An-Najah Staff

To investigate the frequency of potential antihypertensive drug interactions among patients with cardiovascular diseases receiving antihypertensive medications.
Methods: The study took place in Nablus, Palestine starting April through October 2003. Patients with cardiovascular diseases (n=876) or who were receiving one or more antihypertensive medications were evaluated. All drugs prescribed for the patients were obtained from their medical files. A drug interaction database was developed based on updated Drug Interaction Facts to examine potential and level of drug interactions in each patient's regimen. Data were entered and analyzed using SPSS software.
Results: The number of "unique" pairs of potential drug interactions among the antihypertensive agents present in the data was 433. These included 16 cases (3.7%) level one; 34 cases (7.8%) level 2; 116 cases (26.8%) level 3; 136 cases (31.4%) level 4, and 131 (30.3%) level 5 interactions. Both increasing age and number of drugs were significantly associated with the potential for significant interactions at all levels with a p value less than 0.025.
Conclusions: This study found a high frequency of potential drug interactions with agents typically used for hypertension. Similar investigations need to be carried out among patients with other types of chronic diseases. Drug interaction software might be necessary in governmental pharmacy departments.

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 implications of self-medication practices are increasingly recognized around the world; however, little has been reported on the extent of self-medication practiced in Palestine.
OBJECTIVE: To determine the reasons, extent, and correlates of self-medication practices among university students in Palestine.
METHODS: A self-administered questionnaire eliciting self-medication practices was distributed to university students in a cross-sectional design. The 4 variables, sex, type of school, self-care orientation, and medication knowledge, were investigated for possible correlation with self-medication practices. Multiple logistic regression and Chi-square statistics were used in data analysis.
RESULTS: Self-medication practices were reported by 98% of the surveyed students (n=1581). Approximately two thirds of the respondents reported a high self-care orientation and one third reported \"good\" medication knowledge. Multiple logistic regressions indicted that self-care orientation, medication knowledge, and sex were insignificant predictors of self-medication practices, whereas the type of school (P=.012) was a significant predictor. A significant relation between the 4 variables and the type of therapeutic class used in self-medication was observed. For example, males were more inclined to use antiallergic medications (OR=1.48) than females. Medical students were more likely to use laxatives/antidiarrheal agents (OR=1.49) than nonmedical students. Respondents with high a self-care orientation were more inclined to use headache relievers (OR=2.22) compared to those with low self-care orientation. The most commonly reported reason for self-medication practices was simplicity of the illness encountered.
CONCLUSION: Self-medication practices were common among the university students studied. Sex, type of school, self-care orientation, and medication knowledge are important personal factors that are associated with the selection of certain types of therapeutic classes used in self-medication.

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.

Objective: Stroke is a major health problem, yet no studies on stroke have been reported from Palestine. This one-year, hospital-based study was conducted to determine the prevalence of risk factors and the in-hospital mortality rate in patients with ischemic stroke.
Method: All patients admitted to Al-Watani government hospital and diagnosed with ischemic stroke between September 2006 and August 2007 were included in the study. Data were obtained by retrospective review of medical charts. Pearson Chi-square and independent t test were used in the univariate analysis. Multiple logistic regression analysis was used to determine the independent predictors of in-hospital mortality rates among the patients. Statistical testing and graphics were carried out using SPSS 15.
Results: We identified 153 ischemic stroke patients (83 females and 70 males) of whom 92 were having a first-ever stroke (FES). Patients had several prevalent modifiable risk factors such as hypertension (HTN) (66%), diabetes mellitus (DM) (45.8%), and renal reduced renal function (crcl < 60 ml/ min) (33.9%). Twenty-six (17%) of the patients died during hospitalization. Four variables were significantly associated with in-hospital mortality: history of previous stroke (P= 0.004), crcl at admission (P=0.004), number of post-stroke complications (P=0.001), and age (P=0.043). Multiple logistic regression analysis indicated that the number of post-stroke complications (P= 0.001) and previous stroke (P=0.03) were significant independent predictors of in-hospital mortality.
Conclusion: Screening and better control of risk factors, especially HTN, DM and renal dysfunction, are required to decrease the incidence and in-hospital mortality among patients with ischemic stroke.

