Nimer Adeeb,1 Mahmoud Dibas,2 Jose Danilo Bengzon Diestro ,3 Kevin Phan,2 Hugo H Cuellar-Saenz,1 Ahmad Sweid ,4 Sovann V Lay,5 Adrien Guenego ,5 Assala Aslan,1 Leonardo Renieri,6 Sri Hari Sundararajan,7 Guillaume Saliou ,8 Markus Möhlenbruch,9 Robert W Regenhardt,10 Justin E Vranic ,10 Ivan Lylyk ,11 Paul M Foreman,12 Jay A Vachhani,12 Vedran Župančić,13 Muhammad U Hafeez,14 Caleb Rutledge,15 Muhammad Waqas ,16 Vincent M Tutino ,16 James D Rabinov,10 Yifan Ren ,17 Clemens M Schirmer,18 Mariangela Piano,19 Anna L Kuhn,20 Caterina Michelozzi ,21 Stephanie Elens ,22 Robert M Starke,23 Ameer Hassan ,24 Arsalaan Salehani,25 Alex Brehm ,26 Majdeddin MohammedAli  ,1 Jesse Jones ,25 Marios Psychogios,26 Julian Spears,3 Boris Lubicz,22 Pietro Panni,21 Ajit S Puri,20 Guglielmo Pero,19 Christoph J Griessenauer,18,27 Hamed Asadi,17 Adnan Siddiqui ,16 Andrew Ducruet,15 Felipe C Albuquerque ,15 Rose Du,2 Peter Kan ,14 Vladimir Kalousek ,13 Pedro Lylyk,11 Christopher J Stapleton,10 Srikanth Boddu,7 Jared Knopman,7 Mohammad A Aziz-Sultan,2 Nicola Limbucci,6 Pascal Jabbour ,4 Christophe Cognard,5 Aman B Patel,10 Adam A Dmytriw 2,10

Corresponding author: Correspondence to Dr Nimer Adeeb, Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA; nimer_ adeeb@ hotmail. com

Background: The Woven EndoBridge (WEB) device has Food and Drug Administration approval for treatment of wide-necked intracranial bifurcation aneurysms. The WEB device has been shown to result in adequate occlusion in bifurcation aneurysms overall, but its usefulness in the individual bifurcation locations has been evaluated separately only in few case series, which were limited by small sample sizes.

Objective: To compare angiographic and clinical outcomes after treatment of bifurcation aneurysms at various locations, including anterior communicating artery (AComA), anterior cerebral artery (ACA) bifurcation distal to AComA, basilar tip, internal carotid artery (ICA) bifurcation, and middle cerebral artery (MCA) bifurcation aneurysms using the WEB device.

Methods: A retrospective cohort analysis was conducted at 22 academic institutions worldwide to compare treatment outcomes of patients with intracranial bifurcation aneurysms using the WEB device. Data include patient and aneurysm characteristics, procedural details, angiographic and functional outcomes, and complications.

Results: A total of 572 aneurysms were included. MCA (36%), AComA (35.7%), and basilar tip (18.9%) aneurysms were most common. The rate of adequate aneurysm occlusion was significantly higher for basilar tip (91.6%) and ICA bifurcation (96.7%) aneurysms and lower for ACA bifurcation (71.4%) and AComA (80.6%) aneurysms (p=0.04).

Conclusion: To our knowledge, this is the most extensive study to date that compares the treatment of different intracranial bifurcation aneurysms using the WEB device. Basilar tip and ICA bifurcation aneurysms showed significantly higher rates of aneurysms occlusion than other locations, but there was no significant difference in the complication rate between different locations.

Faten Usrof, MSc ¹, Mazen Alzaharna, PhD ¹, Fadel Sharif, PhD ¹

1. Department of Medical Laboratory Sciences, Faculty of Health Sciences, Islamic University of Gaza, Gaza City, Palestine

Corresponding author: faten.usrof@gmail.com 

Background: Colorectal cancer (CRC) is considered most widely recognized malignant growth around the world. CRC is caused by precancerous polyps within the colon as well as rectum and can be prevented by early detection and excision of precursor lesions. In this work, we evaluated the methylation of SEPT9 and SPG20 genes as bio markers for CRC patients in cell free DNA extracted from plasma. 

Methods: This case-control study was carried out on 25 cases with verified CRC and 25 apparently healthy individual controls as dictated by colonoscopy. The workflow consisted of plasma cell-free DNA isolation, bisulfite treatment of DNA, purified of bisulfite treated DNA, and detection of treated DNA by “methylation specific PCR”.

Results: The bisulfite conversion assay yielded 45%–50% of the circulating plasma genomic DNA. The SEPT9 and SPG20 combined assay successfully identified CRC samples 100% as sensitivity and 100 % as specificity with 100% of positive predictive value and AUC 1.000{95% confidence interval, (1.000-1.000)}. A significant increase of mSEPT9-mSPG20 in CRC correlated with histological grade, tumor size, and overall histological type were correlated with CRC (P < 0 05). 

Conclusion: Circulating methylated SEPT9  and  SPG20 DNA sounds like a promising detection tool for colorectal cancer in Gaza strip. 

Keywords: Biomarker, colorectal cancer, cf-DNA, DNA methylation, SEPT9, SPG20.

Rashed Osama ¹  

1: MPH. Tulkarm Health Directorate. Ministry of Health. Nablus. Palestine

Background: Diabetes mellitus (DM) affects more than 422 million people around the world. By the year 2040, the number of people with diabetes is expected to rise to 642 million, most of who are going to be in low- or middle-income countries (1). It is considered a major cause of morbidity and mortality (1).The American Diabetes Association (ADA) holds that good glycemic control is essential for the management of DM; and that glycated hemoglobin (HbA1c) is the best indicator for the monitoring of blood glucose levels (2).HbA1c gives an indication of the average blood glucose levels maintained in the past 3 months .Hence, it is important when estimating the risk of complications associated with the disease . For instance, maintaining HbA1c levels below or around 7 % (i.e., having good glycemic control)contributes to the reduction, delay and prevention of microvascular and macrovascular complications (1).  Studies conducted by Arnetz et al. (3) and Kilpatrick et al. (4) in diabetic patients have shown a significant  correlation( positive or negative) between HbA1c and age, gender, educational level,  life style as well as duration of diabetes. It is thought worthwhile to investigate the significance of such correlations in West Bank , where such the effect of these parameters for the progression of diabetic has not yet been recognized. The aim of this study is to assess the correlation between the above detailed parameters so that they can be used as diagnostic or prognostic markers for the assessment of the degree of control of this disease, to delay or prevent the complications before they can eventually manifest.

Methods: A retrospective cross - sectional study conducted in Diabetic Clinic at Tulkarm Health Directorate. Data was collected in 2020 by reviewing 215 patient’s medical files of type 2 diabetic using a basic information questionnaire on demographic data, duration of disease and life style elements. The researcher took an official permission from the general director of Tulkarm Directorate of Health. The data analyzed by Statistical Package for Social Sciences, (SPSS) Windows version (23) program using the chi-square test to determine whether there is a significant difference between males and females in the categories listed in the questionnaire. Independent –T- Test used to find any significant differences of HbA1c values in relation with gender. One way analysis used to test any significant differences in demographic data .Pearson correlation uses to measure any significant differences in duration of diseases in terms of Hba1c .Multiple regression to investigate any correlation between HbA1c values and life style elements.

Results: The study suggest is a significant differences at the level of 0.05  in terms of  HbA1c values of diabetic patients in  regarding gender, these differences were more HbA1c values  among males with mean (2.79) than females with mean (2.61). HbA1c values for diabetic patients in regarding age groups 66-75(3) was more than age group 56-65(2.5) and age group 25-35(2.4). In addition , HbA1c values for diabetic patients regarding educational level  > 16 years (2.3) was less than educational level  13-16 years (2.8) and education level  1-6 years(2.7) and educational level 7 – 12 years (2.6).

The study also demonstrate without doubt a strong significant positive correlation at the level of 0.05 between duration of disease and HbA1c values of diabetic patients,  as duration of disease increases , HbA1c values showed a significant increase and vice versa (0.000).

Finally,  the study showed  a varied  significant correlation  at the level of 0.05 between most of life style elements  and HbA1c values among diabetic patients  where physical active  and vegetarian diabetic patients on the top of the list followed by diabetic patients who comply a dietary management principles including meal timing , eating between meals and number of meals  and finally obese  and smoker diabetic patients showed a slight correlation with HbA1c values. 

Conclusion: The data in the present study reveal a problem with poor glycemic control (high HbA1c) of type 2 DM patients in Palestine .Several social, clinical and behavioral factors underlie the problem. Knowledge of these factors could be a start toward helping patients and targeting interventions to improve glycemic control and prevent diabetes related complications. Poor glycemic control in Palestine indicates a need for more research and improvement, and highlights the need to review the existing guidelines and develop an awareness program around issues related to diabetes care.

Health professionals and decision makers should direct their efforts and interventions towards the empowerment of patients by providing appropriate educational sources that highlight the benefits of self-management in the context of disease treatment, control, and elimination of risk factors.

Mohamedraed Elshami, MD, MMSc^1,2*, Ahmad Mansour^30597565063*, Mohammed Alser, MD^2,4, Ibrahim Al-Slaibi, MD⁵, Hanan Abu Kmail⁴, Hanan Shurrab⁶, Shahd Qassem³, Faten Usrof⁷, Malik Alruzaygat³, Wafa Aqel³, Roba Nairoukh⁸, Rahaf Kittaneh⁹, Nawras Sawafta³, Yousef Habes³, Obaida Ghanim³, Wesam Almajd Aabed¹¹, Ola Omar¹², Motaz Daraghmeh¹², Jomana Aljbour⁴, Razan Elian⁴, Areen Zhor¹², Haneen Habes³, Mohammed Al-Dadah⁴, Nasser Abu-El-Noor, PhD^13#, Bettina Bottcher, MD, PhD^4#

Corresponding author: Mohamedraed Elshami, MD, MMSc, Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH 44106; Phone: 832-245-6055   Email: mohamedraed.elshami@gmail.com

Background: Poor awareness of lung cancer (LC) risk factors may contribute to late presentation, which leads to poor survival outcomes. This study aimed to evaluate the awareness of LC risk factors among Palestinians and identify the factors associated with good awareness.

Methods: This was a national cross-sectional study conducted in Palestine from July 2019 to March 2020. Participants were recruited using convenience sampling from hospitals, primary healthcare centers, and public spaces located in 11 governorates. A translated-into-Arabic version of the validated LC awareness measure was used to assess recognition of 10 LC risk factors. One point was given for each correctly recognized risk factor. The awareness level was determined by the number of LC risk factors recognized: poor (0 to 3), fair (4 to 7), and good awareness (8 to 10).

Findings: Of 5174 approached, 4817 participants completed the questionnaire (response rate= 93.1%).  A total of 4762 questionnaires were included in the analysis, 2742 from the West Bank and Jerusalem (WBJ) and 2020 from the Gaza Strip. Participants from the WBJ were more likely to be older, have higher monthly income but lower education, and suffer from more chronic diseases.

Smoking-related risk factors were more often recognized than other LC risk factors. The most recognized risk factors were ‘smoking cigarettes’ (n=4466, 93.8%) and ‘smoking shisha [waterpipes]’ (n=4337, 91.1%). The least recognized risk factors were ‘having a close relative with LC’ (n=2084, 43.8%) and ‘having had treatment for any cancer in the past’ (n=2368, 49.7%). A total of 2381 participants (50.0%) displayed good awareness of LC risk factors. Participants from the WBJ and the Gaza Strip had a similar likelihood to display good awareness (50.6% vs. 49.1%). Being ≥45 years old, having higher education and monthly income, knowing someone with cancer, and visiting hospitals and primary healthcare centers were all associated with an increase in the likelihood of displaying good awareness.

Conclusion: Half of study participants displayed good awareness of LC risk factors. Effective implementation of tobacco control policies is essential beside educational initiatives to increase public awareness of the risk of smoking and other LC risk factors.

Mohammad Alkarajeh¹; Mahfouz Ktaifan¹; Abdoh Abdallah¹; Amir Aghbar^1,2; Mosab Maree^1,3; Sa'ed H. Zyoud^4.5; Faris Abushamma^1,2

Corresponding author: Mohammad Alkarajeh, Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine Email: mo.alkarajeh@gmail.com

Background: Non-contrast computerized tomography (NCCT) has become the standard method to diagnose ureteric stones in emergency settings. The purpose of this study is to identify the reliability of kidney-ureter-bladder (KUB) radiography to be used as a triage tool in acute ureteric colic (AUC). Moreover, this article correlates between KUB and NCCT in view of stone characteristics and clinical outcomes.

Methods and participants: A retrospective cohort study recruited patients who had proven ureteric stones on NCCT. A double-blinded review of KUB and NCCT was performed to identify the following variables in both tests: site, maximal calculi length (MCL), and stone density. Correlation between KUB radiography and NCCT has been performed. The inter-method reliability was used to measure the degree to which test scores are consistent when the methods or instruments employed vary.  

Results: One-hundred and fifty-one patients were included, in which 75 (50%) of the patients had negative KUB and positive NCCT for ureteric stones based on the double-blinded review. Lower ureteral calculi were found to be the most common location in both KUB and NCCT images (n=49; 65%, n=81; 54%, respectively). Median MCL of KUB and NCCT were 5 mm (3-8) and 6 mm (4-9), respectively. Hounsfield unit densities of more than 630 were found in 86 (57%), and radiopaque stones were found in 76 (50.3%). There is moderate and significant concordance (Cohen’s kappa = 0.520) between NCCT and KUB regarding stone location (p < 0.01). There is a strong concordance (Cohen’s-kappa = 0.804) between NCCT and KUB in detecting MCL (p < 0.01). Stone density is weakly correlated between KUB and NCCT (Cohen’s kappa= 0.254) (p = 0.001). Fever, acute kidney injury (AKI), and intractable pain were the main indications for surgical intervention in negative KUB and positive NCCT ureteric stones. MCL and upper ureteric stone were the main predictors of surgical intervention in negative KUB positive NCCT ureteric stone.
Conclusion: KUB radiography should not be used as a triage tool in AUC. However, KUB radiography can be reliably used during follow-up as there is a strong correlation between KUB radiography and NCCT for KUB detectable ureteric stones.

