Samaria Research Articles

Microbial profile of burn wound injuries in the Northern West Bank − A retrospective cohort study

BackgroundDetermining frequently colonizing microorganisms and typical demographics affected by burns in the West Bank is essential to aid timely and effective injury management. MethodsThis study included n = 435 patients with burn injuries between January 2018-December 2021 at a tertiary center in Nablus. Eligible medical records were reviewed, and relevant data extracted. Resultsn = 244 males and n = 191 females, average age 14.5 years were included. n = 227 had wound swab cultures, n = 80 which were positive. Scald injuries were the most common mechanism of injury (n = 314, n = 162 in males (p < 0.001), average age of 10.5 years). The most common organisms isolated were Pseudomonas aeruginosa (n = 17) and Staphylococcus aureus (n = 18). n = 17 multidrug resistant (MDR) organisms were cultured, MRSA most commonly (n = 9), followed by K. pneumoniae (ESBL) (n = 5). Overall length of stay (LOS) was 17.27 days in all patients and 28.2 days in those with MDR, with increasing LOS significantly associated with positive culture and MDR development of MDR (p < 0.001). ConclusionsYounger male demographics and longer hospital admission increase the risk of burn wound colonization and MDR development in the Northern West Bank. Pseudomonas aeruginosa and Staphylococcus aureus were prevalent organisms isolated. MDR development represents a significant challenge in the effective management of injuries in an immunologically vulnerable cohort.

Evaluation of performance and estimation of genetic parameters for milk yield and reproductive traits in Awassi and Asaf sheep breeds and crosses in the Palestinian territory.

This study aimed to estimate genetic parameters, including heritability and repeatability, for milk yield and prolificacy in sheep. It included 3682 records from 1837 ewes across various breeds: Awassi, Assaf, and Awassi x Assaf crosses, two Awassi lines: Improved Awassi, AFEC Awassi. The study measured total milk yield (TMY), yield up to 120 days (TMY120), and yield up to 150 days (TMY150), alongside reproductive traits: litter size (LS), number of lambs born alive (NLBA), and lambing interval (LI). The analysis utilized a mixed model and the REML procedure to estimate genetic parameters. Results indicated that litter size (LS) had no significant impact on milk traits, whereas breed, location, ewe parity, and lambing season showed significant effects. Lactation length also significantly influenced TMY. For reproductive traits, treatment was significant for NLBA, with location associated with breed, parity, and season affecting all traits. Heritability estimates for TMY ranged from 0.00 in Awassi x Assaf crosses to 0.11 in Awassi, and for TMY120 and TMY150, from 0.00 in Awassi x Assaf crosses to 0.16 in Awassi. Estimates for LS and NLBA varied similarly. The heritability for LI was 0.03 in Awassi and zero in other breeds and crosses. The findings suggest that in the northern West Bank regions of Nablus and Jenin, Assaf or Awassi x Assaf breeds are preferable. The study underscores the importance of comprehensive performance and pedigree recording for effective sheep farm management.

Antibiotic utilization at an orthopedic inpatient department in a large governmental hospital in the north of the West Bank, Palestine; a retrospective observational study

BackgroundStudies evaluating the patterns of antibiotic consumption are becoming increasingly necessary as a result of the increased use of antibiotics and development of antibiotic resistance globally. This study aimed to evaluate the use of antibiotics in in terms of both quantity and quality at the largest surgical hospital in the north of the West Bank, Palestine.MethodsAn observational retrospective study with a total population sampling method was conducted to collect data from the inpatients of the orthopedic departments of a large governmental hospital in the northern West Bank, Palestine. The data were collected from patients’ files and evaluated using the anatomical therapeutic chemical and defined daily dose (ATC/DDD) methodology, and the drug utilization 90% (DU90%) index. The ATC/DDD methodology, designed by the World Health Organization (WHO), as a well-trusted and standardized tool that allows measuring and comparing antibiotic utilization across different contexts. Antibiotic prescriptions were classified using the World Health Organization Access, Watch and Reserve classification (WHO AWaRe).ResultsOf the 896 patients who were admitted to the hospital in the year 2020 and included in the study, 61.9% were males, and 38.1% were females. The percentage of patients who received antibiotics was 97.0%, and the overall antibiotic usage was 107.91 DDD/100 bed days. The most commonly prescribed antibiotic was cefazolin (50.30 DDD/100 bed days), followed by gentamicin (24.15 DDD/100 bed days) and ceftriaxone (17.35 DDD/100 bed days). The DU90% segment comprised four different agents. Classification of antibiotics according to the WHO AWaRe policy revealed that 75.9% of antibiotics were prescribed from the access list.ConclusionThis study comes as part of the efforts exerted to combat the growing problem of antibiotic resistance in Palestine. Our results showed that the consumption of antibacterial agents in the orthopedic unit at a large governmental hospital in Palestine was relatively high. The results of this study provide valuable insights for the decision-makers to create policies aimed at regulating antibiotic prescriptions. This study also aims to provide a look into the antibiotic prescription patterns, offering a clearer understanding of the current situation of antibiotic consumption in Palestine. It also emphasizes the need for antibiotic stewardship and surveillance programs.

