An-Najah Staff

To evaluate the geographic distribution of Giardia intestinalis genotypes in Nablus, West Bank, Palestine, a genotyping study was performed using clinical fecal samples. Microscopic examination confirmed that 8 of 69 (11.6%) samples were G. intestinalis positive, and subsequent genotyping analyses targeting the smallsubunit ribosomal RNA (18S rRNA) and glutamate dehydrogenase (GDH) genes revealed the G. intestinalis genotypes within the 8 samples. Of these 8 samples, 6 were clustered with assemblage A-II and the remaining 2 samples were clustered with assemblage B by 18S rRNA gene analysis; however, direct sequencing of the GDH gene segments from the latter 2 samples showed a mixed infection profile. To assess those samples, we employed a subcloning approach and successfully isolated 6 independent assemblage B subgenotypes. These partial GDH gene sequences (393 bp) had 15 single-nucleotide polymorphisms, all of which were synonymous transition substitutions at the third nucleotide position of codons. From the results, we concluded that the highly polymorphic gene loci such as GDH gene locus might provide us an opportunity to obtain a detailed molecular data even from the samples with multiple-subgenotype mixed infections. Therefore, subcloning approach is recommended in genotyping studies, especially in those conducted in giardiasis-endemic areas, where the repeated and cumulative infections could be commonly expected

Objective  To detect the species of larval trematodes (cercariae) in Melanopsis praemorsa snails from 5 different fresh water bodies in Palestine.
Methods  A total of 1 880 Melanopsis praemorsa snails were collected from different fresh water bodies in Palestine from October, 2008 to November, 2010. Cercariae in Melanopsis praemorsa snails were obtained by lighting and crushing methods. The behavior of cercariae was observed using a dissecting microscope.
Results  Three different species of larval trematodes were identified from Melanopsis praemorsa snails collected only from Al-Bathan fresh water body, while snails from other water bodies were not infected. These species were microcercous cercaria, xiphidiocercaria and brevifurcate lophocercous cercaria. These cercariae called Cercaria melanopsi palestinia I, Cercaria melanopsi palestinia II and Cercaria melanopsi palestinia III have not been described before from this snail in Palestine. The infection rate of Melanopsis praemorsa collected from Al-Bathan fresh water body was 5.7%, while the overall infection rate of snails collected from all fresh water bodies was 4.3%. Details are presented on the morphology and behavior of the cercariae as well as their development within the snail.
Conclusions  These results have been recorded for the first time and these cercariae may be of medical and veterinary importance.

Objective  To detect the species of larval trematodes (cercariae) in Melanopsis praemorsa snails from 5 different fresh water bodies in Palestine.
Methods  A total of 1 880 Melanopsis praemorsa snails were collected from different fresh water bodies in Palestine from October, 2008 to November, 2010. Cercariae in Melanopsis praemorsa snails were obtained by lighting and crushing methods. The behavior of cercariae was observed using a dissecting microscope.
Results  Three different species of larval trematodes were identified from Melanopsis praemorsa snails collected only from Al-Bathan fresh water body, while snails from other water bodies were not infected. These species were microcercous cercaria, xiphidiocercaria and brevifurcate lophocercous cercaria. These cercariae called Cercaria melanopsi palestinia I, Cercaria melanopsi palestinia II and Cercaria melanopsi palestinia III have not been described before from this snail in Palestine. The infection rate of Melanopsis praemorsa collected from Al-Bathan fresh water body was 5.7%, while the overall infection rate of snails collected from all fresh water bodies was 4.3%. Details are presented on the morphology and behavior of the cercariae as well as their development within the snail.
Conclusions  These results have been recorded for the first time and these cercariae may be of medical and veterinary importance.