Dr Eman alshawish; Raya Tell ; Farah Abu Hait ; Noor Al Rammal; Anas Ghaiada

Faculty of Medicine and Health Science, Nursing and Midwifery College, An-Najah National University

Background: Human breast milk is unique and a natural source of nutrition. However, it also helps to protect against various types of disease, not only infective but also immunological diseases. Breast milk protects not only during the neonatal period but also beyond it. By educating the neonatal immune system it also protects against the development of diseases later in life. IgG antibodies play important roles to protect infants in early life Aim to study the effects of breast milk feeding versus formula feeding in early infancy on the development of serum IgG during pandemic. The purpose of this study was to measure changes in the concentration of immunoglobulin G (IgG) in the mature breast milk of Palestinian mothers during the first 6 months after giving birth between exclusively breastfeeding (EBF) mothers and non-exclusively breastfeeding (nonEBF) mothers and knowing the effect of infection with Corona virus on the concentration of IgG of breastfeeding mothers 

Methods: An experimental randomization design was used to measure changes in the concentration of IgG in the mothers mature milk during the first 6 months after giving birth using ELIZA technique. 41 mothers were recruited in this study distributed in two groups nonEBF and, EBF, 50% of each group have got infected with corona viruses. 

Results: There was a significant difference in IgG concentrations between EBF and non-EBF mothers. IgG was higher in the EBF mothers milk than in the milk of non-EBF mothers at P-value =0.000. Coronavirus infection does not affect IgG production in breastfeeding mothers. 

Conclusion: The concentration of IgG changes in human breast milk along with breastfeeding intervals. EBF enhances the concentration of IgG in breast milk compared to non-EBF. The results of this study can be used in health education programs to convince pregnant women or postpartum women to use EBF for 6 months after giving birth. 

Keyword: Breast feeding Breast milk Exclusive breastfeeding Corona virus IgG

Ashraf Abuejheisheh, MSN, RN1, Omar Tarawneh, RN, MSN2, Jamal A. S. Qaddumi, PhD3, Omar Almahmoud, MSN4, and Muhammad W. Darawad, PhD, RN2

Corresponding Author: Jamal A. S. Qaddumi, Associate Professor, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, 0097, Palestine. Email: jamal9877@najah.edu   

Background: Although many studies discussed evidence-based practice among general nurses, few studies were found by the researchers among intensive care unit nurses. Also, no study has been conducted to investigate the predictors of evidence-based practice among intensive care unit nurses in Jordan. Therefore, this study aims to identify the predictors of evidence-based practice among intensive care unit nurses in Jordan.

Methods: A descriptive cross-sectional design was used to conveniently recruit 132 participants. Self-reported questionnaires were utilized including the Evidence-Based Practice Questionnaire and Evidence-Based Practice barrier scale.

Findings: Participants’ rate of evidence-based practice was 60% (M = 4.2/7), which was significantly correlated with their knowledge (r = 0.739, P < .01) and attitudes (r = 0.564, P < .01) of evidence-based practice. The results revealed a 2-predictor model that explained 62.2% of the variance in evidence-based practice among intensive care unit nurses. The 2 variables were attitude (β = 0.245) and knowledge (β = 0.563).

Interpretations: The outcomes of this study added new information regarding the prediction of evidence-based practice among intensive care unit nurses. An educational program for nurses regarding this issue is crucial to improve their practice aiming at enhancing nursing care. In addition, nursing schools should update their curricula to explain the importance of evidence-based practice and to enhance students’ competencies in research utilization and statistical skills.

Mahdi Aljamal¹ Researcher, MD, Almakaased Hospital, Jerusalem

Corresponding author: Mahdi Aljamal1 Researcher, MD, Almakaased Hospital, Jerusalem. Email: Mahdi.aljamal@gmail.com

Background: It's well known that Whipple Procedure is major surgery, with multiple complications that can occur due to the nature of the surgery, characteristics of the patients, nature of the disease e.g. Pancreatic ductal adenocarcinoma (PDAC) which is known to have the poorest prognosis of all GIT  malignancies, even after the tumor has been completely resected. 1 Pancreatic cancer is generally found in the older population. Pancreaticoduodenectomy seems to be the only way in resolving these resectable tumors. 

Palestine has limited statistical data published internationally regarding the complications rates of the Whipple procedure. The data we have are based on the knowledge of other centers of western countries, which can be different in the setup of people characteristics, institutions characteristics, perioperative care, and all of that can influence the final result and outcomes. That why we need a data collection about the outcomes of Whipple’s procedure in our country, and institutions particularly.  

Patients’ files were reviewed retrospectively for those who underwent Whipple's Procedure between 2015 till the end of  2021. The objectives was to identify the outcomes, complications, and clinical and pathological features that can affect certain complications after the Whipple procedure in our institution, Almakassed hospital, as it is considered a tertiary care hospital in Palestine, Trying to find the correlation between certain clinicopathological factors and characteristics of the disease and the outcomes of patients who underwent Whipple's procedure with intended curative resection. No research was carried out on such a topic, neither by our institution nor other hospitals that do the same operation.

Methods –This study is a retrospective study that studied 49 patients who were operated on with pancreaticoduodenectomy (a.k.a Whipple procedure) by the surgical team at Almakassed hospital from  2015 to the end of 2021. Proposal was sent for research committee in of the hospital and got the approval prior to data collection. Data were found in the patients’ medical records that were accessed through the Hospital Information System - HIS (which was deployed in the hospital since 2015). For each patient included in the study;  review of the history, personal details, past medical history, hospital course including preoperative work up, staging CT scan, laboratory findings, anesthesia evaluation, post-operative hospital course, and final pathology. Data analysis was done using SPSS software (version 23). All operable and resectable tumors that were candidates for the Whipple procedure were included in the study during the mentioned period

Findings: From 2015 until 2021, 49 operated cases were collected and analyzed. The mean age of cases was 56.12 years; the mean hospital stay length was 16 days, ranging from 7 days to 35 days. The most common presenting symptom was jaundice (51 %). Most sites of the tumor were the head of the pancreas (55%). Most patients with malignant tumors were in stage IIB in final pathology. Wound infection was the most common postoperative complication (22%). Major morbidities of these patients consisted of pulmonary complications (10%). Mortality during the same admission of the surgery was 4% (2 patients). Pancreatic anastomosis leak was found in 4 patients, 8%. On analysis of data of wound infection results and possible risk factors; no significant correlation (P-value < 0.05) was found, and this assumed to a small sample size that we have (N = 49). 

Interpretations: Outcomes of our surgical team are comparable to the published data of other centers. Multiple complications can result from such a major procedure. Wound infection is the most common complication after Whipple surgery. Further studies have to be done to include data from other institutions and other previous years (before 2015) to have significant correlations between wound infection and risk factors. In addition, further studies need to study the short- and long-term survival of the patients.  

Essa M.Sweity, ¹ Aidah A. Alkaissi, ² and Wafiq. Othman ³

¹ MSN Critical Care Nurse, Faculty of Graduate Studies, An-Najah National University, Nablus 44839, Palestine.   

Corresponding Author: Essa M.Sweity.  Email: E.sweity@najah.edu 0598428085

Background: Postoperative pulmonary complications (PPCs) often occur after cardiac operations, and are a leading cause of morbidity, inhibits oxygenation, increase hospital length of stay and mortality.  Although clinical evidence for PPCs prevention is often unclear and crucial measures take place to reduce PPCs. One device usually used for this reason is the incentive spirometry (IS). The Aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation and decreases hospital stay following coronary artery bypass graft (CABG) surgery patients.

Methods: This was a clinical randomized prospective study at An-Najah National University Hospital, Nablus-Palestine. The participants how are 18 years or older, scheduled to have coronary artery bypass grafting (CABG) and patients who were well motivated and compliant, were randomized into two groups according to a randomization list formatted by http://www.randomization.com.

Participants: A total of 80 patients were selected as candidates for CABG Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room.

Intervention:

Group 1: Incentive spirometry was utilized by the patient with 10 breaths, 6 times per day for a period of 10 minutes in every session with a breathing technique for 2 days preoperatively.

The patients were taught how to use IS by a nurse who would not be involved in the patient’s postoperative care. (Experimental group) (IS).

Group 2: No IS preoperatively, only IS postoperatively (Control Group)

Analysis: The data were analysed with SPSS version 22 for Windows (IBM Corp., Armonk, NY, USA). Data normality was tested using Kolmogorov–Smirnov test. The data were not normally distributed. Thus, nonparametric statistics tests were used. The Scale data are expressed as the median (quartile 1 [Q1]–quartile 3 [Q3]). The groups were compared with the Mann-Whitney U Test. Categorical variables (YES/NO questions) were statistically analysed with Chi-square tests have been used. A P value ≤ 0.05 was considered to indicate a statistically significant difference.

Result: The study findings showed that there was a significant difference between the IS group and control group in the incidence of post-operative atelectasis, there were 8 patients (20.0%) in IS group and 17 patients (42.5 %) in control group (p= 0.03). Mechanical ventilation duration was significantly less in group IS group, median was four hours versus six hours in control group (p < 0.001). Hospital length of stay was significantly less in group IS group, median was six days versus seven days in control group (p < 0.001). Median of amount of arterial blood oxygen and oxygen saturation was significantly effective improvement in IS group with (p < 0.005). 

Conclusion: Preoperative incentive spirometry for 2 days along with exercises of deep breathing, encouraged coughing and early ambulation following CABG are in connection with prevention and decrease incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant.

Abdallah AbuJlambo¹, Mohammed Fouad Elsheikh Khalil², Islam Ayyash³, Maha Basel Abu Zarifa⁴, Mohammed Imad⁵, Mohammed alkhaldi⁶, Siham Al-Shawamreh⁶

Corresponding author: Abdallah AbuJlambo1; Researcher Abdallah AbuJlambo1: M.D., PgD in community mental health, ICU physician at AL-Shifa Medical Complex. Eamil: Abdallah.AboJlambo@gmail.com

Background: Chronic pain is one of the most common reasons for seeking healthcare services and can even lead to disability. The association between pain and depression is impacted or mediated by event interpretations (cognitions), rather than the experience itself, according to cognitive-behavioral pain theories. The evidence for this perspective has almost entirely come from studies of persons under the age of 65. Due to the limited and contradictory evidence available, the significance of cognitions in the pain experience of older persons has remained unclear. This study aimed to assess whether catastrophizing played a mediating role in the relationship between pain intensity and depressed mood in adults with persistent pain as proposed by a cognitive-behavioral mediation model among the people who attended at the outpatient department at Shifa Medical Complex.

Methods: A cross-sectional research was undertaken among individuals with chronic pain syndrome between September 1 and September 20, 2021. The research took place at outpatient clinics for rheumatology, orthopedics, and neurology in Shifa Medical Complex, Gaza city. This research was place at Shifa Medical Complex, where patients regularly attend outpatient clinics for pain evaluation and therapy. On the other hand, those clinics are not specialized to manage chronic pain, but practitioners at these clinics follow the patients up. Thus, this led us to select patients based on their self-report of chronic pain.

Findings: The research findings highlight median pain duration was 4 years. The most common site for pain was in the lower limbs especially in the knee joint (n= 73, 26.8%). There was a considerable proportion of participants reported symptoms of depression (cut-off ≥10) 226 (83.1%), anxiety (cut-off ≥8) 228 (83.8%), and stress (cut-off ≥15) 241 (88.6%). The majority of participants showed moderate depression severity, 86 (31.6%), extremely sever anxiety features 153 (56.3%), and stress features 123 (45.2%) respectively. There was a statistically significant, weak positive correlation between pain intensity and DASS21-depression, r (270) = 0.278, P < 0.001. Median DASS21-depression score statistically significant different between groups based on NRS severity index: mild 11 (6.5-22), moderate 15 (8-20), sever 20 (14-26) X² (2) = 14.12, P <0.001.

Interpretations: This study confirms the mediating role of catastrophe in the relationship between the two use psychometric sounds to treat pain intensity and depression in elderly people with persistent pain measure. These findings indicate that clinicians should solve catastrophic problems to improve treatment outcomes for this population.

Supervisor: Dr. Mutaz Dredei PhD in nursing, School of Nursing, Birzeit University, Ramallah, Palestine

Corresponding authors: Majd Ajaleen, BSN, RN, Graduated from Birzeit University, Jerusalem. Email: majd.ajaleen@gmail.com.

Background: Menstrual cycle is a critical time in the life of females. It influences different daily life aspects, including academic performance, the menstruation involves many physical symptoms and emotional changes. No studies were conducted to investigate its impact on Palestinian students.

Objective: To determine the effect of menstrual physical and emotional symptoms on health, attendance and academic performance among Birzeit university female students.

Methods: A cross sectional study on 547 female students in Birzeit University who were selected randomly. An online questionnaire was structured for the purpose of this study; it consisted of fifty questions in total. It included the following variable: demographic and menstruation characteristics emotional signs; Depression, Anxiety and Stress scale (DASS21), physical symptoms, to assess how they affect academic performance.

Results: based on finding the majority of the students 363 (93.1%) experienced physical symptoms during their menstruation, , participants reported a normal level of depression 194 (49.7%), anxiety 264 (67.7%), and stress 231(59.2%). In addition, Spearman's Rho test results shows a positive correlation between the physical symptoms of menstruation and academic performance (p<0.001).

Conclusion: It can be concluded menstruation physical symptoms and emotional signs negatively affect the academic performance among Birzeit University female students. Therefore, it is recommended that the university must be more aware of female students by understanding and providing more facilities such as providing pads’ machines.

Keywords: menstruation, physical symptoms, emotional signs, academic performance

Yunis Daralammouri¹ ; Mohammed Jabri¹; Osayd Mosleh¹ ; Yazan Abedalaziz¹ ; Murad Azamtta^1, ; Adham Abu Taha¹ ; Sa'ed Zyoud^1,2,3

¹ An-najah National University Faculty of Medicine and Health Sciences

² Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine

³Clinical Research Center, An-Najah National University Hospital, Nablus 44839, Palestine

Background: Several studies have shown sex differences in the presentation, diagnosis, therapy, and outcomes of acute coronary syndrome. Women with acute coronary syndrome had worse short- and long-term outcomes than men. The purpose of this study is to examine the impact of sex discrepancies on the clinical presentations of acute myocardial infarction, treatment methods, and patient outcomes at a large Palestinian tertiary hospital.

Methods: A retrospective cohort study to include all patients with myocardial infarction presented to An-Najah National University Hospital from 2018 to 2020 was used. In addition, age, sex, body mass index, smoking history, ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction, comorbidities, previous percutaneous coronary intervention, and previous coronary artery bypass graft were all gathered and analyzed.