Prevalence and risk factors of postpartum depression among women attending primary healthcare centers in northern of West Bank/ Palestine: a cross-sectional study, 2022

BackgroundPostpartum depression (PPD) has a huge negative impact on the health of the mother and the family, both physically and mentally. Few postpartum depression studies have been done in Palestine. This study aimed to examine the prevalence and the most probable risk factor of PDD among Palestinian women in the northern West Bank.MethodsThis is a cross-sectional study of 380 mothers, ages 18 and 44 years, visiting vaccination clinics with their infants after 7-12 weeks of delivery between 1 May 2022 and 30 June 2022. Postpartum women seeking care at the seven largest primary health care centers of the Ministry of Health in four cities in the Northern West Bank in Palestine were asked to complete a self-administered questionnaire that included the Edinburgh Postnatal Depression Scale and demographic and birth details. A score of 13 or higher was used to indicate PPD risk. Descriptive and analytical analyses were performed using SPSS version 20. The level of significance was set at 5%.ResultsThe median age of the participants was 27 years with a range of 26 years. A total of 129 women had an EPDS score of 13 or more, giving a prevalence rate of post-partum depression of 33.9%. The predictors of postpartum depression were stressful life events during pregnancy (p-value 0.003, OR: 2.1, 95% CI [1.27-3.4]), vacuum use during delivery p-values 0.002, OR: 4, 95% CI: [1.64-9.91]), low social support (p-value less than 0.001, OR: 2.5, 95%CI: [1.7-4.2]) and husband’s low level of education (p-value less than 0.001, OR: 5.2, 95%CI: [2.7-10]).ConclusionThe study showed a high prevalence of PPD among Palestinian mothers in the northern West Bank. Our study found that PPD risk factors include lack of social support, the husband’s low education, and stressful events during pregnancy. This will emphasize the importance of PPD screening and early intervention, especially among vulnerable women.

Range expansion of the Black-winged Kite, Elanus caeruleus, in Palestine

The Black-winged Kite, Elanus caeruleus, is an opportunistic breeding species that is a resident in the Middle East. This study investigates its distribution patterns and breeding behaviour in Palestine based on observations spanning from 2014 to 2022. The species was first recdorded in Palestine in September 2014. Up until 2018, its presence was recorded at only a few specific locations, primarily in the northern Jordan Valley along the Jordanian border, Al Mukata’ valley in Jenin, and the western regions of the central and northern West Bank. However, a noticeable population increase and a remarkable expansion in its geographical range have been observed since then. The first documented breeding observation took place in 2019, and we identified 25 breeding sites. Clutch size varied between two to three eggs per nest, with an average of 2.71±0.49 (n=7). Additionally, instances of double-brooding were noted. Given the opportunistic breeding tendencies, the availability of suitable habitats, and potential food resources, we anticipate a continued expansion of the Black-winged Kite’s distribution in Palestine.

Flora and Conservation Issues in Two Protected Areas in Palestine: Wadi Al-Zarqa Al-Ulwi and Wadi Qana

The Palestinian environment suffered from abuse and neglect for decades. As a nascent state, Palestine aspired to protect and restore its environment, in line with international standards and conventions. Yet, many challenges remain, including a lack of data, the science–policy–practice gaps, and the lack of sovereignty. The management of protected areas (PAs) is particularly challenging under these circumstance. Two key protected areas in the northern West Bank (Wadi Qana and Wadi Al-Zarqa Al-Ulwi) were surveyed, with a focus on plant communities and dealing with threats. The two areas had similar Mediterranean flora with differences, including in rare plants. Both areas have important but different wetlands in their buffer zones. The data show that the protection of the two areas is important because of the differences noted, and both areas are valued as IUCN category IV (habitat/species management area) protection. Such protection is possible by working with local communities and bridging the science–policy–practice gaps.

