An-Najah Staff

Background and aims:
Maternal intake of medications and supplements has changed over time, and it may be related to adverse reproductive outcomes. The purpose of this study was to evaluate the extent of utilization of supplements, medications, and herbs by pregnant women in Palestine and the expected effects.
Methods:
Pregnant women attending the prenatal clinic at Rafedia Governmental Hospital at Nablus/Palestine were interviewed using a questionnaire containing questions regarding medications intake and disease status. Data obtained from pregnant women were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 10.
Results: Of the pregnant women attending Rafedia prenatal clinic, 70.2% were village residents, 89.9% of them had no chronic diseases at the time of pregnancy except for anemia which was a common condition. More than half of the pregnant women did take vitamins, iron, and calcium (56.4%, 63.3%, 57.8%, respectively) during pregnancy. Less than fifty percent of the pregnant women took folic acid. Nausea and vomiting were common but most women did not take any medications to treat it. Less than one third of the pregnant women took over the counter (OTC) medications, mainly analgesics, and more than two thirds took prescription only medications (POM), mainly antibiotics. Mean medication intake per pregnant woman was 1.6±0.9. Most of the women who took medications did take only one (44.5%), a lesser percentage took two (30.8%) or more (9.3%) medications. The medications taken belonged to categories B and C, and few belonged to category D. About 45% of pregnant women used herbal medications to treat mainly GIT problems such as upset stomach, diarrhea, and constipation. The majority of pregnant women in this study did not visit a dentist during their pregnancy.
Discussion and Conclusion:
In this study, utilization of OTC, POM, and herbal medications was common among pregnant women. Not all women received supplements, particularly folic acid. The majority of pregnant women were anemic yet they did not take iron as they should. Women and health care providers need to be educated about the importance of supplement intake during pregnancy. Self-medicating or doctors prescriptions of POM, OTC, and herbal medications during pregnancy support the importance of expanding the knowledge about the potential risks and benefits of such treatments.

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.

No studies were carried out in Palestine to investigate the prescribed antimicrobial agents in hospitalized pediatric patients. The objective of this study was to evaluate and therapeutically analyze the pattern of parenteral antimicrobial prescriptions among pediatric patients in Al-Watani Government Hospital in Palestine. Such audit will be of great value to clinicians and health policy makers.
Material and Methods: Data on antimicrobial prescribing were collected for 30 consecutive days for all pediatric patients admitted to Al-Watani government hospital. Data on antimicrobial prescribing were entered and analyzed using Statistical Package for Social Sciences (SPSS) program. Analysis was done for age, sex, diagnosis, site of infection, number of antimicrobial agents given, how many times the drug regimen has been changed and the frequency of individual drug use.
Results: Three hundred and forty pediatric patients were admitted to Al-Watani government hospital during the study period. Gastroenteritis was the most common cause of hospitalization, while upper respiratory tract infection (URTI) was the most common cause of parenteral antimicrobial agent administration. Two hundred and ten (61.8%) patients received parenteral antimicrobial agents while 16 (4.7%) received both parenteral and oral antimicrobial agents. Single antimicrobial agent was prescribed for (50.6%) patients. Cefuroxime was the main single antimicrobial agent used; it was administered to 70/226 (31%) patients.
Conclusion: Treatment patterns used for most patients were nearly according to current empiric therapeutic recommendations. However, improving the availability of rapid diagnostic methods to differentiate between viral and bacterial infections is suggested to reduce empiric therapy numbers by antimicrobial agents so as to decrease chance for drug resistance.

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.

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.

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.