Results: : Of the 422 patients that were enrolled in this study, 96 (22.7%) were women. Compared with men, women were older (p <0.001), and had significantly higher rates of diabetes mellitus (p <0.001), and hypertension (P <0.001). In addition, women had more chances to present with atypical chest pain (p = 0.012). Furthermore, non-ST segment elevation myocardial infarction was more prevalent among women (p = 0.017). Regarding the in-hospital course, the median number of stents was statistically significant in men (p = 0.029), but women have significantly higher in-hospital mortality (p = 0.013).

Conclusion: Myocardial infarction presents differently in males and women. Women had more comorbidities, were older than men, had atypical presentations, and had a higher in-hospital mortality rate. As a result, while diagnosing and treating patients suspected of having a myocardial infarction, healthcare practitioners must account for these discrepancies in order to reduce the mortality rate among women.

Keywords: Palestine; myocardial infarction; sex differences; presentation; management; outcome 

Alaa Eddin K. Salameh (1)*, Mohammed R. Bakeer, MD (2), Zeyad I. Maslamani, MD (3)

• Urology department, Palestine Medical Complex, Ramallah, Palestine
• General Surgery department, Palestine Medical Complex, Ramallah, Palestine
• General Surgery Department, Istishari Arab Hospital, Ramallah, Palestine

• Corresponding author: Alaa Eddin K. Salameh, MD, Urology department, Palestine Medical Complex, Ramallah, Palestine, Email: sala.alaa@gmail.com

Abstract

Objective: Evaluate the appropriateness of VTE prophylaxis in urology and general surgery departments in order to decrease the morbidity and mortality of Deep Venous Thrombosis/Pulmonary Embolism.

Place and duration: The audit was conducted in urology and general surgery departments in Palestine Medical Complex (PMC) in October 2021.

Subjects and Methods: A total of 181 cases were collected taking into account age, gender and type of surgery performed, the existing risk factors, the risk stratification of the case using the validated risk assessment tool (Caprini score), exclusion criteria, prophylaxis given or not, type of prophylaxis given, the appropriateness of the prophylaxis and duration of prophylaxis.

Results: a total of 181 cases were collected, male 59% (n=107) and female 41% (n=74) with a mean age of 47.95 years. Of the 181 patients 31.6% cases were Low Risk for developing VTE, 40.8% were Moderate-Risk, 23.2% were High-Risk and 4.4% cases were Highest Risk. All Low-Risk cases did not receive VTE prophylaxis, of Moderate Risk cases, 71 did not receive any prophylaxis, 2 cases received the appropriate prophylaxis and 1 case prophylaxis given partially. High Risk cases, 19 did not receive any prophylaxis, 14 received the appropriate prophylaxis and 9 cases prophylaxis given partially. In Highest Risk cases, 1 patient did not receive any prophylaxis and 7 cases received appropriate prophylaxis. On three months follow up, of 181 patients, 58 patients lost follow up. Nine patients developed DVT and seven of them passed away due to DVT.

Conclusion: Most patients from moderate and high-risk groups were not given the appropriate VTE prophylaxis or not given at all, despite of that most of highest risk group 87.5% were given the appropriate prophylaxis. All patients who will undergo surgery should be adequately assessed and screened for the presence of VTE risk factors and categorized according to the Caprini score for VTE risk stratification. The screening should be done early in the admission and appropriate prophylaxis should be given. The audit should be repeated for reevaluation after adequate time.

Keywords: Clinical Audit, Venous Thromboembolism, Caprini Score.

Mustafa Abu Jayyab¹, KhamisElessi²

1.Researcher, medical student, Faculty of medicine, Islamic university of Gaza

2.Researcher, MD, MSc-EBM; PM& R, Faculty of medicine, Islamic university of Gaza

Background

The use of anticoagulants in pregnancy should receive greater attention in both pregnancy and the postpartum periods [1]. The balance of risks and benefits to both the mother and the fetus should be carefully examined when choosing a proper anticoagulant therapy [2]. A clinical audit is usually defined as the evaluation of a clinical process through the utilization of evidence-based criteria and/or the end product of care compared to others [3]. 

The concept of using anticoagulants and thrombolytics in pregnancy is very crucial, as pregnancy coincides with a fivefold increase in VTE risk, with the risk rising to 20-fold or more in puerperium. The risk increases even more when hemophilia is present. The risk of VTE can persist till 12 weeks of postpartum [4]

The aim of this work was to compare and audit the use of anticoagulant therapy in pregnancy according to RCOG guidelines.

Methodology

Retrospective data were collected from pregnant women on anticoagulant therapy in the Department of Obstetrics and Gynecology of Al-Emarati  Hospital, Gaza. A total of 250 pregnant women were included in this study. The study protocol was approved by the ethics committee of Faculty of Medicine, Islamic University of Gaza. 

Findings:

Regarding the percentage of cases following the international guidelines, among the 250 studied cases on anticoagulant therapy, 48.57% has filled her VTE risk assessment score, while 51.43% was an empty risk assessment paper

Anticoagulant was used in 50 pregnant women (8 with moderate risk and 42 with minor risk). 50% of Patients with moderate risk  managed without Heparin which disagree with RCOG Guidelines, 80% of pregnant women with minor risk was managed with Heparin which disagree with RCOG Guidelines

Interpretation:

Women requiring anticoagulation need careful attention throughout pregnancy and the postpartum period. Risks and benefits to the mother and fetus should be balanced in the choice of anticoagulant therapy, degree of monitoring, and therapeutic target. Future research should investigate different approaches and combinations of anticoagulant agents in pregnancy. Development of anticoagulant agents that are homogeneous, efficacious, safe to the fetus, and not affected by physiological perturbations of pregnancy will have a tremendous effect on the outcomes of pregnancy in women who require anticoagulation.

Mohammed Jabri¹; Mahfouz Ktaifan¹; Amir Aghbar^1,2; Faris Abushamma^1,2

¹Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine

²Urology Center, An-Najah National University Hospital, Nablus 44839, Palestine

Presenting author: Mahfouz Ktaifan, Email: m.ktaifan@gmail.com

Abstract

Background: Urinary tract infection after urological procedures occurs in 1-6%. At NNUH, sepsis after urological procures reached up to 6% in 2021. A new protocol using urine dip stick to screen for infection prior to the endourological procedures has been established and implemented since 2022. The purpose of this re-audit and study is to examine the reliability of urine nitrite to predict urosepsis after endourological surgeries taking into account that the EAU guidelines recommend urine culture prior to invasive urological procedures.

Patients and Methods: A prospective audit targeted patients undergoing urological procedures was conducted. This audit cycle was held at the urology centre, An-Najah National University Hospital, Palestine, between January 2021 and January 2022. Then, the re-audit phase was performed from February 2022 to May 2022. In the re-audit phase, a new implementation was adopted consisting of preoperative urine analysis for patients having urologic procedures. Demographics, clinical data, type of procedure which classified into three categories (TURP/T/TRUS bx, RIRS and URS, and PCNL) and laboratory date were collected. Patients were monitored post-operatively by measuring vital signs within 24 hours to identify sepsis and followed in clinic after 2-4 weeks. Both Systemic inflammatory response syndrome (SIRS) score and quick Sepsis Related Organ Failure Assessment (qSOFA) score were used to define sepsis directly post op. The follow up clinic visit was used to assure no symptomatic UTIs within 28 days after the procedure 

Results: 564 patients were included in audit phase and 124 patients were included in the re-audit phase. The median age for the sample was 52.5. 69 (77%) were males.  The SIRS criteria revealed scoring =>2 in 2 (1.6) of the cohort without overt clinically sepsis. qSOFA is zero. WBCs had a median of 7.6 [6.4-8.9].4 (3%) patients had positive nitrite. An improvement in the sepsis rate was observed in the re-audit phase. The sepsis rate was declined from 6.46 % to 1.6% (p < 0.028) with no evidence of clinically overt sepsis in the re-audit cycle.

Conclusions: Screening for UTIs preoperatively using urine nitrite predicts potential positive urine cultures which should be treated and avoid serious sepsis post operatively. Urine nitrite is a potential alternative screening tool to the standard urine culture. 

Haytham AbuMohsen1 Mohamad AbuShikha 2

1. Internship Doctor, MD. Tubas Governmental Hospital , West Bank, occupied Palestinian territory.

2 General Practitioner, MD. Tubas Governmental Hospital , West Bank, occupied Palestinian territory.

*Corresponding author: Haytham AbuMohsen, Internship Doctor, MD, Tubas Governmental Hospital, Palestine. Email: hithammohamad97@gmail.com.

Background

Antibiotics misuse is increasing worldwide and multidrug-resistant pathogens is not uncommon now in Palestine (1-3). Antibiotics resistance is considered a serious threat that could be fatal both at the individual and populations level (4).The most common source of prescribing antibiotics in the medical field is in the treatment of upper respiratory tract infections (5).  Acute upper respiratory tract infections (URTI) are generally caused by viral pathogens and do not require antibiotics in most circumstances (6). A previously done audits in Gaza, Saudi Arabia have reported that physicians did not generally follow the international guidelines for appropriate antibiotic use for URTI (7, 8). However, adherence to the international guidelines about both the need for prescribing antibiotic and the line of antibiotics prescribed for these conditions has never been checked in West Bank. The aim of this audit is to measure the adherence of Tubas Governmental Hospital Doctors to the international guidelines when treating sore throat, tonsillitis and otitis media and make at least 10% improvement in the compliance within 2 months of different interventions. 

Methods

 This study is a full cycle audit and re-audit that was done at Tubas Governmental Hospital , West Bank. Audit/Re-audit included 297 patients who presented during March/June 2022 respectively to the emergency department of Tubas Governmental Hospital with sore throat, tonsillitis or otitis media. Random shifts selection on daily basis, stratified by covering the highest possible different doctors after taking their consent to participate in this study. Audit and re-audit phases involved short interview with the doctors after dealing with cases of URTI at which the needed data were gathered. Intervention phase were held during April-May 2022 and included survey to access the underlying causes of the poor adherence, then oral and poster presentations of the URTI NICE guideline, oral presentation of audit results and recommendations, developing mobile/web applications that determines the need for antibiotics, and a circular to improve the noting of these cases. Written approval from Palestinian MoH and hospital administration was taken. Oral approvals from doctors to participate in the study were taken. Approvals from patients were waved as the required data has a minimal risk on them. Data were entered and analyzed using SPSS, results were presented using custom and custom tables. P-values of <0.05 were considered significant using chi square test.

Findings

A total of 297 cases were observed in our study including 169 case in the audit phase and 128 case in the re-audit phase. 57.9% of the patients were males and 42.1% were females. 169 case were tonsillitis (56.9%), 88 case were sore throat (29.6%) and 40 case were acute otitis media (13.5%). The mean of FeverPAIN score of the 257 case of tonsillitis and sore throat was 2.45 ± 1.27. An improvement in the adherence to international URTI antibiotics prescription guidelines in the re-audit phase than that of the audit phase was noticed. Positive changes in percentages of correct antibiotics prescriptions in the re-audit phase including : +6.5% positive change for correct direct antibiotics prescriptions, +44.4% for correct backup antibiotics prescriptions, +63.4% for correct no antibiotics prescriptions. Additionally, positive changes in the percentage of prescribing first line antibiotic mainly amoxicillin of (+14.1%), also there is a reduction in prescribing second line antibiotics including amoxi-clav (-19.9%) , azithromycin (-2.4%), and cephalosporins.

Interpretations

 Poor adherence to the international guidelines of antibiotic prescription for URTIs was found indicating a possible national problem. There is an obvious trend toward using the second line antibiotic for URTI in Palestine. Our interventions to improve compliance with national antibiotic guidelines for URTI appeared to have positively changed prescribing practice over a short period of time. This quality improvement work adds to an important of starting to use audits in West Bank. Moreover, we believe that the improvement strategies and approach used in our study could be carried out easily in other practices. Several limitations have faced us including refusal of some physicians to participate in the study, lack of time of physicians, forgetting part of the needed data during the interview, not attending oral presentations by physicians and refusal to use mobile/desktop applications by other physicians.

Mohamed Abouzid1, Dina M. El‑Sherif2*, Nael Kamel Eltewacy3* , Nesrine Ben Hadj Dahman4, Salah A. Okasha5, Sherief Ghozy6, Sheikh Mohammed Shariful Islam7*  Afnan W.M. Jobran 8 and EARG Collaborators

1 Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy,

Poznan University of Medical Sciences, Poznan, Poland. 

2 National Institute of Oceanography and Fisheries, NIOF, Cairo, Egypt.

 3 Faculty of Pharmacy, Beni-Suef University, Minia, Egypt. 

4 Faculty of Medicine of Tunis, University of Tunis El Manar, HOD Medical Research; Doctors of the World Tunisia, Tunis,

Tunisia. 

5 Department of Agronomy, Plant Breeding and Bio‑Statistic, Faculty

of Agriculture, Suez Canal University Ismailia, Mansoura, Egypt. 

6 Faculty of Medicine, Mansoura University, Mansoura, Egypt. 

7 Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition 

Sciences, Deakin University, Melbourne, Australia.

8 Faculty of medicine, Al-Quds University, Jerusalem, Palestine

*Correspondence: dina.moh55@yahoo.com; nael.eltwacy@gmail.com;

shariful.islam@deakin.edu.au

2 National Institute of Oceanography and Fisheries, NIOF, Cairo, Egypt

3 Faculty of Pharmacy, Beni-Suef University, Minia, Egypt

7 Institute for Physical Activity and Nutrition (IPAN), School of Exercise

and Nutrition Sciences, Deakin University, Melbourne, Australia

Background:

On December 31, 2019, cases of unexplained pneumonia were reported in Wuhan city, China [1]. After performing extensive investigations, isolation of a virus related to the genus coronaviruses was done and later named the novel coronavirus (COVID-19) by the world health organization on 12 January [1]. Soon afterward, COVID-19 disease turned into a global pandemic, affecting more than 71 million people worldwide by December 11, 2020 [2, 3]. Due to the massive number of infected people, several governments in the Middle East and North Africa (MENA) region announced more stringent containment measures for containing COVID-19 spread, including a general lockdown by the end of March 2020 for at least two weeks [2]. The MENA region has its social specificities, as group activities and social interaction are highly valued compared to other areas. Therefore, lifestyle and habits have changed due to social distancing and self-isolation, which are both considered strongly impacting the individuals’ lives during the pandemic.