Background and Objective: The patient package insert is an important source of drug information. The aim of this study was to evaluate and compare the PPI of the anti-infective agents manufactured in Palestine with the imported equivalents.
Method: The selection criteria generated 15 different anti-infective agents available as 36 locally manufactured products and 15 imported equivalents. The design of the patient package insert was evaluated in terms of the number of words used in eight main headings and the presence or absence of certain information regarding nine statements.
Results: Inserts of locally manufactured products have significantly fewer words than those of imported products with respect to warnings, dosage and administration, and side effects. The most significant difference was found in the warnings. Moreover, differences were found between inserts of local and imported products in terms of the presence of the nine informative statements. Locally manufactured products did not mention inactive ingredients, clinical pharmacology or date of last revision, but all of them provided information on the use of the drug during pregnancy and lactation and on the duration of therapy. However, in general they provided less information than the imported equivalents.
Conclusion: Palestinian authorities and local manufacturers should implement appropriate measures to regulate the quality and quantity of information in the patient package insert of locally produced anti-infective agents. PPI improvement will better direct health practices to the benefit of the patients. Key words: patient package insert, evaluation, Palestine, drug information.

Objectives The objectives of this study were to assess the knowledge and practices associated with pesticide use in an agricultural community in Palestine, and to determine the prevalence of self-reported health symptoms related to pesticide exposure.
Methods   In this cross-sectional questionnaire study, agricultural farm workers in Nablus district, Palestine, were interviewed on their knowledge and practices of pesticide use. Comparisons of knowledge and practices of pesticide use between various groups were performed using the Mann–Whitney U-test or the Kruskal–Wallis rank test of variance. The program of the Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis.
Results   The questionnaire was completed by 381 farm workers. The mean age ± SD of the participants was 38.8 ± 11.8 years. The majority (97.9%) of the participants were male. The mean participant scores for knowledge and safety procedures were 2.8 ± 3.2 out of 8 and 9.8 ± 2.4 out of 15, respectively. There was a significant positive correlation (r = 0.323; P < 0.001) between the knowledge and safety procedure scores. Unsafe behaviors were identified as the storage of pesticide products at home, the preparation of pesticides in the kitchen, inadequate disposal of empty pesticide containers, eating and drinking during pesticide application, and using inadequate protective clothing. The most frequent self-reported toxicity symptoms associated with pesticide use were skin rash (37.5%), headache (37%), excessive sweating (24.9%), and diarrhea (21.3%). There was a strong significant negative correlation (r = −0.83; P < 0.001) between self-reported toxicity symptoms and scores for protective measures.
Conclusion  The results of this study indicate that most farm workers in this district need more educational programs regarding the safety and use of pesticides. Legislation promoting the use of safer pesticides is also needed.


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Objective: The purpose of this study was to determine the availability and adequacy of antidote stocking at hospitals in north Palestine based on published guidelines for antidote stocking.
Methodology: This study is a cross sectional survey of all hospitals at north Palestine (n=11) using a questionnaire which was completed by the director of the pharmacy department at each hospital. The questionnaire was divided into 2 parts. The first part contained a list of 25 antidotes while the second part contained a list of 12 antidotes. This classification is based on the guideline proposed by the British Association for Emergency Medicine (BAEM). The net antidote stock results were compared with the American guidelines as well. Result: The overall availability of each antidote in the first list varied widely from zero for glucagon to 100% for atropine. The number antidotes of the first list that were stocked in the 11 hospitals ranged from 5 to 12 antidotes but none of the hospitals stocked all the 25 antidotes. Additionally, availability of antidotes in the second list varied widely from zero for polyethylene glycol to 100% for dobutamine. The number of antidotes stocked ranged from 5 to 9 but none of the hospitals stocked all the 12 antidotes.
Discussion and Conclusion: hospitals in north Palestine do not have adequate stock of antidotes. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions. Coordination between Palestinian hospitals and the PCDIC at An-Najah National University is also important.