Mistreatment of Women during Childbirth and Associated Factors in Northern West Bank, Palestine.

Mistreatment of women during childbirth is a clear breach of women’s rights during childbirth. This study aimed to determine the prevalence and associated factors of mistreatment of women during childbirth in the north of West Bank, Palestine. A cross-sectional study was conducted among 269 women within the first 16 weeks of their last vaginal childbirth to understand the childbirth events by using proportionate stratified random sampling. An Arabic valid questionnaire was used as a study instrument. Simple and multiple logistic regression analyses were conducted to determine the factors associated with each type of mistreatment. The mean age of the women was 26.5 (SD 4.77) years. The overall prevalence of mistreatment was 97.8%. There were six types of mistreatment. Nine factors were significantly associated with the occurrence of one or more types of mistreatment. Delivery at a public childbirth facility was associated with all of the six types (aAdjOR: 2.17–16.77; p-values < 0.001–0.013). Women who lived in villages (aAdjOR 2.33; p-value = 0.047), had low education (aAdjOR 5.09; p-value = 0.004), underwent induction of labour (aAdjOR 3.03; p-value = 0.001), had a long duration of labour (aAdjOR 1.10; p-value = 0.011), did not receive pain killers (aAdjOR: 2.18–3.63; p-values = 0.010–0.020), or had an episiotomy or tear (aAdjOR 5.98; p-value < 0.001) were more likely to experience one or more types of mistreatment. With every one-hour increase in the duration of labor, women were 1.099 times more likely to experience a failure to meet the professional standard of care. Women were less likely to experience mistreatment with increasing age. Women with increasing age (aAdjOR: 0.91–0.92; p-values = 0.003–0.014) and parity (aAdjOR 0.72; p-value = 0.010) were less likely to experience mistreatment. Awareness of women’s fundamental rights during childbirth, making the childbirth process as normal as possible, and improving the childbirth facilities’ conditions, policies, practices and working environment may decrease mistreatment occurrence.

Comparing Soil Erosion Rates on Terraced and Sloping Cultivated Land in Palestine Using FRN 137Cs Trace.

Soil erosion is a serious problem in Palestine. It is enhanced mainly by poor farming practices used in upland agricultural areas occupying the Central Highland of Palestine. The objective of this study is to assess the impact of terracing on soil erosion and deposition rates in the Al-Yamoun area (the Northern West Bank) using the fallout radionuclides cesium -137 (FRN 137Cs). The FRN 137Cs technique, which has proved its efficiency in estimating erosion rates over the last 50–60 years, was used for the first time in Palestine to measure rates of erosion and deposition. The activity of 137Cs was measured by gamma spectrometry using an HPGe detector. For the reference site, the 137Cs inventories ranged between 2499 and 4086 Bq/m2. The average value of the reference site is 3315 ± 410 Bq/m2, which corresponds to a coefficient of variance of 12%, suggesting that the reference site is well representative for estimating 137Cs fallout. This 137Cs amount is too high for bomb-derived fallout and indicates that a significant part of the deposition is from the Chernobyl accident. The 137Cs inventories at both studied sites (terrace site and foot slope site) are significantly lower than those of the reference site. For the terrace site, the inventories are found between 1707 and 2749 Bq/m2, while for the slope site they are between 1050 and 2617 Bq/m2. The lower 137Cs values at both studied sites than values at the reference site indicate that the entire areas of both study sites are eroded and no depositional activity occurs.