Among the multiple consequences of the current pandemic, there have been two significant impacts; stockpiling food as a result of grocery restriction and spending more time indoor; including working from home, tele-education, and restricted outdoor physical activities [4,5,6]. Furthermore, quarantine work routine disruption could contribute to boredom which is linked to higher greater energy intake [7]. Besides, the frequent stressful exposure to visual and auditory news concerning COVID-19 can be linked to overeating, in particular high-sugar foods, known as “food craving” [8]. These habits may temporarily ease stress and give a false feeling of happiness since simple carbohydrates can influence the production of serotonin; hence, impact the mood positively [9]. Nerveless, there is a proportional relationship between carbohydrate food craving and food glycemic index that is associated with a higher risk of developing cardiovascular diseases, obesity, and chronic inflammation. Additionally, these diseases have been proven to raise the risk for more COVID-19 severe complications [10, 11]. In the same context, sedentary habits attributable to lockdown measures as alternations in sleeping, and smoking habits are substantially changing the lifestyle, especially among health workers [12]. A study conducted on 955 men showed that sleep could be a risk factor for obesity, especially in young men [13]. 

Methods: 

We conducted an online survey in 17 countries (Egypt, Jordan, United Arab Emirates, Kuwait, Bahrain,Saudi Arabia, Oman, Qatar, Yemen, Syria, Palestine, Algeria, Morocco, Libya, Tunisia, Iraq, and Sudan) from the MENA

region on August and September 2020. The questionnaire included self-reported information on lifestyle behaviors, including physical activity, eating habits, smoking, watching television, social media use and sleep before and during the pandemic. Logistic regression was performed to analyze the impact of COVID-19 on lifestyle behaviors.

Results:

 A total of 5896 participants were included in the final analysis and 62.8% were females. The BMI of the participants was 25.4 ± 5.8 kg/m2. Around 38.4% of the participants stopped practicing any physical activities during

the confinement (P < 0.001), and 57.1% reported spending more than 2 h on social media (P < 0.001). There were no significant changes in smoking habits. Also, 30.9% reported an improvement in their eating habits compared with

24.8% reported worsening of their eating habits. Fast-food consumption decreased significantly in 48.8% of the study population. This direct/indirect exposure to COVID-19 was associated with an increased consumption of carbohydrates

(OR = 1.09; 95% CI = 1.02–1.17; P = 0.01), egg (OR = 1.08; 95% CI = 1.02–1.16; P = 0.01), sugar (OR = 1.09; 95% CI = 1.02–1.16; P = 0.02), meat, and poultry (OR = 1.13; 95% CI = 1.06–1.20; P < 0.01). There was also associated increase in hours spent on watching television (OR = 1.07; 95% CI = 1.02–1.12; P < 0.01) and social media (OR = 1.09; 95%

CI = 1.01–1.18; P = 0.03). However, our results showed a reduction in sleeping hours among those exposed to COVID-19 infection (OR = 0.85; 95% CI = 0.77–0.94; P < 0.01).

Conclusions:

 The COVID-19 pandemic was associated with an increase in food consumption and sedentary life. Being exposed to COVID-19 by direct infection or through an infected household is a significant predictor of amplifying these changes. Public health interventions are needed to address healthy lifestyle behaviors during and after the COVID-19 pandemic.

Raed,¹ Tareq Z. Alzughayyar,² Sadi A. Abukhalaf,³ Rami A. Misk,² and Jihad Samer Zalloum³

Aidah Alkaissi, Fadi J. Zaben, Mohammad Abu Rajab, Mahdia Alkony

Nursing and Midwifery Department, Faculty of Medicine & Health Sciences- An-Najah National University

Corresponding author: Dr. Aidah Alkaissi, E-Mail: aidah@najah.edu

Background: Exploring lived experiences of recovered COVID-19 patients might have scientific, social, and policy relevance that apply to the healthcare infrastructure. This multi-center phenomenological study was conducted to explore lived experiences of Palestinian patients who recovered from COVID-19.  

Methods: In this qualitative study, a phenomenological descriptive approach was used. A purposive sampling technique was employed to select the study participants. Semi-structured qualitative interviews were conducted with patients who recovered from COVID-19 (n = 20). The recording was transcribed and analyzed by using Giorgio’s phenomenological analysis method.

Findings: Semi-structured interviews were conducted with 14 male and 6 female participants. The age of the participants ranged from 25-50 years. Nine themes and multiple subthemes emerged from the qualitative data. The themes were relevant to patient’s feelings about the experience, mental issues, social discriminations/stigma, symptoms, life in isolation, using supportive treatment, personal preventive measures, social support, and life after recovery.

Interpretations: Survivors who were interviewed in this study recounted devastating experiences with regard to their mental health, social stigmatization, feeling guilt, shame, and hesitant to regain contact with others. Mental health issues should be addressed as a part of the care plan for patients with COVID-19. More studies are still needed to investigate if introducing mental healthcare providers to the care team of patients with COVID-19 can improve the experiences of the patients.

Abdallah Abu-Jlambo¹, Abdelrahman Alshaikh Ahmad², Eman Abu Shiha³, Khalid Alnahhal⁴, Khamis Elessi^5.

1 Researcher, MD, Junior Medical Doctor at European Gaza Hospital (EGH).

2 Researcher, MD, Resident year 3 at European Medical Hospital (EGH).

3 Researcher, MD, Junior Medical Doctor at Al-Shifa Medical Complex.

4 Researcher, MD, Junior Medical Doctor.

5 Researcher, MD, PhD, Neurorehabilitation and Pain Medicine consultant, Associate Professor and Head of Evidence-Based Medicine Unit at Faculty of Medicine, Islamic University, Gaza, Palestine.

Correspond author Abdallah.AboJlambo@gmail.com.

Background: The Great March of Return (GMR) which started on March 30, 2018 to mark the 42nd anniversary of Land Day thousands of Palestinians in the Gaza Strip marched to the eastern border with Israel. In these rallies, tens of thousands of Palestinian civilians including women and children (according to March organizers) participated in the protest 500-700 meters away from the perimeter fence between Israel and the Gaza Strip in five places - Eastern Jabalia, Eastern Gaza, Eastern Bureij, Eastern Khanyounis and Eastern Rafah. The GMR rallies represented a major challenge for the local health teams due to lack of facilities and shortage of supplies. Through the following protesting events a triaging and management system was developed to help manage the mass causalities. The aim was to define the effectiveness of Emergency departments in the process of triaging and managing mass causalities at the 1^st memory of land day protesting events.

Methods: Data were collected prospectively for every trauma patient presenting to emergency departments of Shifa hospital in the north and European Gaza Hospital in the south using specially made data collection sheets of specified variables regarding patient assessment, management and time spent in the ER.

Findings: Total number of 61 trauma cases presented to both hospitals (24 to EGH, 37 to Al-Shifa) from 2:00 pm till 7:00 pm, most of them were male patients (60 males), the mean age was 21.6 years. Blood pressure was recorded for 34 patients, among them 30 were normotensives, 3 were hypotensive initially and 1 arrived with un-recordable blood pressure. Pulse rate was normal for 28 pts, tachycardia in 20 patients and 1 a systolic. The rest of patients were not vitalized initially. The mean waiting time spent by trauma patients before being seen by medical staff was 34.6 minutes in the ER. Regarding distribution of injuries, most patients were having head (24 cases) and lower limb (20 cases) trauma. Regarding ER investigations, CBC were done for 48 patients, FAST scan for 9 patients, X RAY for 37 patients and CT for 24 patients in need. Resuscitation intravenous fluid infusion was utilized in 34 patients and 1 patient needed urgent blood transfusion, the stability was assessed before being mobilized from ER and most of patients remained stable till left, 1 was a transient responder and the remaining 3 patients were hypotensive. Three trauma patients needed ER endotracheal intubation with subsequent ICU admission and 1 patient needed thoracostomy tube. Most patients with non-significant trauma were discharge home (26 cases), significant trauma patients who needed further observation (15 cases) were admitted in the hospital and 16 cases were transferred to OR for operative intervention. 

Interpretation: Al-Shifa hospital trauma center remains the main recipient of all trauma patients due to larger catchment area covered by the hospital. It was obvious that the numbers of causalities were lesser than what was reported during the launch of GMR rallies. All of study cases were young male patients with different types of injuries but of note, the targeting was for the head and lower limbs. The documentation process of vital signs especially for blood pressure and pulse rate was defective in big numbers of cases among trauma cases. Patients spent more than half an hour in the ER before being moved to next level of care and that can cause more crowdedness in the ER halls.  

Dr. Souad Belikbeir ,Dr. Lubna Saudi, Dr. Yazan Abueideh , Dr. Joumana Sweedan, Dr. Ibrahim Fadila, Dr. Massa Qassem

Institution: An-Najah National University.

Abstract   

Background: Diabetes mellitus (DM) is a major public health problem worldwide with prevalence of 9.3% in 2019, of which T1DM accounting 10% to 15%. In Palestine the prevalence is 15.3%, with 4,4% having T1DM. Chronic disease leads to stressful events to which patients respond differently depending on the severity of the disease and their social life. The aim of this study is to determine characteristics and experiences of T1DM patients who visit diabetic clinics in Nablus and Ramallah.

Methodology:  mixed methodology study was conducted in T1DM patients aged ≥18 years old: cross sectional study was conducted to characterize epidemiological and clinical data of these patients in Nablus and Ramallah and qualitative methods were used to explore experience of T1DM patients in various periods from November2020 to June2021 due to COVID19 lockdowns.

IBM-SPSS Statistics Version20.0 was used for statistical analyses. Descriptive analysis and Pearson Chi2 test or independent t-test were used to evaluate the relation between different independent variables and the diabetes control status. P-value ˂5% was set as level of significance. Interviews were analyzed using thematic approach.

Results:177 T1DM patients were included with mean age (SD) of 26.88±7.569 years old.  Females represented 53.1%. From villages 47.7%. 62.1% were unmarried, 65.5% achieved a university degree and 63.4% unemployed. 43.7% of patients were diagnosed with T1DM 10 years ago.  Positive family history 65%. 65% were non-smokers and moderately active 43.4%. Last HbA1c SD was 9.46 ±2.327, 85.9% were uncontrolled (HbA1c ≥7%). 13.2% have complication: 11.5% with retinopathy and 7.5 % neuropathy.

Differences in control of diabetes we found to be statistically significant among the three categories of level of education: primary, high school and university (p-value 0.013).

Thirteen patients were interviewed. Five themes and seventeen subthemes were identified: self-perception, attitude toward disease, impact on education and occupation, impact of social environment and relation with health system.

Conclusion: The findings showed that our patents are mainly young females, highly educated, unemployed, single, with disease duration of >10 years, uncontrolled, normal BMI without complications. A low educational level increases the risk of uncontrolled diabetes. There are indicators of maladaptation, which might be linked to community's social stigma.

Abdullah I. Jallambo¹, Mohammed Al-Ser², Omar S. Naji³, Omar A. Mousa⁴, Mohammed Zimmo⁵.

1 Researcher, MD, Junior Medical Doctor, European Gaza Hospital (EGH), Gaza, Palestine.

2 Researcher, MD, Junior Medical Doctor, Nasser Medical Complex (NMC) Gaza, Palestine.

2 Researcher, MD, Junior Medical Doctor, Palestine-Turkey Friendship Hospital (TiKA), Gaza, Palestine.

3 Researcher, MD, Junior Medical Doctor, European Gaza Hospital (EGH), Gaza, Palestine.

4 Researcher, PhD, Gynecology consultant, Al Shifa medical complex, Gaza, Palestine.

Correspond author Abdallah.AboJlambo@gmail.com

Abstract

Background: Stroke is one of the leading causes of death and disability in Palestine. In Palestine, a lower middle‐income country (LMIC) in the Middle East, national data from 2014 suggest that 11% of all deaths in public hospitals were attributable to cerebrovascular disease, making it the second leading cause of death after coronary heart disease.1 It is important to provide multidisciplinary and comprehensive high standards care to prevent further attack of acute stroke among patient with cerebrovascular disease. There are limited data on how much cover entities in Gaza-Strip adherent to the stroke prevention guidelines in patients with cerebrovascular actions. To fill this gap, in our study we aimed to investigate the secondary preventive strategies of stroke in patients with stroke and transient ischemic attacks (TIA) at Al-Shifa medical complex. We are emphasizing the importance of commitment to nationally accepted evidence-based guidelines for secondary prevention stroke among CVA patients. 

Methods: Comprehensive data from all patients with acute stroke admitted to one public hospitals in the Gaza Strip of Palestine. The data were prospectively collected from Patients with Stroke and TIA fulfilling the inclusion criteria and admitted to the Neurology department during (October 2019 – December 2019). The collection was prospective, in two steps. The first step is the review of patients' files who is already admitted to the hospital and the documented notes in files will be the first source. The Second step is to ask the patient directly, about any verbal instructions that doctors said and not documented in files

Results: The number of patients admitted to the neurology department during this period was 54 cases of CVA and 4 cases of TIA. In‐hospital evaluation all patients received a head computed tomography scan; 53 patient had ischemic stroke and one case had hemorrhagic stroke. 72% of cases were more than 50 years of age. Overall, among all patients there are 46 (79.3%) patients are a known case of HTN and 7 (12.1%) patients are not, and 5 (8.6%) patients newly discovered. More than half of the hypertension patients were discharged on SBP > 140. Only 12% of patients were asked about the number of cigarettes they used to smoke daily. Just One case only had LDL level before discharge. Most patients with ischemic stroke received antiplatelet therapy (90%). Statins were prescribed to 58% of cases after the current complaint. 90% of patients were screened for DM. BMI was not measured for any of the patients. Around 70% of patients have received no recommendation regards aerobic physical activity. Whereas, 45% of them have not been told about physiotherapy. Less than half of patients have been advised to change the food style. Sleep study has not been planned for any patient nor CPAP recommended. Around 45% of patients were evaluated of cardiogenic embolism as a cause of TIA or CVA. 100% all patient received ECG, and of the 58 cases, only 2 cases were evaluated by noninvasive images for carotid artery disease.

Conclusion: Recommended inpatient preventive assessments were not provided in the majority of admitted patients. We conclude to increase adherence for evidence-based guidelines on the prevention of future stroke among patients with stroke or TIA.  Particularly investigations for vascular obstruction, lipid lowering medication, and evaluation of risk factors control techniques: smoking, BMI, physical activity, and nutritional habits. 

Laian Abualia¹, Leen Sabobeh², Ikhlas Alfoqaha³, Wael Sadaqah⁴, Zaher Nazzal⁵.

1. Researcher, MD. An-Najah National University-Nablus.
2. Researcher, MD. An-Najah National University-Nablus.
3. Researcher, MD. An-Najah National University-Nablus.
4. Researcher, anesthesia and ICU specialist. An-Najah National University hospital-Nablus.
5. Researcher, community medicine specialist. An-Najah National University-Nablus.

