An-Najah Staff

Objective: To evaluate the possible in vitro interaction between ethanolic extracts of Rhus coriaria (R. coriaria) (seed), Sacropoterium spinosum (S. spinosum) (seed), Rosa damascena (R.damascene) (flower) and certain known antimicrobial drugs including oxytetracycline HCl,pweansi ccialrlirnie Gd ,o cuetp ahgaaleinxsint ,3 s ucllfiandicimale sthtroaxiinnse oafs msoudltiiudmru, ga-nrde seinstraonflto xPasceiund. oTmhoisn assy naeerrguyg sintuodsay (P. aeruginosa).
Methods: Evaluation of synergy interaction between plant extracts and antimicrobial agents was carried out using microdilution method.
Results: The results of this satnudd yte ssht oawnetdim thicarto tbhiearle a igse an tdse. cTrehaes em ions tt hien tMerIeCs tiinn gc arsees uolft cwomasb tihnaatt iothne o cf oemthbainnoaltiico np labnett wexeterna cRts.coriaria and these antibiotics, showed a high decrease in minimum inhibitory concentration (MIC),and a strong bactericidal activity against these strains.
Conclusions: These results may indicate that combinations between R. coriaria extract and these antibiotics could be useful in fighting emerging drug-resistance P. aeruginosa, which may due to that R. coriaria extract contain natural iunnhdiebriwtoarys wleoardkiinngg tboy t hdeif fiedreenntti fmiceacthioann iosfm tsh eo ra icnthivieb imtinogle ecfuflluesx ppruemsepnst. Nino wR . wceo rhiaarviea .e xFpuerrthimere,n itns vivo experiments are needed to confirm pseudomonal protection.

Objective: This study was conducted to update the prevalence of methicillin-resistant S. aureus (MRSA) isolates among human clinical S. aureus isolates recovered from Northern Palestine, to evaluate the possible presence of vancomycin-Resistant S. aureus (VRSA) and vancomycin- intermediate resistant S. aureus strains (VISA) and to determine the antimicrobial susceptibilities of these clinical isolates.
Methods: The in-vitro activities of 11 antibiotics against 204 non-duplicate S. aureus isolates from clinical samples in North of Palestine were determined by the disk-diffusion method. These samples were isolated between June 2006 and December 2007. The minimum inhibitory concentration (MIC) of vancomycin for 115 methicillin resistant Staphylococcus aureus (MRSA) strains was carried out using the agar dilution method.
Results: One hundred and fifteen (56.4%) of these isolates were MRSA and according to their antibiotic profile these are multidrug resistant (resistant to three or more non-β-lactam antibiotics). Ninety nine (43.6%) isolates were methicillin sensitive S. aureus (MSSA), forty four of MSSA isolates (44.4%) were multidrug resistant, while forty five (45.6%) were non multidrug resistant. Our results showed that the most common resistance (95.6%) was to penicillin. Two strains of MRSA have shown to be vancomycin- intermediate resistant, had MIC 4 and 8 μg/ml and these vancomycin- intermediate resistant S. aureus strains (VISA) are resistant to all antibiotics tested.
Conclusion: According to our information this is the first study report about VISA in Palestine. 

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 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.

Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication. Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD). Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD. Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.

Headache is one of the most common complaints in clinical practice. Few studies regarding headache in university students have been conducted in the Middle East. The objective of this study was to explore the prevalence, clinical characteristics, triggering factors and treatment options of headaches in university undergraduate students in Palestine/Middle East. Data were collected by interviewing a sample of 1900 students. The Headache Assessment Quiz was used to measure quality and severity of headache and to collect data on triggering factors and symptom management. A total of 1808 (95.2%) reported having at least one headache episode in the previous year. A positive family history of headache was found in 40% of students. The prevalence rate of frequent headache (tow or more episodes/month) was found in 1096 (60.9%) students; 613 women (55.9%). Of those having frequent headaches, 228 (20.8%) experienced moderate to severe episodes, 341 (31.2%) had pulsating, throbbing and pounding pain, and 274 (25%) had unilateral pain. The most common triggering factors among students with frequent headaches were: tension/stress (78.2%) and sleep deprivation (75.4%). Less than 5% of students sought medical assistance during headache episodes. Most students (79.1%) reported self-therapy with a single analgesic (53.4%), herbs (10.2%) or combination (15.5%), while 20.9% reported using no medication of any type to decrease pain. Paracetamol (48.5%) followed by ibuprofen (4.9%) were the most commonly used non-prescription analgesic drugs. Headache is a prevalent symptom in the college age population. Further research is needed to determine the prevalence of specific types of headaches. Healthcare providers are required to educate this population as well as to assist students in properly diagnosing and treating headache types.

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 χ2, 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.

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 6 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 1 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. Key Words: Stroke—incidence rate—Palestine.

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.

There are sixteen feed mills in Palestine with a total capacity of about 25000 tons per month, as well as three others under construction with a total capacity of 5500 tons monthly. However, despite the expansion in feed milling, Israeli feed-mills still dominate the local market. This study aimed to examine the reasons for this, and the potential of the local feed industry in the context of open regional trade. Palestinian feed mills vary considerably in their production capacity and in the type of machinery used. In many cases, however, il is observed that feed mills purchased used machinery procured from the Israeli factories. This may have important consequences for the productivity of these mills and their cost structure as well as the quality of manufactured feed. Owners of local feed mills rationalize this by pointing to their very limited financial resources, and the small size of the domestic markets. • Another important point in this context is that local feed mills import all their raw materials from foreign sources, but their storage capacity is noticeably limited (around 9000 tons), again on account of their weak financial base. This has added to their production cost and severely under minded competitiveness vis-a-vis Israeli manufacturers. The aggregate demand for various types of livestock feed as of early 1999 is estimated at 25000 tons per month (17000 tones for the West Dank and 8000 tons for the Gaza Strip). In addition, the consumption of barley is estimated at about 8000 tons per month. Local feed mills currently produce about I 1000 tons per month, which accounts for only 25% of poultry feed and 55% of other livestock feed. This study examined the reasons for the low share of local feed mills, and came up with the following factors.

1. Several factories produce only mash feed, whereas the demand is stronger for feed in pellets and crumbled forms. Much factories arc unable to buy the machinery needed for this purpose.
2. There is a wide spread belief that local feed is of fluctuating and generally inferior quality, especially in comparison with Israeli feed.
3. Credit facilities provided by the Israeli firms arc much more relaxed than those available in local factories.

" The study demonstrated the need to introduce major improvements in the local feed industry in an effort to improve its competitive standing.