Role of Kindergarten Curriculum in Instilling Ethical Values among Children in Governorates of Northern West Bank, Palestine

Objectives: This study aims to identify the role of kindergarten curricula in instilling ethical values among children from the point of view of kindergarten’s principals and teachers in the northern governorates in West Bank, Palestine.&#x0D; Methods: The study relies on an analytical descriptive approach. The sample of the study consisted of (317) kindergarten principals and teachers selected in a random manner. A survey consisting of (40) paragraphs spread over four areas (objectives, content, methods and activities, calendar) was designed; the validity and reliability coefficients of the questionnaire were verified.&#x0D; Results: The results of the study show that the role of kindergarten curricula in instilling ethical values in children from the point of view of kindergarten principals and teachers in the governorates of the northern West Bank was average. They also showed that there were statistically significant differences at the level of significance (0.05α=) in the average responses of the study sample members due to job title, kindergarten type, qualification, and teachers experience.&#x0D; Conclusions: Based on the above results, it is recommended to conduct a study of the same title dealing with primary school teachers in public and private schools in the northern West Bank governorates.

Fifth and ninth grade students’ engagement in science classes in Palestine

In the study reported on here I aimed to measure the extent to which fifth and ninth grade science students were cognitively, behaviourally, emotionally and socially engaged in science classes. These constructs of engagement were examined based on a set of variables: the grade, students’ gender, teachers’ gender, teachers’ specialisation, teachers’ experience and teachers’ academic degree. To measure these constructs, I used the Wang Engagement Scale as well as a descriptive approach, especially in its relational components. The population, which comprised 15,057 students from the northern West Bank, was divided into groups; from each I chose a representative sample drawn using a random sampling technique based on the size of each of the three directorates of education (Jenin, Qabatia and Tubas). A questionnaire was then designed and delivered to 1,132 respondents from the fifth and ninth grades. The results suggest that fifth graders are by far more engaged than ninth graders, especially female students, and that female teachers, teachers with a degree in science, teachers with 1 to 5 years of experience and teachers with a 2-year associate degree were particularly motivating for student engagement.

A comprehensive evaluation of potentially significant drug-drug, drug-herb, and drug-food interactions among cancer patients receiving anticancer drugs

IntroductionDuring the cancer treatment path, cancer patients use numerous drugs, including anticancer, supportive, and other prescribed medications, along with herbs and certain products. This puts them at risk of significant drug interactions (DIs). This study describes DIs in cancer patients and their prevalence and predictors.MethodsA cross-sectional study design was used to achieve the study objectives. The study was carried out in two centers in the northern West Bank, Palestine. The Lexicomp® Drug Interactions tool (Lexi-Comp, Hudson OH, USA) was applied to check the potential DIs. In addition, the Statistical Package for the Social Sciences (SPSS) was used to show the results and find the associations.ResultsThe final analysis included 327 patients. Most of the participants were older than 50 years (61.2%), female (68.5%), and had a solid tumor (74.6%). The total number of potential DIs was 1753, including 1510 drug-drug interactions (DDIs), 24 drug-herb interactions, and 219 drug-food interactions. Importantly, the prevalence of DDIs was 88.1%. In multivariate analysis, the number of potential DDIs significantly decreased with the duration of treatment (p = 0.007), while it increased with the number of comorbidities (p < 0.001) and the number of drugs used (p < 0.001).ConclusionsWe found a high prevalence of DIs among cancer patients. This required health care providers to develop a comprehensive protocol to monitor and evaluate DIs by improving doctor-pharmacist communication and supporting the role of clinical pharmacists.

Gender-based violence experiences among Palestinian women during the COVID-19 pandemic: mental health professionals\u2019 perceptions and concerns

BackgroundIn a geopolitically at-risk environment, such as Palestine, gender-based violence (GBV) is still a crucial problem rooted in discriminatory laws and traditional habits exacerbated by the ongoing Israeli military occupation. Moreover, the lack of updated data makes it difficult to grasp the magnitude of the phenomenon entirely; the purpose of the current study was to explore mental health professionals’ perceptions and concerns on GBV among Palestinian women during the COVID-19 pandemic.MethodsParticipants in the study were 30 Mental Health Professionals (MHP) selected using convenience and snowball sampling techniques from among MHP in northern West Bank, Palestine.ResultsA thematic content analysis revealed seven main themes of GBV during the pandemic. Palestinian MHP reported that the increased number of GBV cases among women during the COVID-19, quarantine, physical distancing measures, and closure of non-essential services significantly heightened the risks of GBV among Palestinian women. Moreover, Palestinian women involved with or married to older men or married at a very young age were at risk of GBV more than others. Results of qualitative analysis also showed that Israeli occupation and the political violence characterizing the area for decades (including restriction of movement, house demolitions, separation of family members, etc.) have also exacerbated and increased GBV in the occupied Palestinian territories.ConclusionsImproving intervention skills and supervision services among Palestinian MHP to help women who face GBV is recommended. Moreover, additional research should be conducted to explore the risk and potential factors of GBV, agency, and coping strategies to deal with GBV.