Corresponding author: abualialaian@gmail.com.

Abstract

Background: The field of medicine in general and anesthesia in specific are developing rapidly, in parallel nowadays, intending to decrease pain and increase patient’s satisfaction. Dexmedetomidine is a highly selective α2-adrenoceptor agonist. Its sedative, anxiolytic, analgesic, sympatholytic, and hemodynamic stabilizing properties have been a focus of attention after its approval by the FDA; in this study, we will investigate the effect of Dexmedetomidine as an adjuvant to local anesthesia in Supraclavicular Plexus Block.

Methodology: The participants were collected at An-Najah National University hospital-Nablus, and after gaining consent, they were randomized-by block randomization method-into two groups. Both groups were given Bupivacaine as a local anesthetic, and Dexmedetomidine was added to one group. During the operation, patients were evaluated for the onset of the sensory and motor block, as well as blood pressure, After the surgery, patients were evaluated for pain, somnolence, nausea, and vomiting, and their blood pressure was measured again.

Results: The study involved a total of 53 participants, with 28 in the intervention group and 25 in the control group. Dexmedetomidine significantly extended the duration of sensory and motor block in this study. It also accelerates the onset of anesthesia, with medians of 5.25 (1.5-6) and 6 (1.5-9), respectively, and elongates the duration of analgesia, with the intervention group had a median of 385 (235-915) compared to the control group had a median of 240. (115-750).

Conclusion: Dexmedetomidine has favorable effect on anesthesia and analgesia with no effect of the hemodynamics of the patients.

Key words: Dexmedetomidine, Bupivacaine, Supraclavicular Plexus Block.

Faris Abushamma1, Zain Khayyat2, Aya Soroghle3, Sa’ed H Zyoud4, Ahmad Jaradat5, Maha Akkawi6, Hanood Aburass7, Iyad KK Qaddumi8, Razan Odeh9, Husam Salameh10, Salah Albuheissi11.

• Researcher, MD. Department of Urology, An-Najah National University Hospital, Nablus, 44839,Palestine.
• Researcher, MD. Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
• Researcher, MD. Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
• Researcher, PhD. Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, an-Najah National University, Nablus, 44839,Palestine
• Researcher, MD. Department of Urology, An-Najah National University Hospital, Nablus, 44839,Palestine.
• Researcher, MD. Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine.
• Researcher, MD. Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine.
• Researcher, MD. Department of Urology, Rafedia General Hospital, Nablus, 44839, Palestine.
• Researcher, MD. Department of Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine.
• Researcher, MD. Department of Oncology,An-Najah National University Hospital, Nablus, 44839, Palestine.
• Researcher, prof. Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK

Corresponding author: Aya Al-Soroghli , MD      Email: ayasoroghle40@gmail.com

Purpose: Non-muscle invasive bladder cancer (NMIBC) is a potentially curable or controllable disease if strict adherence to a surveillance protocol is followed. Management and surveillance of NMIBC begins at the time of diagnosis up to a few years thereafter. There is scanty data in the literature evaluating the impact of non-compliance with the surveillance protocols on progression, recurrence, and mortality rate.

Patients and Methods: An observational, retrospective cohort study recruited data between 2012 and 2017 at two tertiary hospitals. Data were collected consecutively. NMIBC patients who had at least 3 years of follow-up data were included. Patients were divided into different groups based on their compliance with the cystoscopy follow-up protocol as recommended by the European guidelines. We compared the cystoscopy compliant group with the non-compliant group in view of recurrence, progression, and mortality. In addition, missing variable items during surveillance were calculated using a new scoring model to predict adverse outcomes.

Results: Eighty-eight NMIBC patients met our criteria. Recurrence rate (RR), progression rate (PR), metastasis rate (MsR), and mortality rate (MR) are significantly higher in non-compliant group, RR: (92.6%) (P< 0.001), PR: (54.1%) (P< 0.001), MsR: (37.7%) (P< 0.001), MR: (23.5%) (P= 0.002) respectively. In the subgroup analysis, intermediate and high-risk groups have a PR rate of zero in the compliant group, while it is 100% (P< 0.001) and 56.4% (P=0.001) in the non-compliant group, respectively. Use of a Kaplan Meier (KM) graph shows that compliant patients had a better survival in comparison to non-compliant patients. Scoring there or more is statistically and clinically significantly associated with higher recurrence, progression, and mortality. RR: (94%) (P=0.016), PR: 49% (P< 0.001) and MR (26%) (P=0.012).

Conclusion: Non-compliance to a standardized surveillance protocol in NMIBC is associated statistically and clinically with adverse outcomes in comparison to a compliant group. This mandates strict adherence to surveillance guidelines particularly in patients with high-risk disease.

Note: This article has been recently published on mar 31,2021

 LINK : https://pubmed.ncbi.nlm.nih.gov/33833577/

Ruba Nieroukh 1, Raghad Saleh 2, Ahmed Abuhilal 3, Mayar Danadneh 4, Elham Kateeb 5.

1. Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem, State of Palestine.
2. Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem, State of Palestine.
3. Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem, State of Palestine.
4. Oral Health Research and Promotion Unit, Faculty of Dentistry, Al-Quds University, Jerusalem, State of Palestine.
5. Oral Health Research and Promotion Unit, Deanship of Scientific Research, Al-Quds University, Jerusalem, Palestine

Corresponding author: ruba.nier97@gmail.com

Background: Dental plaque is one of the major factors in the initiation and progression of dental caries, gingivitis and periodontal diseases. It has been reported that tooth brushing alone can clean only 3 surfaces of the tooth's five surfaces. Thus combining tooth brushing with interdental cleaning is crucial. Dental floss is one of the most effective interdental interventions that remove plaque between the teeth. The purpose of this study was to evaluate the awareness, attitudes and practices of dental students at Al-Quds University, Palestine, related to the use of dental floss. Periodontal diseases are probably the most common disease worldwide. The WHO recently reported that severe periodontitis exists in 5-20% of adult populations. Oral diseases can be prevented by the appropriate oral health behavior; mechanical plaque control is the golden principle in the prevention of oral diseases. the use of dental floss along with regular tooth brushing has been recommended routinely for prevention of gingival diseases, the statistics throughout the world is not encouraging. Only 15.8% of the population in India used dental floss. Americans population a third (34%) clean between their teeth with floss every day. The use of dental floss was very rare in North Jordan (Mafraq Governorate), Saudi Arabia and Egypt the findings about the use of dental floss were negligible.

Methods: This is a cross-sectional analysis performed between first to fifth-year dental students from the Faculty of Dentistry at Al Quds University to determine the experience of the use of dental floss, the mindset towards the importance of the use of dental floss, and the practice of students regarding the use of dental floss. Data was conducted among 292 dental students between March 28, 2020, and April 10, 2020. Dental students received an online survey posted to their official Facebook groups and sent to them via the Messenger app. Out of 870 students registered at AQU Dental Faculty, 790 students were enrolled in school official Facebook groups and had access to the survey link. Sample size calculation was carried out using the Raosoft online calculator which estimated 292 as a minimum sample needed to achieve 95% confidence level and 5% margin of error. Sample size calculation was carried out using the Raosoft online calculator which estimated 292 as a minimum sample needed to achieve 95% confidence level and 5% margin of error.

Findings: The participants comprised 18.2 % in the 1st year, 16.1 % in the 2nd year, 18.2 % in the 3rd year, 22.3 % in the 4th and 25.3 % in the 5th year. 292 students completed the test. 33.3 % of students who use dental floss believe that modern toothbrush is equivalent to dental floss, the dental floss use correlation with students who claimed that modern toothbrushes with advanced bristle construction extract interdental plaque identical to dental floss was smaller, X2=6.2, p=0.01. 55.2 % of students thought that the frequent use of dental floss next to the toothbrush is essential to gingival health in comparison to the use of dental floss X2=5.6, p= 0.02. 35 % of students using dental floss thought it was difficult to use dental floss, With the use of dental flossX2=20, p=0.05. 48.5% of students who use dental floss believe that the use of dental floss is not taught in dental education, X2 =4.2, p =0.04. 58.2 % of students who use dental floss have sufficient knowledge on how it is used, X2=25, p<0.05 for knowledge outcomes. For practice results Students using mouthwash used dental floss more, X2=10.8, p=0.001.

Interpretations: The findings in this study showed that dental floss when used as an adjunct to a toothbrush has higher effectiveness in the removal of dental plaque and gingival disease than a toothbrush alone. Although Al-Quds University dental students have adequate knowledge on how effective it is to use the floss as an adjunct to the toothbrush, we still should encourage the community and students to do so, thus we recommend that oral health awareness of every single preventive measure should reach its maximum.

Alaa Eldeen Elmassry 1, Iyad Hussien 2, Akram A. Jarbou 3

1. Consultant Internist – Head of Internal medicine department – Nasser Medical Complex – Khanyounis – Gaza Strip
2. Consultant Neurologist – Nasser Medical Complex - Khanyounis – Gaza Strip
3. Intern Doctor – Nasser Medical Complex – Khanyounis – Gaza Strip

Correspondence Akram Jarbou: akram.jarbou.96@gmail.com

Background: Posterior reversible encephalopathy syndrome (PRES is a clinical –radiological entity characterized by sudden onset disturbance in consciousness, visual impairment, headache, and seizures with characteristic radiological findings include cerebral vasogenic edema predominantly in the parieto-occipital white matter of the brain .It is believed that it is associated with many conditions like autoimmune diseases, immunosuppressive agents, organ transplantation, acute glomerulonephritis, and sepsis.  PRES occurs mainly in adult age group , however few cases have been described in children.

Case presentation: We report herein a case of 12-year-old boy with no medical history who initially presented with sore throat, fever , followed by hematuria , hypertension and acute kidney injury consistent with acute glomerulonephritis. He started to receive medical treatment for acute GN, and few days apart he started to develop acute headache, visual disturbances , altered mental status followed by episodes of tonic – clonic convulsions which necessitate him to be admitted to ICU as a case of status epilepticus. MRI brain showed bilateral parieto-occipital hyper intense subcortical lesions suggestive of PRES and eventually he was treated with antihypertensive and anticonvulsant drugs with good improvement.

Importance of case: This case report explains the importance of considering PRES in the differential diagnosis in children presenting with acute mental state change and seizures in acute glomerulonephritis and hypertensive conditions.

Methods: this is a case report for 12-year-old male patient at internal medicine department of Nasser Medical Complex - Khanyounis – Gaza Strip.

Conclusion: we are reporting a rare case of 12-year-old male patient who developed acute headache, visual disturbance, tonic – clonic convulsions with MRI findings of PRES as a result of acute glomerulonephritis. PRES should be in the differential diagnosis for any patient with autoimmune disease, kidney disease, malignancy, on immunosuppressant therapy or organ transplantation who presents with neurological symptoms, hypertension and disturbance of consciousness. Head MRI often reveals edema in the subcortical white matter of the posterior portion of the cerebral hemispheres. Rigorous control of hypertension, seizures are important strategies in managing PRES and preventing recurrence.

Faris Abushamma ^1,2 , Mahfouz Ktaifan ¹ , Abdoh Abdallah ^{1 ,} Mohammad Alkarajeh ^{1 ,} Mosab Maree ^{1,3 ,} Ahmed Awadghanem ^1,3 , Ahmed Jaradat ^1,2 , Amir Aghbar ^1,2 , Sa'ed H Zyoud ^4,5 , Francis X Keeley Jr ⁶

1. Researcher, MD, FRCS - Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
2. Researcher, MD- Department of Urology, An- Najah National University Hospital, Nablus, 44839, Palestine.
3. Researcher, MD- Department of Radiology, An-Najah National University Hospital, Nablus, 44839, Palestine.
4. Researcher, PhD- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
5. Researcher, PhD- Clinical Research Center, An- Najah National University Hospital, Nablus, 44839, Palestine.
6. Researcher, MD, FRCS- Bristol Urological Institute, North Bristol NHS Trust Bristol, UK.

Corresponding author: m.ktiafan@gmail.com

Background: Acute ureteric colic (AUC) is generally one of the most common reasons for emergency department attendance. Expectant management is recommended in non- complicated ureteral calculi. However, data regarding the optimal duration of observation or indications of early intervention (EI) are not well understood. This article describes the clinical and radiological factors that promote EI in AUC.

Patients and Methods: This was an observational and retrospective cohort study. 161 patients (adults from both sexes) with AUC diagnosed based on non-contrast computerized tomography (NCCT) between 2019 and 2020 in An-Najah National University Hospital-Palestine, were enrolled in the study. These patients were classified into two main categories: spontaneous passage of stone (SSP) and EI. In addition, a comparative analysis was performed to identify clinical and radiological variables that promote EI.

 Inclusion Criteria

1. A ureteral calculus proven by an NCCT scan.
2. Follow-up clinic data available within six weeks of discharge from the emergency department.

Exclusion Criteria

1. Ultrasound- or X-ray-based diagnosis of ureteral stone.
2. Complicated ureteric stone such as sepsis, or eGFR less than 30 mL/min.
3. Single anatomical or functional kidney.
4. Age less than 18 years old.

Statistical Analysis: All analysis was performed with SPSS Statistics version 21.0 (IBM). Categorical variables were presented as abso- lute frequency (percentage). The Pearson’s chi-square test or Fisher’s exact test, as appropriate, were applied to assess the differences for categorical variables, and the Mann–Whitney U-test was used for continuous variables. P-values of <0.05 were considered statistically significant. Multiple logistic regression analysis was used to identify patients’ clinical and radiological characteristics asso- ciated with EI in AUC. “EI in AUC (Intervention⁄SSP)” was used as the dependent variable in the model. Variables included in the regression analysis were those with statis- tically significant p-values (<0.05) in the univariate analy- sis but we excluded the CRP because of significant missing data.

Ethical Considerations: The Institutional Review Board (IRB) of An-Najah National University has approved this study. Because of the retrospective chart review, the IRB waived informed consent. The research was conducted in accordance with the Helsinki Declaration. There is no confidentiality risk because the analysis employed anonymized clinical data that cannot be connected to the patients who participated.

