An-Najah Staff

Antibiotics are considered to be among the most commonly sold drug classes in Palestine. Resistance to antibiotics has increased for reasons relating to the use and misuse of antibiotics. The aim of this study was to evaluate the knowledge, and attitudes regarding antibiotic use and awareness about resistance among adults visiting the emergency departments at hospitals in North Palestine. A self-administered cross-sectional questionnaire survey involving participants aged 18 or over was conducted from June 2012 to February 2013. Adults who visited the emergency departments at hospitals in North Palestine were included. Demographic characteristics, knowledge and attitudes towards antibiotic use were included in the questionnaire. Poor and good knowledge were defined as a total knowledge score of 0–7 and 8–15 of 15 questions, respectively. Attitude scores of 0–3 and 4–7 of 7 questions were considered poor and good, respectively. A total of 375 questionnaires were included in the study. A response rate of 83.3% was attained. About 55.0% of the participants had a good knowledge and 56.5% had a good attitude towards rational antibiotic use. A significant positive correlation was shown between participants’ knowledge scores and participants’ attitude scores towards antibiotic use (R = 0.344, P = 0.001. Participants with a high family income were more likely to be aware of appropriate antibiotic use than participants with a low family income (P-value <0.001). Participants with a higher educational level (university) had a good attitude towards rational antibiotic use than those with a lower education level (P-value <0.001). This study has documented important knowledge and attitude gaps in antibiotic use. These findings will help health policymakers in Palestine to implement intervention programmes to rationalize antibiotic use. Continuing medical education, professional development and training workshops for healthcare professionals regarding rational use of antibiotics and health risks associated with the spread of antibiotic resistance are needed. In addition, minimizing non-prescription use of antibiotics and increasing the public awareness about the health and economic hazards of antibiotic resistance are also required.

Background Hepatitis B and C virus infection is a lead cause of morbidity and mortality among hemodialysis patients. Yet, little research has focused on the morbidity measures of these serious disorders in low and middle income countries. The study aims to estimate the prevalence of hepatitis B and C among hemodialysis patients in the West Bank hospitals in Palestine. Methods A retrospective medical records review design was performed for all governmental and private hospitals in the West Bank which provide hemodialysis services for the patients. Data was retrieved from the patients’ medical files and from the computerized health information system in some hemodialysis centers. SPSS software version 16 was used for data entry and analysis. Results In overall, 868 hemodialysis patients attending nine hemodialysis hospitals in the West Bank was recruited. The overall prevalence of hepatitis B virus was found to be 3.8 % (33 cases) with a range from 0.0 % (in Jericho and Qalqelia districts) to 11.8 % (in Bethlehem district). Regarding hepatitis C virus, the overall prevalence was estimated around 7.4 % (64 cases) with a range from 2.9 % (in Nablus district) to 15.9 % (in Qalqelia district). Conclusions Although relatively low prevalence of both hepatitis B and C virus was found in a couple of hemodialysis hospitals, some higher prevalence values urge for the implementation of stricter infection prevention measures and more effective follow up procedures.

Background In Palestine, medicinal plants have continued to play a vital role in fulfilling animal healthcare needs of rural communities. However, these valuable resources are being depleted mainly due to over-harvesting, inappropriate agricultural practices (e.g., over use of herbicides), agricultural expansion, and over-grazing. Therefore, immediate action is required to conserve these resources and document the associated knowledge. The purpose of this study was, thus, to document and analyze information associated with medicinal plants that are used in managing animal health problems in the West Bank, Palestine.
Materials and methods Ethnobotanical data were collected from Apr 2012, to Feb 2014 mainly using semi-structured interviews with informants sampled using purposive sampling technique and through field observations.
Results The study revealed the use of 138 medicinal plant species in the West Bank for the treatment of several livestock diseases, of these 75 species representing 70 genera and 33 families were reported by 3 independent informants or above. Classification of the ethnoveterinary plant species cited by three informants or above used in a rank-order priority (ROP) based on their claimed relative healing potential has demonstrated that the following are the plants with the highest efficacy: Camellia sinenses, Teucrium capitatum, and Salvia fruticosa with ROPs of 97.1, 93.2, and 91.4, respectively, are used primarily to relieve gastric disorders. Gastrointestinal disorders is the disease group in the study area that scored the highest Informant consensus factor (ICF) value (0.90), followed by urinary, and reproductive disorders (0.89). Conclusion Our study provided evidence that medicinal plants are still playing important role in the management of livestock diseases, and showed that ethnoveterinary plants used in animal health care in Palestine have been also recorded in human Traditional Arabic Palestinian Herbal Medicine (TAPHM), and demonstrated a strong link between human and veterinary medical practices. This survey has identified a number of important medicinal plants used by the Palestinian farmers of the West Bank area for the treatment of various animal ailments. It provides a baseline for future phytochemical and pharmacological investigations into the beneficial medicinal properties of such plants. 

