-adherence are schizophrenia and drug unavailability. Keywords: Adherence; Factors; Guidelines; Outpatients; Psychiatric Disorders.
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    DRUG UTILIZATION PATTERN AMONG TYPE II DIABETIC PATIENTS IN PALESTINE
    (2023-09-24) Mai Ayed Ahmad Awad
    Background: Diabetes mellitus is a type of frequent metabolic illnesses that leads to hyperglycemia from a number of different pathogenic pathways. Drug utilization studies on anti-diabetic agents is essential for encouraging responsible drug use and providing useful data for health planning. Objective: This study aims to describe the drug utilization and the drug description pattern of Type 2 Diabetes Mellitus (T2DM) in Palestine and determine whether it follows the international guidelines of taking hypoglycemic medications in T2DM specially the initial drug prescribed after diagnosis with T2DM mainly in patients treated in diabetic health care centers in MOH. Methods: A cross-sectional survey was conducted in patients treated in diabetic health care centers in Ministry of Health (MOH). The study participants were selected randomly, and 400 patients were interviewed from the diabetic clinics in the northern and middle areas of the West Bank, Palestine. All ethical guidelines were taken into consideration in this study. Results: The results showed that 400 patients were interviewed, 138 (34.5%) were males and 262 (65.5%) were females. The mean age of the patients is 60 years old. The most initial drug prescribed for diabetic patients was metformin. The study's adherence showed that 68% of patients take their medicines as directed yet 24% occasionally forget. Also, vast majority of diabetic patients (about 90%) follow their prescribed medication regimen, taking the recommended dosage exactly as indicated and neither more nor less. Our analysis's findings indicated that there isn't a statistically significant difference in the way that metformin is prescribed in various areas. Glimepiride prescriptions, however, differed statistically significantly (p=0.01) throughout the areas that were visited. Conclusion: Findings of the study have revealed that the most often used medication was metformin as initial therapy, followed by glimepiride. Combination treatment was more frequently used. Therefore, steps may be taken to promote rational prescription by studying the present prescribing practices. Keywords: Drug utilization review, Diabetes mellitus type II, oral hypoglycemic agents, hyperglycemia.
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    GENERATION OF ENGINEERED DERMAL TISSUES ENRICHED WITH CHITOSAN-MULTIWALL CARBON NANOTUBE COMPLEX FOR UTILIZATION IN WOUND HEALING
    (An - Najah National University, 2023-05-29) Amal Jafar Alqato
    Introduction and background: The process of wound healing is complicated and involves four precise stages: hemostasis, inflammation, proliferation, and remodeling. When interrupted, this process can result in chronic wounds, constituting significant health and economic burden. Engineered skin tissues (EST) with different constituents have been proposed as a potential treatment. Aim of the project: To generate engineered dermis tissues (EDTs) as a substitute for the dermis layer to enhance wound healing. Material and Methods: The scaffolds of the generated EDTs were based on collagen, which is similar to the natural dermis, and it was enriched with chitosan, a natural biocompatible and biodegradable polymer that possesses wound-healing properties, and different concentrations of multiwall carbon nanotubes (MWCNTs) that can enhance the mechanical properties of the EDTs. The effect of incorporating angiotensin-II (Ang II) in the tissues on angiogenesis was also investigated. All tissues were populated by 3T3 cells. The EDTs were transplanted in a mouse wound model, and the wound sites were analyzed macroscopically and histologically by masson-trichrome stain after 14 days of transplantation to evaluate the quality of wound healing. Results: Overall, our study found that transplanted tissue had no negative impact on animal health. It reduced contraction and facilitated epithelization, but did not affect the percentage of wound closure. EDTs transplantation did not affect the thickness of the new epidermis, but it increased the thickness of the dermis. The incorporation of Ang II in the matrix of the EDT did not affect the degree of angiogenesis. Conclusions and Recommendations: The transplanted tissue enhanced the quality of wound healing by promoting epithelialization and reducing contraction. This finding is significant for the development of potential treatments for slow-healing or high-risk scarring wounds.