Results: One-hundred and sixty-one patients were included. High WBCs are associated with a significant increase in EI. Forty-three percent (n=37) of patients with serum WBCs higher than 10 had an EI, while 23% had SSP (n=17;p<0.001). High CRP level is also significantly associated with EI (n=36; 86%; p<0.001). Upper and middle ureteral calculi are statistically associated with EI (n=54; 62%) in comparison to the SSP cohort (n=22; 30%;p<0.001). EI is also linked to the maximal length of ureteric calculi (MCL) of 9 mm (6–13mm), and HU density of stone of 700 (430–990) H.U (p<0.001). Ureteric stone volume of 0.2 (0.06– 0.3) cm3 is significantly associated with EI (p<0.001). Ureteral wall thickness of 3 (2–3 mm), the presence of extrarenal pelvis (n=20; 23%), and AP diameter of renal pelvis 18 (13– 28 mm) are all significantly associated with a higher rate of EI (p<0.001). Multiple binary logistic regression analysis showed that MCL is the strongest predictor of EI.

Conclusion: MCL is an independent and robust predictor of EI in AUC. Biochemical variables and radiological characteristics can also act as an adjunct to promote EI.

Strength and Limitations: Although this is the first cohort study in the Arab world, we have encountered a few limitations. The retrospective nature of this study and the possibility of missing some patients are considered the main limitations of this study. Furthermore, the lack of a standard protocol for intervention and the concept that clinicians were not blinded to the size of the stone are also potential reasons for clinical bias as treating physicians may have a lower threshold for intervention in larger and higher stones. However, in the absence of randomized clinical trials, this article represents real-life practice. Despite having a significant correlation of EI with raised CRP, however, 43% of our cohort did not have an available CRP.35,36 Nevertheless, given these promising findings and predictors of EI in AUC, we have started a prospective, national, and multicentre trial to validate all factors with a view to developing a scoring model to predict EI in AUC.

Faris Abushamma ^1,2 , Mahfouz Ktaifan ¹ , Abdoh Abdallah ^{1 ,} Mohammad Alkarajeh ^{1 ,} Mosab Maree ^{1,3 ,} Ahmed Awadghanem ^1,3 , Ahmed Jaradat ^1,2 , Amir Aghbar ^1,2 , Sa'ed H Zyoud ^4,5 , Francis X Keeley Jr ⁶

1. Researcher, MD, FRCS - Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
2. Researcher, MD- Department of Urology, An- Najah National University Hospital, Nablus, 44839, Palestine.
3. Researcher, MD- Department of Radiology, An-Najah National University Hospital, Nablus, 44839, Palestine.
4. Researcher, PhD- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
5. Researcher, PhD- Clinical Research Center, An- Najah National University Hospital, Nablus, 44839, Palestine.
6. Researcher, MD, FRCS- Bristol Urological Institute, North Bristol NHS Trust Bristol, UK.

Corresponding author: m.ktiafan@gmail.com

Background: Acute ureteric colic (AUC) is generally one of the most common reasons for emergency department attendance. Expectant management is recommended in non- complicated ureteral calculi. However, data regarding the optimal duration of observation or indications of early intervention (EI) are not well understood. This article describes the clinical and radiological factors that promote EI in AUC.

Patients and Methods: This was an observational and retrospective cohort study. 161 patients (adults from both sexes) with AUC diagnosed based on non-contrast computerized tomography (NCCT) between 2019 and 2020 in An-Najah National University Hospital-Palestine, were enrolled in the study. These patients were classified into two main categories: spontaneous passage of stone (SSP) and EI. In addition, a comparative analysis was performed to identify clinical and radiological variables that promote EI.

 Inclusion Criteria

1. A ureteral calculus proven by an NCCT scan.
2. Follow-up clinic data available within six weeks of discharge from the emergency department.

Exclusion Criteria

1. Ultrasound- or X-ray-based diagnosis of ureteral stone.
2. Complicated ureteric stone such as sepsis, or eGFR less than 30 mL/min.
3. Single anatomical or functional kidney.
4. Age less than 18 years old.

Statistical Analysis: All analysis was performed with SPSS Statistics version 21.0 (IBM). Categorical variables were presented as abso- lute frequency (percentage). The Pearson’s chi-square test or Fisher’s exact test, as appropriate, were applied to assess the differences for categorical variables, and the Mann–Whitney U-test was used for continuous variables. P-values of <0.05 were considered statistically significant. Multiple logistic regression analysis was used to identify patients’ clinical and radiological characteristics asso- ciated with EI in AUC. “EI in AUC (Intervention⁄SSP)” was used as the dependent variable in the model. Variables included in the regression analysis were those with statis- tically significant p-values (<0.05) in the univariate analy- sis but we excluded the CRP because of significant missing data.

Ethical Considerations: The Institutional Review Board (IRB) of An-Najah National University has approved this study. Because of the retrospective chart review, the IRB waived informed consent. The research was conducted in accordance with the Helsinki Declaration. There is no confidentiality risk because the analysis employed anonymized clinical data that cannot be connected to the patients who participated.

Results: One-hundred and sixty-one patients were included. High WBCs are associated with a significant increase in EI. Forty-three percent (n=37) of patients with serum WBCs higher than 10 had an EI, while 23% had SSP (n=17;p<0.001). High CRP level is also significantly associated with EI (n=36; 86%; p<0.001). Upper and middle ureteral calculi are statistically associated with EI (n=54; 62%) in comparison to the SSP cohort (n=22; 30%;p<0.001). EI is also linked to the maximal length of ureteric calculi (MCL) of 9 mm (6–13mm), and HU density of stone of 700 (430–990) H.U (p<0.001). Ureteric stone volume of 0.2 (0.06– 0.3) cm3 is significantly associated with EI (p<0.001). Ureteral wall thickness of 3 (2–3 mm), the presence of extrarenal pelvis (n=20; 23%), and AP diameter of renal pelvis 18 (13– 28 mm) are all significantly associated with a higher rate of EI (p<0.001). Multiple binary logistic regression analysis showed that MCL is the strongest predictor of EI.

Conclusion: MCL is an independent and robust predictor of EI in AUC. Biochemical variables and radiological characteristics can also act as an adjunct to promote EI.

Strength and Limitations: Although this is the first cohort study in the Arab world, we have encountered a few limitations. The retrospective nature of this study and the possibility of missing some patients are considered the main limitations of this study. Furthermore, the lack of a standard protocol for intervention and the concept that clinicians were not blinded to the size of the stone are also potential reasons for clinical bias as treating physicians may have a lower threshold for intervention in larger and higher stones. However, in the absence of randomized clinical trials, this article represents real-life practice. Despite having a significant correlation of EI with raised CRP, however, 43% of our cohort did not have an available CRP.35,36 Nevertheless, given these promising findings and predictors of EI in AUC, we have started a prospective, national, and multicentre trial to validate all factors with a view to developing a scoring model to predict EI in AUC.

Contributors:  Dr Natalie Marzouqa*,MBBS,  Dr Lebeth Jacob*, MBBS,  Mr Andrew Busuttil*,MBBS. PhD. , Mr Daryll Baker* FRCS PhD

Affiliation: * University College London Hospitals Foundation Trust, Vascular Surgery Department, London, UK

Corresponding author is Natalie Marzouqa: nataliemarzouqa@gmail.com, address: Cedars Flat 3, QEH staff residences, Gayton Road, King’s Lynn, Norfolk, UK, PE30 4ET

Introduction

Stroke is the third leading cause of death in developed nations and the leading cause of long-term disability. Carotid artery stenosis accounts for 20 to 30% of ischaemic strokes. Carotid Endarterectomy (CEA) has proven highly effective in preventing the development of strokes, transient ischaemic attacks and reducing mortality rates among patients with symptomatic carotid artery stenosis of 50-99%. The most common complication of CEA is wound haematomas. This study evaluates a protocol driven haemostasis pathway aimed at reducing post-operative haematoma, for patients undergoing CEA. A recent quality improvement project identified a significantly high neck haematoma rate as well as a high return to theatre rate for the complication. We set out to develop a protocol to reduce the incidence of neck haematoma and identify any effect this has on the return to theatre and neck haematoma rates.

Method

A prospective cohort outcome study between June 2019 and June 2020 was conducted, with the introduction of this stepwise pathway introduced as a quality improvement measure.

• Patch haemostasis ensured with meticulous attention to bleeding points.
• 10 minutes of Light compression applied – activated clotting time checked/ protamine given if required.
• 10 minutes post protamine - 1 g tranexamic acid administered if needed.
• If bleeding persists after 10 minutes, discussed with haematology / platelet transfusion.

This was implemented at the end of successful patch closure, for each CEA.

Data Recorded

We recorded 212 patients in this study. The patients’ demographics and clinical data were recorded on a standardized form used to collect data for entry into the national vascular registry of the vascular society of Great Britain and Ireland. The clinical variables recorded included onset of symptoms, dates of neurological/vascular assessment, preoperative antiplatelet /anticoagulation regimen, date of CEA, operating surgeon, type of anaesthetic, use of patch/shunt/Transcranial Doppler, protamine/tranexamic acid/intraoperative platelet use.  Complications recorded included intraoperative stroke/Transient Ischaemic Accident, post-operative haematoma, other complications such as cardiovascular events and death. Surgical outcomes also included length of hospital stay, postoperative antiplatelet regimen and complications such a nerve injury in surgical follow-up.

The data mentioned was collected and the write up was done by Dr Marzouqa and Dr Jacob within their role as Vascular senior house officers in UCLH. Data analysis and supervision was done by both Mr Baker and Mr Busuttil.

Analysis

We chose to include all 212 CEA patients between June 2019 and June 2020. This study was done in an NHS trust in the UK; therefore, ethical approval was not required. The study was simply registered as an audit of the trust.

 Simple excel calculators were used to come up with the following results.

Results:

Surgical outcomes generally improved following intervention. We compared 100 patients pre intervention to 112 patients following intervention. Patients who had haematoma post-operatively reduced from 7 to 4. Return to theatre due to this haematoma dropped from 6 to 1. Minor bleeding did not happen in any of a 100 patients pre-intervention but happened in 2 patients after implementing the intervention. 5 patients experienced stroke which dropped to 2 post-intervention. ACS did not change as we had one patient on each side of the intervention.

The distribution of protocol implementation in the post intervention group was as follows. 75% of the 112 did not need intervention, 17% needed protamine sulphate to reverse heparin given intra-operatively, 1% of patients needed tranexamic acid and 7% needed both protamine sulphate and tranexamic acid.

The length of stay in hospital pre-intervention distributed 50% with a one day stay, 16% with a two day stay and 34% with three or more days of stay in hospital. Comparing this to post intervention, 53% of patients stayed 2 days, 19% were admitted for a total of 5 days, 18% stayed for 10 days, 8% for >10 days and 2% were discharged the next day.

Looking at post-operative complications in the two groups, in the pre-intervention group, 78% of the patient did not experience any complications, 9% had Strokes/TIAs, 7% experienced haematomas, 2% has intra-operative haemorrhage and 4% had other complications. As for the post-intervention group, 81% of the patients had no complications, 3% had strokes/TIAs, 3% had haematomas, 4% had nerve injury, 3% had CCA dissection, 2% had superficial bleeding and 4% had other complications.

Study limitations

This study has several limitations. Firstly, as data was prospectively collected and retrospectively analysed, its strength was limited. Secondly, as the procedure was performed by a small number of surgeons, it is difficult to draw any generalised conclusions. The small size of the study also provides significant limitations. Incidence of post-operative haematoma after CEA is not easy to ascertain reliably. Most haematomas which were stable and not requiring any intervention were subject to clinician selection bias. An objective screening tool may be needed to overcome this bias.

Various studies have associated haematoma formation to perioperative antiplatelet and anticoagulation use. Patients in this study received single/ dual antiplatelets or anticoagulation. This was based on general comorbidities and medical management determined by the stroke clinicians. To determine the true effect of the haemostasis pathway implemented a study which can standardise perioperative antiplatelet/anticoagulation use would be optimal.

Finally, some studies do show greater intraoperative and postoperative haemodynamic stability in regional anaesthesia use. In this study the anaesthesia implemented was at the anaesthetic team’s discretion. Standardising this variable will provide a more precise estimate of the true effect of haemostasis pathway implementation. 

Conclusion

Our protocol appears to reduce post-CEA haematoma rates to 3.6% from 7% which was observed in our 2018 quality improvement project. Return to theatre rates had also dropped from 6% to 0.9%, this was without an increase in peri-operative stroke rates despite using protamine and tranexamic acid when needed.

Diya Asad1,Qusai Zreqat 1,Shahd Idais 1, Bara'ah M.Huseein 2.

1. Senior medical student _ Al-Quds University.
2. 4th year medical student _ Al-Quds University.

Corresponding author: Shahd Idais: Shahdidais@gmail.com

Background: Gastroparesis is defined as a delay in gastric emptying without any

mechanical obstruction in stomach, which is a serious complication of diabetes mellitus

and frequently presented with anorexia, early satiety, vomiting, postprandial abdominal

fullness and discomfort.This is first study in Palestine, aims to assess knowledge,

patients' attitude and treatment options used in practice.

methods: A pilot cross sectional study design, using random sampling for Palestinian,

DM type 2, adults>18 years were evaluated by face to face interview using an electronic

data collection tool(BoboTollBox) of diabetic gastroparesis related questionnaire and

GCSI(Gastroparesis Cardinal Symptom Index) arabic version. Beside the GCSI,

questions were mainly on demographic information, disease onset and management,

glycemic control, smoking and diet. A total of 1500 patients (54.5% females ,

61.12+-10.83 years old) were included in this study from seven governmental hospitals

with bad capacity

finding/ results: Statistical analysis shows that The prevalence of clinical symptoms of

gastroparesis among type 2 diabetics was 21%. The clinical symptoms of Gastroparesis

(GCSI score more than or equal 1.9) were significantly affected by the duration of

diabetes, increased age, and higher HA1c. The most common symptoms were stomach

fullness, Nausea and early satiety (95.6%, 91.8% and 91.2% respectively). Nausea and

bloating were the most frequent and initial symptoms. There was a significant

relationship between the GCSI score and fluid intake but no relationship smoking. The

overall incidence found to be more common in obese females.

Interpretations: Diabetic gastroparesis is underdiagnosed in Palestine, not only

because the standard method for diagnosis is not available but also because doctors

under-appreciate GI complaints in diabetic patients. Screening is possible via GCSI

score on routine visits and referral to specialist for further evaluation and management if

severe. The main strength point in this study that it's the first study in Palestine to be

conducted in the field of diabetic gastroparesis, so results are likely to have a large

impact on doctors' discussion in the future regarding diagnosis and treatment Some

limitations on the study were that Gastroparesis Cardinal Symptoms index- GCSI is only

available in English. so we worked on translating and validating an Arabic using

Linguistic Validation of a clinical Outcome assessment (COA).