Background
The objective of this study was to evaluate the appropriateness of antibiotic suspensions use for pediatrics among Palestinian mothers’ including their reconstitution, dose administration, duration, and storage conditions.
Methods
This study was a questionnaire based cross sectional descriptive study. It was conducted at a governmental primary healthcare center and a pediatric private clinic in Nablus city between January and March 2013. A sample of 400 mothers were met and asked to answer a face to face questionnaire.
Results
The results showed that 347 (86.8 %) of mothers told that they read instructions, 311 (77.8 %) could understand manufacturers’ instructions, and 176 (44.0 %) of mothers asked pharmacists for advice when instructions were not well understood. In order to prepare antibiotic suspension, 302 (75.5 %) used boiled then cooled water, 192 (48.4 %) of mothers used a syringe to measure the needed amount of water, and 304 (76.6 %) added water in two steps, 392 (98.0 %) of mothers claimed that they shook the suspension bottle before use. Regarding dose administration, 313 (78.2 %) considered syringe as the most accurate tool for dose administration, most of mothers told that they gave drug dose with major meals when direction were to give three times daily, about use duration only 6 (1.5 %) mothers said that they used antibiotic suspension after 2 weeks, and 53 (6.5 %) gave left over antibiotic suspension to another child. One hundred seventy seven (44.2 %) mothers told they stored dry powder antibiotic in medicinal cabinet, while 226 (56.5 %) of them stored suspension in refrigerator.
Conclusion
The results reflect a good level of correct practice. However, there is a room for improvement. The pharmacists are recommended to explain the correct directions, to supply a syringe with suitable calibration for dose administration, and to counsel parents about suitable storage condition, frequency of dosing and duration of use.

Background The aim of this study was to find the prevalence of potential drug-herb interactions in patients with chronic diseases and identify factors associated with these interactions if present.
Method The study was a questionnaire based cross-sectional study. It was conducted at a number of governmental primary healthcare centers which include outpatient clinics for chronic diseases between July and November 2013. Patients come to these clinics monthly or bimonthly to receive their medications for their chronic diseases free. The patients in this study were seen at these clinics and their medications were reported from the most recent prescription in their files.
Results A total of 400 patients agreed to be interviewed, 209 (52.3 %) were females. The most commonly used medications were metformin, insulin, and enalapril. Among the patients, 237 (59.3 %) were using 395 medicinal herbs. The most commonly used herbs were sage, anise and peppermint. In 51 out of the 237 cases (21.5 %) at least one potential drug-herb interaction was found. Male patients were more likely to have potential drug-herb interactions. Patients with potential drug herb interactions were older, having a higher mean number of chronic diseases and medications (P-value < 0.05). Only 133 out of 237 (56.1 %) users told their prescribers or pharmacists before using medicinal herbs.
Conclusion Use of medicinal herbs is a common practice among Palestinian patients attending primary healthcare centers. A substantial proportion failed to disclose to their doctors or pharmacists about herbal products they used, therefore, the physicians and pharmacists are recommended to ask patients about the use of medicinal herbs to avoid any possible negative outcomes. Better counseling and communication between patients and healthcare providers is recommended. 

Ethnopharmacological relevance:
Recent ethnopharmacological surveys showed that herbal remedies are the most preferred modality of complementary and alternative medicine (CAM). In Palestine as in many other countries, herbal remedies are widely used in the treatment of many diseases.
Aim of the study:
The aim of this study was to investigate the use of herbal remedies by women living with breast cancer in the West Bank of Palestine.
Methods:
This study was a questionnaire based cross-sectional descriptive study on the use of herbal remedies by breast cancer patients in the West Bank. A questionnaire was distributed to 115 patients at outpatient cancer clinics in face to face interviews.
Results:
The study had a response rate of 89.6%. Of all respondents, 68% were herbal remedies users. Women with breast cancer used 46 plant species belonging to 32 families. Of these, Brassicaceae and Lamiaceae were the most prevalent. Ephedra alata was the most commonly used plant species in the treatment of breast cancer. Leaves and seeds were the most commonly used parts and decoction was the most commonly used method of preparation. Herbal remedies users were more likely to use herbal remedies instead of chemotherapy. The most commonly stated reason for using herbal remedies was the belief in boosting the patient's immune system to fight cancer.
Conclusion:
The use of herbal remedies is prevalent in breast cancer patients in Palestine. The use of herbal remedies was associated with educational level, time since diagnosis, type of surgery use, and use of endocrine therapy. It was apparent that the majority of users were satisfied with herbal remedies use. Clinical trials and pharmacological tests are required to be established for the presence of side effects, toxicity and efficacy for these herbal remedies.

Genetic diversity in 50 snake melon accessions collected from Palestine (West Bank) was assessed by examining variation in 17 phenotypic characters. These accessions belonged to four important landraces of Cucumis melo var. flexuosus: Green ‘‘Baladi’’ (GB), white Baladi (WB) green Sahouri (GS), and white Sahouri (WS). Principal component analysis (PCA) and a dendrogram were performed to determine relationships among populations and to obtain information on the usefulness of those characters for the definition of cultivars. PCA revealed that secondary fruit skin color, flesh color, primary fruit skin color, and secondary skin color pattern were the principal characters to discriminate melon accessions examined in the present study. According to the scatter diagram and dendrogram, landraces of C. melo var. flexuosus: GB, WB, GS, and WS formed different clusters. However, based on Euclidean genetic coefficient distances, GB and WB had the least degree of relatedness with GS and WS, indicating distantly related landraces (Baladi and Sahouri). On the other hand, the highest degree of relatedness was detected between WS on one hand, and both GS and WB on the other indicating closely related cultivars. Fruit traits variability among the different snake melon landraces was evaluated and discussed in this study. This evaluation of fruit trait variability can assist geneticists and breeders to identify populations with desirable characteristics for inclusion in cultivars breeding programs.