Objectives: Staphylococcus aureus is an important pathogen associated with diseases in a variety of hosts including humans. It produces several toxins and virulence factors that contribute to its pathogenic potential such as staphylococcal enterotoxins (SEs). This study was conducted to determine enterotoxigenicity of S. aureus associated with chronic urogenital tract infection by detecting enterotoxin genes.
Setting: This study was done in The Microbiology laboratory, An-Najah N. University, Palestine.
Methodology: A total of 90 S. aureus isolates recovered from clinical samples from patients suffering from chronic urogenital tract infection in the North of Palestine were used to detect the presence of staphylococcal enterotoxin genes sea, seb, sec, sed and see by polymerase chain reaction (PCR) assay. Results: Out of 90 S. aureus isolates tested, it was found that 57 (63.3%) of these isolates harboured one or more enterotoxin genes. Up to 78.9% of the enterotoxigenic isolates possessed one SE gene. The majority of these enterotoxigenic strains (61.4%) isolated from both semen and urine samples harbored sec gene either alone or in combination with other genes. Also the prevalence of genes in combination was significantly more common in S. aureus isolates derived from urine 9/33 (27.3%), as compared to those derived from semen 3/24 (12.5%).
Conclusions: The role of enterotoxin genes in the pathogenesis of urogenital tract infection is still unknown. However, it is evident that urogenital infection can be caused by S. aureus strains which lack these genes. Other newly detected genes may play a role in pathogenesis.

A total of 68 Staphylococcus aureus strains isolated from different human clinical samples in the North of Palestine were examined to detect staphylococcal enterotoxin (SE) genes A (sea), B (seb), C (sec), D (sed) and (see). Of the total isolates examined, 41.2% (28/68) were enterotoxigenic S. aureus. Twelve strains (42.9%) of enterotoxigenic S. aureus harbored seagene, ten strains (35.7%) were carried see- gene, six strains (21.4%) were positive for sec-gene. None of these enterotoxigenic S. aureus isolates harbored more than one of toxin genes. The presence of these toxin genes and other genes not be detected here might play a role in process of pathogenesis of S. aureus disease other than food poisoning but this cannot be substantiated by the results of the present study

Enterotoxin genes (sea-see) in Staphylococcus aureus isolates recovered from milk of clinically healthy sheep and cows in the north of Palestine were determined using a polymerase chain reaction (PCR). Thirty-seven (37%) out of 100 S. aureus isolates were toxin gene positive. Four strains (10.8%) were sea-positive, 20 (54.1%) were seb-positive, 4 (10.8%) were sec-positive, 6 (16.2%) were sed-positive and 3 (8.1%) were see-positive. None of these enterotoxigenic isolates carried more than one toxin gene. This study indicates that the presence of enterotoxigenic S. aureus in raw milk can contribute to the sources of staphylococcal food poisoning in Palestine.

Nine medicinal plants growing in Palestine were screened in vitro for potential antibacterial activity against 6 bacterial strains by well diffusion and micro-dilution techniques. Both aqueous and organic solvents were used. The dried extracts of Sacropoterium spinosum (Rosaceae) (seed), Ruta chalepensis L (Rutaceae) (leaf), Cassia senna (Ligumenosa) (leaf), Lawsonia inermis (Lythraceae) (leaf), Psidium guajava (Myrtaceae) (Leaf), Carataegus azerullus (Rosaceae) (Leaf), Ranunclus asiaticus(Ranunculaceae) (Flowers), Calendula officinalis (Composita) (Flowers),and Salvia syriaca (Labiatae) (leaf) were screened. The bacterial strains tested were; Methicillin-resistant Staphylococcus aureus (MRSA); three strains (1, 2 & 3), multidrug resistant Pseudomonas aeruginosa, Proteus vulgaris and Klebsiella pneumonia. The average diameter of inhibition zones ranged from 9 to 30 mm and 11 to 28 mm for aqueous and ethanol extract, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) was the most inhibited microorganism. Sacropoterium spinosum extract was the most active against Methicillinresistant Staphylococcus aureus (MRSA) and multidrug resistant Pseudomonas aeruginosa. The MIC value of ethanol extract was 0.781 mg/ml against MRSA while 0.390 mg/ml against Pseudomonas aeruginosa. The combination effect of ethanol extracts of (Sacropoterium spinosum with Lawsonia Inermis) on bacterial species tested exhibited a higher effect than that of any individual extract. Such results lead to an interesting promise for further investigation to design potentially active antibacterial augmentative agents of natural sources.

Disk diffusion and micro-dilution techniques were used to determine the antibacterial activity of water, ethanolic and methanolic extracts of Rhus coriaria ripe berries against five clinical bacterial strains (Methicillin-resistant Staphylococcus aureus (MRSA), multi-drug resistant Pseudomonas aeruginosa, enterohemorrhagic Escherichia coli O157 (EHEC), Proteus vulgaris and Klebsiella pneumoniae). Bacillus subtilis ATCC6633 was used as a reference strain. The zone of inhibition varies depending on bacterial species and type of extract. The average diameter of inhibition zones ranges from 0 to 19 mm, 15 to 25 mm and 15 to 22 mm for water, ethanolic and methanolic extract, respectively. The MIC value of ethanolic extract was 1.25 mg/ml against MRSA, EHEC, P. aeruginosa and Proteus vulgaris, while 0.156 mg/ml against B. subtilis. In general these results showed that the antibacterial activity of R. coriaria ripe berries extracts was more effective against Gram-positive bacteria than Gram-negative.