Khalil.I.Shawamri 1. Loai.S.Abu-Rayyan. 2. Sohaib Abo-Jheshi.3.

1. Researcher. Emergency MSN, CNS, BSN. (Al-Mohtasib governmental hospital , Hebron , Palestine )
2. Researcher. MPH, BSN. (Al-Mohtasib governmental hospital , Hebron , Palestine )

3. Researcher. Psychiatric MSN, CNS, BSN. (Al-Mohtasib governmental hospital , Hebron , Palestine ).

Corresponding author: kshawamri@icloud.com

Abstract

Background: In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), starts from Wuhan, China, which has been identified as cause of the pandemic, resulting in millions of cases of deaths worldwide (Ramzy et al., 2020). In march 2020, the first case was being discovered in Palestine, especially in Beit Lahm city. (Qutob et al.,2020).In occupied Palestinian territory, including east Jerusalem, from march 2020 to 12 March 2021, there was more over than 232,665 confirmed cases of Covid-19 with 2,467 deaths, as it reported to WHO (WHO. 2021). This study was done to assess the emergency nurse’s knowledge, attitude and perception of practice toward CPR for Covid_19 patient in Palestinian West Bank governmental hospital after the death cases were reported a high numbers in Palestinian hospitals. it discussed the approach of dealing with CPR cases according to AHA new Covid_19 CPR guidelines. The study aimed to make the policy makers and administrative in health institutions to increase their preparedness and compliance with the new AHA Covid_19 guidelines. Also, It will integrate the new AHA guidelines in curriculum of Baccalaureate Nursing Programs (BSN). In addition, It will be data base for researchers in future.

Method: The study includes all nurses who work in emergency departments in all Palestinian West Bank governmental hospitals , they were 230 nurses. A Quantitative cross-sectional, descriptive study was used to evaluate the nurses knowledge, attitude, and practice throughout self-administered questioner in time period of 1st march to the 15th may.2021. The collected sample was 210 nurses with an exclude to the pilot study sample (20 nurses). The data were collected in order to analyze the response of study participants throughout descriptive statistics (mean, standard deviation S.D).

Results: There were a 42% of Palestinian governmental emergency nurses had a moderate level of knowledge toward CPR for Covid_19 patients, for the attitude dimension, there were a 48,1% of nursing had a neutral attitude toward CPR for the Covid_19 patients, and 56% of study participants had a good level of practice toward CPR for Covid_19 clients.

Conclusion: There was a significant relation between gander, employment status and previously trained for CPR with the perception of practice with a p value <0.05.

Recommendation: The study enhanced the continuing education committee and empower their roles in all Palestinian hospital, also follow a strict policies, measures for CPR to improve nursing and staff team commitment of implementing AHA protocols and finally, establishing a protocol all nurses who will be accepted to work in emergency department must have at least basic life support(BLS).

Keywords: Emergency nurse, cardiopulmonary resuscitation (CPR), Covid_19 patients, American Heart Association (AHA).

© Arab American University- Jenin 2021. All rights reserved

Authors:

Ameed Taher, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Ezzideen Malhis, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Souad Belkebir, Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Therese Zink, Department of Family Medicine & School of Public Health, Brown University, Providence, RI USA.

Corresponding Author: Ameed Taher  Email: ameed1997@yahoo.com

Abstract

Background: First conceptualized in the 1970s, Fibromyalgia (FM) is the second most common condition observed by rheumatologists, with an estimated global mean prevalence of 2.7%. Despite that, it is still underdiagnosed, and its legitimacy questioned. Patients with FM are often stigmatized due to the lack of clearly defined symptoms and pathophysiology, and the psychologizing of the condition. Knowledge deficiencies and negative attitudes among physicians toward FM have been demonstrated in several countries. This study aims to explore Palestinian physicians' knowledge, educational experiences, clinical practice behaviors, and attitudes regarding FM.

Methods: Physicians in different specialties who were most likely to care for patients with FM were purposively sampled and consented to participate in semi-structured interviews.  Interviews were audio recorded and transcribed and a thematic content approach to analysis was used.

Results: Fourteen physicians in Palestine were interviewed. Three themes and seven subthemes were identified from the interviews: knowledge and attitudes (subthemes: educational realities, physicians' attitudes toward FM), approach to clinical care and related issues (diagnosis and etiology of FM, management of FM, unwillingness to manage FM patients), and challenges (doctor-patient relationship, adequacy and acceptance of psychological services).

Conclusion: Knowledge deficiencies and negative attitudes about FM were common among the Palestinian physicians we interviewed, even in those specialties deemed most likely to make the FM diagnosis. The inadequacies of healthcare (too many patients and too little time), the lack of psychological services, and the misunderstandings about mental health in Palestine were thought to affect the education of future physicians and the quality of care for FM patients. 

Walaa Abu Alia¹, Beesan Maraq², Zaher Nazzal³,  Mahmoud Odeh⁴, Rabee Makhalfa⁴, Ali Nassif⁴, Mousa Aabed⁵.

1. MD, Primary Health Directorate, Ministry of Health, Ramallah, Palestine. 
2. MD, PBFM, Primary Health Directorate, Ministry of Health, Ramallah, Palestine. 
3. MD, Consultant Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
4. Intern Doctor, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
5. MD, Consultant Family Medicine, Ministry of Health, Gaza, Palestine.

Correspondent author: Zaher Nazzal, MD, Consultant Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University. Email:  znazzal@najah.edu, Mob: +(972) (599) 545421.

Nablus, Palestine, Box 7,707 Tel. (09) (972) +  2342902/4/7/8/14 Fax:+ 2342905(09) (972).

ABSTRACT

Background: In response to this extraordinary outbreak, many countries and companies rush to develop an effective vaccine, authorize, and deliver it to all people across the world. Despite these extensive efforts, curbing this pandemic relies highly upon vaccination coverage. This study aimed to determine SARS-COV-2 vaccine uptake among Palestinian healthcare workers, the factors that influence vaccination uptake, and the motivators and barriers to vaccination.

Methods: A cross-sectional study was conducted using an online anonymous self-administered questionnaire during April and May 2021, enough time after the Palestinian Ministry of Health launched the COVID-19 vaccination campaign. The questionnaire collected socio-demographic characteristics, vaccination attitude and vaccination uptake status, and motivators and barriers towards vaccination. In addition, multivariate logistic regression was performed to identify the influencing factors of vaccination uptake.

Results: The study included 1018 participants from different professions, including 560 (55.0%) females. Of the participants, 677 (66.5%; 95% CI: 63.5%- 69.4%) received the vaccine. Higher uptake was observed among males (aOR=1.5; 95%CI: 1.1-2.1), single HCWs (aOR=1.3; 95%CI: 1.1-1.8), HCWs working in the non-governmental sector (aOR=1.6; 95%CI: 1.2-2.4), higher monthly income (aOR=1.9; 95%CI: 1.4-2.8) and smoking (aOR=1.5; 95%CI: 1.1-3.5). The lower level of negative vaccination attitudes predicted higher intake; mistrust of vaccine belief (aOR=1.6; 95%CI: 1.4-1.7) and worries over unforeseen future effects (aOR=1.2; 95%CI: 1.1-1.3).

Conclusion: In conclusion, the COVID-19 vaccination uptake was comparable to other studies worldwide but still needs to be improved, especially in the context of this ongoing global pandemic. It is imperative to invest resources to promote vaccination uptake and target all the vaccine misconceptions and fears.

Our study has many strengths, including a large diverse population, with participants representing a wide range of professions, genders, ages, and geographic areas. However, the study has some limitations. First, the online survey distribution and nonrandom sampling method used in this study may introduce selection bias, resulting in a study population not representative of all Palestinian HCWs. Second, the cross-sectional survey method may limit the ability to draw conclusions and establish causal relationships.

Author: Mohammed Qtait 1

1. Hebron Government Hospital, Ministry of Health, Hebron, Palestine.

Corresponding author: Mohammed Qtait

 Email: mohamadtaha98@hotmail.com

Abstract

Background: Burn related injuries are relatively common, mostly accidental, and highly preventable forms of injury. First aid management of burn injuries can have a significant impact on the outcome and morbidity of these injuries, yet there seems to be an inadequacy in the knowledge related to burn management worldwide. First aid is the initial assistance or treatment given at the site of accident to someone who is injured or suddenly taken ill, before the arrival of ambulance.

 Objective: To assess the general knowledge, of relative for burn first aid, and to know the way of use to first aid for burns, and to evaluate the needs of society for program first aid

Method: A cross-sectional study was conducted in main governmental hospital contain burn unite in Palestine during the one year January  2018 to 31 December  2018 with burns any percent A representative sample of Palestinian parents who live in west bank and came to family emergency department in hospital was included.

 Result: A total of 150 participants comprising 23.3 males and 76.7 females with age of participant under 40 years were included. The majority (58%) were educated up to school or higher. most sours of information about first aid from doctors and nurses, the second source internet and TV and radio. most of participants mot take first aid course previously. 66% of participants use "cool running water in the first aid, 66.7% of participants not correct answer about Duration of cooling. 71% of participants answer incorrect answer how to deal with Scenario of fire burn wound, most of participants use using traditional therapy for first aid, and Use toothpaste or tomato or other things. Conclusion: First aid training should be compulsory for all people. This training should be periodically continued re-assessment and updated at regular intervals. It should be a part of school health advisors’ continuous professional development. Therefore, the need for more studies that address the promotion and protection of health in community is highlighted, thus enabling the transformation of people in relation to the knowledge of first aid actions in burn. This way, such training will make the people skilled to face and know how to act when facing situations that generate a greater complexity in their daily lives. People need more training in the first aid especially in burn first aid is a simple, cheap, and accessible means of managing burns initially. First aid course in the university for all student systemic with suitable language.

Abstract: This article is about the impact of covid 19 in altering sleeping pattern among ICU's patients, and the impact of some type of sedation in covid patients from the patients and thier companion experience as they speach  .

 Hiba Alsharha, South of Hebron ,Dura .

1. Researcher, NLP,RN.Dura Govermental Hospital.

Postal code :10470.

Corresponding author: nursesharahaa@gmail.com.

Background: Between the period of 1.11.2020 untill 1.6.2021 at the Dura Govermental hospital , the ICU pateints complaining from inability to sleep, altered sleep pattern, as the pateint's experience and nurses ,pateint's collegue and all other health care providers seen ,even in all other intensive care untis in all hospitals in the world , which make the study necessary to conducted .

Methods –Data was collected in 2020-2021 using a purposeful sample used in depth face to face  semi-structured interview with ICU pateints at DGH. Sample collection was based on evaluating the pateint who complaining from altered sleeping pattern and allow them to express thier feelings and explain their experience ,50 pateints  were included male and female over the age of 40 and their companions  were  interviewed  . Ethics Committee included (The Dura govermantal hospital manger and mitron) approved the study and informed consent was obtained from interviewees.

Analysis of the Data :the data was analyezed by use inductive thematic content analyasis through the affected ICU pateints , there is 6main themes and 30 sub themes explored ,the data taken fron the pateint were transcript verbatime, which included impact of covid 19 in walking up at night, Impact of covid 19 in insomnia, Impact of covid 19 in increase stress among pateints, impact of covid19 in increase night terrors, Impact of lack of sleep in deteoriotion of pshychological health.

Findings : the study showed the main effect of covid 19 in altering sleeping pattern and their impact in detoriouration of pateint pshychological health, the effect of some sedation like Halidole that use a lot at ICUs in reduce the effect of covid on pateint's sleep only when the pateint complaining from pshychotic symptomes , but when the pateints complaining from pain Perflgan is the best choices to reduce the pateints pain and help them to sleep.

Interpretations: covid 19 impact sleeping pattern among ICU pateints expicially whose over the age of 50, the study showed that the older the pateints were the greater impact of  covid 19 in sleeping patern, walking up at night,insomnia ,night terrors and others, also the pateint's with CPAP were complaning continously from lack of sleep and insomnia , more than others on high flow nasal canula, which  reduced when the nurses give those pateints some type of sedation, like Halidole  IM but when the pateint complaning from Pshychotic sighn and symptomes like depression and delirrium as pateint's companion said , but when the pateint feel of pain there was no effect of halidole , the symptomes reduced when tne pateint take Perflgan.

Zaher Nazzal¹ ,Fatima Abdel Jaleel¹, Aseel Ashayer¹, Husam Salameh² , Zakaria Hamdan^3*

¹Department of Medicine, Faculty of medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

² Department of Oncology, An-Najah National University Hospital, 44839 Nablus, Palestine.

³Department of Nephrology, An-Najah National University Hospital, 44839 Nablus, Palestine.

Email addresses :

znazzal@najah.edu

fatimadiabaj@hotmail.com

aseel_ashayer@hotmail.com

husam.salameh@najah.edu

z.hamdan@najah.edu

Corresponding author : Dr. Zakaria Hamdan : Nephrologist, Department of Nephrology, An-Najah National University Hospital, 44839 Nablus, Palestine. z.hamdan@najah.edu. +970592346486

Key words: Acute Kidney Injury, Cancer patients, Risk factors, Palestine

ABSTRACT

Background

 The treatment of cancer has undergone significant advances in recent times. Despite the advantages that chemotherapeutics provide for different malignancies, nephrotoxicity remains a complication, and sometimes limits life-saving therapy. Acute kidney injury (AKI) is a major concern in cancer patients which needs to be studied. It is related to many contributory factors including cancer-related and patient-specific factors as well as chemotherapy-related renal toxicity, which negatively impact the outcome in managing cancer patients. .

Objectives

 Assessing the incidence of AKI in cancer patients at Najah National university hospital in the years 2016-2017, as well as the demographics and clinical characteristics of patients in relation to the risk of AKI.

Methods

 A Retrospective cohort study was conducted at Najah National University Hospital (NNUH) in the period 2016-2017. A data abstraction sheet was used to collect related variables using computerized data from registration forms completed by physicians in addition to laboratory, pathology, and radiology departments after ethical approval from the Institutional  Review Board (IRB) at Najah National University was obtained.

Participants

All adults older than 16 years old with solid tumors or multiple myeloma who had been admitted to NNUH during the study period. An admission was defined as a stay of >24 hours in the hospital with serum creatinine value at the admission and another reading during hospital stay.

Exclusion criteria : patients with bone marrow transplantation and those who were treated as outpatients were excluded.

Analysis and results

IRB approval and Oncology department and NNUH approval were obtained.

A total of 820 admissions (227 patients) were collected in a 2-year period (2016 and 2017). 182 (27 patients) were excluded due to missed creatinine readings.