BACKGROUND:  Although stroke is one of the leading causes of morbidity and mortality worldwide, no studies on stroke were reported from Palestine. The objective of this study was to identify the risk factors and incidence rates of stroke in a well-defined area in north Palestine (i.e., the district of Nablus) with 362,159 native Palestinian inhabitants.
METHODS:  All patients admitted to Al-Watani governmental hospital from September 2006 to August 2007 and given the diagnosis of acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographic characteristics and clinical data pertaining to the patients were obtained from their medical files.
RESULTS:  A total of 186 patients with stroke (95 female and 91 male) were identified during the study. The average age of the patients was 69.09 +/- 10.9 years. Among the total patients, 112 had a first-ever stroke (FES) and 74 had recurrent stroke (RS). Hypertension, diabetes mellitus, and renal dysfunction were the most common risk factors with comparable prevalence in both FES and RS. The majority of patients (153; 82.3%) had ischemic stroke subtype whereas 33 (17.7%) had hemorrhagic stroke subtype. The overall (FES + RS) annual crude incidence rate of stroke was 51.4 per 100,000 persons whereas the annual crude incidence rate of FES was 31 per 100,000 persons. The age-adjusted incidence rates were 54.5 (FES) and 89.8 (FES and RS). The overall inhospital mortality was 21% and was higher in patients with RS than in those with FES.
CONCLUSION:  Modifiable risk factors were common among patients with stroke. Better control of these risk factors might decrease incidence of stroke and all consequences thereafter. Incidence rate and inhospital mortality of stroke reported in this study were within the range reported from other Arab countries.

BACKGROUND:  Herbal self-therapy is a common practice among Palestinians. However, no published data are available on herbal self-therapy in the Middle East in general, and in Palestine in particular.
OBJECTIVE:  This study was conducted to (1) determine the extent of herbal self-therapy among university students, (2) investigate the different types of herbal remedies used and (3) investigate the correlates and reasons associated with such practices.
METHODOLOGY:  This cross-sectional, descriptive study was carried out using a structured questionnaire that contained five sections: (1) demographics; (2) medication knowledge and self-care orientation; (3) types of herbal remedies used; (4) clinical conditions treated; and finally, (5) the reasons reported by students for herbal self-therapy practice. Pearson chi(2), multiple logistic regression and one-way ANOVA were performed using SPSS 13 program.
RESULTS:  33.9% of the respondents reported using herbal remedies in self-therapy. Female gender, students at medical colleges and those with high self-care orientation were significant predictive model for herbal use. Sage (Salvia fruticosa L.), chamomile (Chamaemelum nobile L.), anise (Pimpinella anisum L.), and thyme (Thymus vulgaris L.) were the most commonly utilized herbal remedies. The types of herbal remedies selected were significantly influenced by gender, but not by the level of medication knowledge or self-care orientation. Herbal remedies were used primarily for the treatment of headache, flu, menstrual pain and sore throat. The main motivating factor for using herbal remedies reported for using herbal remedies was simplicity of symptoms.
CONCLUSIONS:  Herbal self-therapy was a common practice among university students. Health care providers need to be aware of the students' self-therapy practices and need to have sufficient knowledge regarding herbs not simply because of the widespread use, but also because of significant reported side effects. Academics need to consider offering courses about herbal remedies to students in both the medical and non-medical faculties to broaden their treatment capabilities during this time of increased unregulated medical interventions such as herbal therapy.

BACKGROUND:  The aim of this study was to analyze the types and cost of medications prescribed at discharge for ischemic stroke survivors.
METHODS:  This is a descriptive study of medications prescribed for ischemic stroke survivors admitted to Al-watani hospital during a 6-month period.
RESULTS:  A total of 95 consecutive stroke patients were included in the study period; 78 (82.1%) survivors were having ischemic stroke subtype and were designated the study group. The average age of the survivors was 66.9 +/- 12.7 years. Survivors had prevalent risk factors such as diabetes mellitus (70%), hypertension (68%), and ischemic heart disease (34.6%). On average, survivors experienced a minimum of 0.73 complications (range 0-3) with the most common being infections (n = 35, 44.8%). Forty-two per cent of the ischemic stroke survivors were taking antiplatelet drugs prior to the current attack. At discharge, ischemic stroke survivors were prescribed an average of 4.9 medications from 4.3 different drug classes. All ischemic stroke survivors were prescribed antiplatelet therapy at discharge. Aspirin monotherapy was prescribed for 61 survivors while the combination of aspirin/clopidogrel antiplatelet therapy was prescribed for 17 survivors. The average monthly cost for prophylactic therapy and for medications used to treat post-stroke complication was approximately 52 USD per survivor.
CONCLUSION:  Most of the patients in the study group were having the traditional risk factors for ischemic stroke and were suffering form typical post-stroke complications. Lack of medical insurance will impose a heavy financial burden on stroke survivors in Palestine.