 Using RIFLE (Risk, Injury, Failure, Loss and End stage renal disease) criteria, 6.9%  admissions were complicated with AKI. The severity of these fell into the categories of the Risk, Injury and Failure; 3.3%, 1.7% and 1.9% respectively. In the multivariate model , the odds ratio for developing AKI was significantly higher for patients with congestive heart failure, chronic kidney disease, sepsis and ICU admissions. The odds for mortality (5.673 fold) were significantly greater among AKI patients.

Conclusion: The rate of AKI in patients admitted to NNUH was correlated significantly with congestive heart failure, chronic kidney disease, sepsis and ICU admission, which contributed to worse outcomes and higher mortality rates.

Strengths and limitations

Strengths included that AKI is a critical problem regarding cancer patients, it’s done in a population-based hospital setting with 100% governmental coverage and NNUH is considered one of the biggest tertiary referral hospitals in the west bank so most complicated cancer cases especially renal complications will be found there. Whereas limitations included Missed creatinine values, some information were missed and shortage of similar studies that focus on the same outcome.

Authors; Aya Masalmeh 1, Sireen Zaaqiq 2, Hanna Khader 3, Ihab Alayan 4, Mohammad Abu Hamdieh 5.

Corresponding author:

Ayamasalmeh@gmail.com

Background:

The Palestinian society is considered a young society where the percentage of young people is high and the percentage of the elderly is relatively low.  In mid-year 2019, the number of the elderly aged 60 years and above reached 257,151 persons (5%), So the Quality of life (QOL) among elderly is an important area of concern which reflects the health status and social well-being of this vulnerable population. Moreover, it enhances life expectancy and provides a good secured life, However, in Palestine there's still no legal and dedicated protection regime for older people's rights so they are still suffering from weak protection systems, health and social care, and weak preventive medical care and rehabilitation services, thus increasing the direct costs of care and the indirect costs leading to the of loss of productivity, and social and economic burden.

This study aims to explore the physical QOL among elderly in Bethlehem and Jerusalem and to explore the psychosocial QOL among elderly in Bethlehem and Jerusalem.

Methods:

Data was collected in 2020 using a qualitative case study approach, the researchers used a snowball non-probability sampling, conducted in depth interviews with limited number of elderly people, the sample in this study was 16 participants, Researchers have developed interview questions it consisted of three parts. The first part covered the demographic data of the participants. The second part aimed to explore the physical QOL among elderly in Bethlehem and Jerusalem, while the third part aimed to explore the psychosocial QOL among elderly in Bethlehem and Jerusalem, in addition to the cover page that showed the goals and confidentiality of the study,  In this research, elderly people in their home were the participants and one on one individual 30 minutes interviews at homes were conducted with every participant, and taking an appointment and for consent form to record the interviews.

Participants:

Snowball sample of elderly people, elderly people who are 65 years old and above (8 from Bethlehem district and 8 from Jerusalem district) and this sample includes both Male and female.

Exclusion: The elderly people who have mental and cognitive problems, elderly with hearing and speaking disabilities.

Findings:

Content analysis for the recorded data was done, initially transcribed and identified by two researchers. The QOL quotes were deductively coded and the two main themes emerged are the physical and the psychosocial aspects with their subthemes.

Subthemes of Physical domain are Mobility and adaptive equipment for safety, General physical conditions, Sleep and Pain.

9 out of 16 participants expressed their physical condition as acceptable compared with their age other participants are not pleased with their physical condition. Sleep is considered as one of the most vital physical, mental and emotional need. Some of participants relate the sleep with health condition, so having a health problem affects negatively on their sleep pattern; 8 out of 16 participants have medical problems that effect on sleeping pattern so having a health problem affects negatively on their sleep pattern. Mobility is one of the major issues that faces the elderly people in our community; some of the participants discuss fears for this issue and fears of what might occur in future if they become completely dependent on others or become fully residents in their house, 5 out of 16 participants have difficulty with mobility pattern. Pain is one of the factors that have an effect negatively on health, 7 out of 16 participants has pain effect on ADL so affect the QOL. When the severity of physical changes increases the QOL will be impacted however all of participants have mentioned during interviews that aging process decreases the QOL. All of this affect on Quality of Life.  

Subthemes of Psychosocial Domain are Psychosocial status, social relationships & activities, Financial status, Mutual respect, Aging fears and Memorable events.

Most of elderly people (thirteen out of sixteen) have expressed the psychosocial status as good without feeling of anxiety depression, and perceived social support and it was affected positively in their health. Also, the importance of presence of social relationship with others whether their children, neighbors and with friends, so they mentioned this relationship could decrease the feeling of loneliness, which help them to take advantage of their time and energy in order to invest in relationships and social activates; 2 out of 16 participants defined some factors that affect social relationships with others. As well for elderly, respect from their family and neighbors is essential, because this increases their value in society s which improves the quality of life; all of participants have mutual respect from their family and neighbors. Status financial security is important for elderly due to the increase in costs of living, health care, and medication prices; this security will provide a good quality of life to elderly; 2 out of 16 participants said the money was not enough to meet their needs. Finally, most of the participants connect the term of fear with death. Most of them fear from becoming disable in the future, and some of the participants compared themselves with others who have a problem related to aging, so this increases their feeling of fear; 5 out of 16 participants don’t have any fears as aging continues, while 11 out of 16 participants express some fears and challenges with aging.

Conclusion:

To conclude our study provided the elderly in Bethlehem and Jerusalem the chance to discuss their physical and psychosocial status, and share their life experiences and conditions and how it impact on their QOL. After analysing the data, we discovered that physical and psychosocial aspects are related to each other, and that many factors affect the QOL and these factor range between physical and psychosocial. The main physical problems they have related to chronic disease associated with pain, sleep disturbances and immobility. Moreover, the psychosocial aspect due to stress, aging fear and bad memorable event. Regardless of having some physical and psychosocial problems, they can still manage to control and have good QOL.

Yusri M. Abdel-Hafez¹, Hani A. Siaj¹, Mohammad I. Janajri¹, Yazan S. Abu-Baker¹, Zakaria I. Hamdan², Ahmad I. Anaya³, Banan M. Ayesh⁴, Zaher A. Nazzal⁵

1. Researcher – MD Intern – Faculty of Medicine, An-Najah National University, Nablus, Palestine
2. Researcher – MD Nephrologist– An-Najah National University Hospital, Nablus, Palestine
3. Researcher – MD Internal Medicine– An-Najah National University Hospital, Nablus, Palestine
4. Researcher – Pharm D. Infectious Disease– An-Najah National University Hospital, Nablus, Palestine
5. Researcher – ABCM – Faculty of Medicine, An-Najah National University, Nablus, Palestine

Corresponding author: Dr. Zaher A. Nazzal – P448 - znazzal@najah.edu

Background:

Under the light of recent years, developments in the global healthcare system have caused an unwelcomed increase in the number of life-threatening infections due to various fungi. This is especially common in tertiary care centers, where high risk patients receive various treatment for their complex and terminal conditions. With many care centers using Amphotericin B as the first choice in treating these infections, we have decided to assess one of its common side effects, nephrotoxicity, along with hypokalemia, to determine the epidemiology, risk factors, and protective measures of this drug.

Methodology:

The study was a retrospective observational chart review study in which documents of all patients receiving conventional Amphotericin B in NNUH and Al Makassed Hospital during the period of January 2018 - December 2020 were reviewed and evaluated for the development of nephrotoxicity, according to the KDIGO criteria, excluding patients who have received the drug intermittently, in fewer than two doses, or through non-IV routes, giving a total of 117 patients participating. The study also involved collecting various data to assess the existence of any significant risk factors or protective measures. The data collected from the patients’ files included, but were not limited to age, gender, comorbidities, Amphotericin B treatment details, medications, and hypothesized protective measures.

Results:

Data analysis has shown a nephrotoxicity incidence of 46% and a hypokalemia incidence of 33% with our sample showing a roughly equal representation of both genders and a median age of 49.6 years ± 19.7. Initial crosstab analysis has shown several variables to be associated with nephrotoxicity and hypokalemia; however, Multivariable analysis has shown no association between the initially significant variables and the development of nephrotoxicity with the exception of COVID-19 approaching a significant p-value while holding a wide 95% CI. Multivariable analysis of the initially significant variables and the development of hypokalemia has shown a 3.4 increased risk (p-value=0.01) in females compared to males.

Conclusion:

Our research has shown a relatively lower, yet consistent, incidence of nephrotoxicity and hypokalemia compared to literature with the interesting findings of COVID-19 and gender in the development of nephrotoxicity and hypokalemia, respectively.

Submitted By:

Sara  Saabneh        Nireen Hasan Ali            Rola Yassin                              

First Supervisor:  Dr. Iyad Ali 

Second supervisor: Dr. Zaher Nazzal

Abstract

Background: Vitamin D deficiency has been observed worldwide in pregnant women. However the epidemiological data of vitamin D deficiency among large group of Palestinian pregnant women is limited. This study is to evaluate the prevalence of severe vitamin D deficiency among pregnant women in Palestine and to analyze the association of vitamin D status with some pregnancy outcomes (in mother and newborn).

Methods: A descriptive, cross-sectional study was conducted in Palestine from December 2020 to May 2021 using face to face interview questionnaire, which was adapted from previous studies in this field. Data collected by convenient sampling. The pregnant answered a questionnaire covering socio-demographic and economic variables; risk factors; past medical ,surgical and family history, OB-GYN history , delivery outcome on maternal and fetal basis, and the serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured by electrochemiluminescence assay.

Results:

The mean level of 25 (OH)D was 9.1 ± 5.1 ng/ml. Only 1% of subjects had 25 (OH)D levels >30 ng/ml, whereas 31.6% had levels between 10 and 30 ng/ml; the remaining 67.4% were severely vitamin D deficient (<10 ng/ml).

Conclusions:

Severe vitamin D deficiency is highly prevalent among pregnant women in Palestine. Vitamin D supplementation campaigns which should cover pregnant women to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas.

Souad Belkbeir 1, Lubna Saudi 2,  Yazan Abueideh 3, Joumana Sweedan 4,  Ibrahim Fadila 5, Massa Qassem 6

1. Researcher, MD, PhD. Assistant professor- An-Najah National University- Nablus
2. Researcher, MD, PhD. Assistant professor- An-Najah National University- Nablus
3. New medical graduate– An-Najah National University – Nablus
4. Sixth-year medical student – An-Najah National University – Nablus
5. New Medical graduate– An-Najah National University – Nablus
6. New Medical graduate– An-Najah National University – Nablus

Corresponding author: Yazan.Abueideh1@gmail.com                                                   

Background: Diabetes mellitus (DM) is a major public health problem worldwide with prevalence of 9.3% in 2019, of which T1DM accounting 10% to 15%. In Palestine the prevalence is 15.3%, with 4,4% having T1DM. Chronic disease leads to stressful events to which patients respond differently depending on the severity of the disease and their social life. The aim of this study is to determine characteristics and experiences of T1DM patients who visit diabetic clinics in Nablus and Ramallah.

Methodology:  mixed methodology study was conducted in T1DM patients aged ≥18 years old: cross sectional study was conducted to characterize epidemiological and clinical data of these patients in Nablus and Ramallah and qualitative methods were used to explore experience of T1DM patients in various periods from November2020 to June2021 due to COVID19 lockdowns.

IBM-SPSS Statistics Version20.0 was used for statistical analyses. Descriptive analysis and Pearson Chi2 test or independent t-test were used to evaluate the relation between different independent variables and the diabetes control status. P-value ˂5% was set as level of significance. Interviews were analyzed using thematic approach.

Results:177 T1DM patients were included with mean age (SD) of 26.88±7.569 years old.  Females represented 53.1%. From villages 47.7%. 62.1% were unmarried, 65.5% achieved a university degree and 63.4% unemployed. 43.7% of patients were diagnosed with T1DM 10 years ago.  Positive family history 65%. 65% were non-smokers and moderately active 43.4%. Last HbA1c SD was 9.46 ±2.327, 85.9% were uncontrolled (HbA1c ≥7%). 13.2% have complication: 11.5% with retinopathy and 7.5 % neuropathy.

Differences in control of diabetes we found to be statistically significant among the three categories of level of education: primary, high school and university (p-value 0.013).

Thirteen patients were interviewed. Five themes and seventeen subthemes were identified: self-perception, attitude toward disease, impact on education and occupation, impact of social environment and relation with health system.

Conclusion:

The findings showed that our patents are mainly young females, highly educated, unemployed, single, with disease duration of >10 years, uncontrolled, normal BMI without complications. A low educational level increases the risk of uncontrolled diabetes. There are indicators of maladaptation, which might be linked to community's social stigma.

Ameed Taher 1, Ezzideen Malhis 2, Souad Belkebir 3, Therese Zink 4.

1. Researcher, MD. Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
2. Researcher, MD. Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
3. Researcher, MD, MPH. Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
4. Researcher, MD, MPH. Department of Family Medicine & School of Public Health, Brown University, Providence, RI USA.

Corresponding author: ameed1997@yahoo.com

Background: First conceptualized in the 1970s, Fibromyalgia (FM) is the second most common condition observed by rheumatologists, with an estimated global mean prevalence of 2.7%. Despite that, it is still underdiagnosed, and its legitimacy questioned. Patients with FM are often stigmatized due to the lack of clearly defined symptoms and pathophysiology, and the psychologizing of the condition. Knowledge deficiencies and negative attitudes among physicians toward FM have been demonstrated in several countries. This study aims to explore Palestinian physicians' knowledge, educational experiences, clinical practice behaviors, and attitudes regarding FM.

Methods – Physicians in different specialties who were most likely to care for patients with FM were purposively sampled and consented to participate in semi-structured interviews.  Interviews were audio recorded and transcribed and a thematic content approach to analysis was used. Ethical approval was granted by the Institutional Review Board of An-Najah National University, and a written consent was obtained before each interview.

Results: Fourteen physicians in Palestine were interviewed. Three themes and seven subthemes were identified from the interviews: knowledge and attitudes (subthemes: educational realities, physicians' attitudes toward FM), approach to clinical care and related issues (diagnosis and etiology of FM, management of FM, unwillingness to manage FM patients), and challenges (doctor-patient relationship, adequacy and acceptance of psychological services).

Conclusion: Knowledge deficiencies and negative attitudes about FM were common among the Palestinian physicians we interviewed, even in those specialties deemed most likely to make the FM diagnosis. The inadequacies of healthcare (too many patients and too little time), the lack of psychological services, and the misunderstandings about mental health in Palestine were thought to affect the education of future physicians and the quality of care for FM patients.