Aflatoxin B1 contamination of wheat flour, coffee, and pistachios consumed in Northern Palestine

The objective of the present work was to investigate the levels of aflatoxin B1 (AFB1) in some commonly consumed food items (wheat flour, roasted coffee beans, and pistachios) at the markets of Palestine. The samples were collected from the cities in the Northern West Bank (Nablus, Tulkarm, and Jenin). The pistachio and coffee samples were collected from the main toasters in these cities, while the flour samples were collected from the major bakeries in these cities. A total of 90 samples were collected, 30 from each city. The samples were analysed by a direct quantitative competitive enzyme-linked immunosorbent assay (ELISA) to determine the amounts of AFB1. AFB1 contamination was detected in all of the collected samples. The percentage of samples exceeding the permissible limit prescribed by the European Commission (EC) Regulation of Maximum Residual Levels (MRL) was 33.3%. AFB1 contamination levels in the flour samples ranged between 0.4 - 2 µg/kg, with a mean of 0.75 µg/kg. All of the tested samples were below the EC-MRL level of 12 µg/kg. The amount of AFB1 in the roasted coffee beans ranged between 12 - 49 µg/kg, with a mean of 25.03 µg/kg. All of the tested samples exceeded the EC-MRL level of 5 µg/kg. The pistachios had a contamination level between 0.7- 2.20 µg/kg, with a mean of 1.28 µg/kg, and none exceeded the EC-MRL level of 8 µg/kg for direct human consumption. No differences were observed between the targeted areas (p &gt; 0.05). The results obtained on the contamination levels of AFB1 indicated a serious public health issues. Further improvement of food handling and storage conditions must be exercised.

Occupational Exposure Assessment and Seroprevalence of Brucella Specific Antibodies Among Veterinarians in the Northern Palestine.

Background: Brucellosis is one of the most popular zoonosis in the world caused by bacteria belonging to the genus Brucella. The disease is considered an occupational risk to persons dealing with animals and animal products. Brucellosis is endemic in livestock in Palestine. Yet, few studies investigated human brucellosis in Palestine. We aimed to estimate Brucella seropositivity among veterinary healthcare professionals in Northern Palestine, and to assess the associated risk factors.Methods: A cross-sectional study was conducted in four governorates in the Northern West Bank (Jenin, Nablus, Qalqylia, and Tulkarm). A sample of 100 veterinarians was collected. Participants were interviewed using a structured questionnaire to assess risk factors. Blood samples were collected to be screened for the presence of anti-Brucella IgG using the Enzyme-Linked Immunosorbent Assay (ELISA).Results: The seroprevalence of Brucellosis by ELISA was 76%. Risk factors included working in the public sector, dealing with animals' vaccination, longer period of exposure, and advancing in age.Conclusions: Brucellosis is a high-risk occupational disease among veterinarians. Its prevalence rate among veterinary healthcare workers in the Northern West Bank, Palestine was very high compared to neighboring countries and internationally.

Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: a cross-sectional study from Palestine

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disorder, which has a significant impact on patients' health-related quality of life (HRQoL), and limits physical function as well as increases pain and fatigue. Therefore, this study aimed to evaluate the HRQoL and functional disability profile of patients with RA in Palestine to determine the socio-demographic and clinical features associated with low HRQoL and functional disability in patients with RA and to investigate the impact of drugs used on functional disability and HRQoL.MethodologyA cross-sectional, observational study conducted at rheumatology clinics in Northern West-Bank, Palestine (Alwatani Hospital—Nablus, Khalil Suleiman Hospital—Jenin, Thabet Thatbet Hospital-Tulkarem, and Darweesh Nazzal Hospital—Qalqilia). EuroQoL-5 Dimension scale (EQ-5D-5L) was used to evaluate HRQoL, Health Assessment Questionnaire, Disability Index (HAQ-DI) to evaluate the functional disability, and the Health Assessment Questionnaire pain visual analog scale (HAQ-VAS) to evaluate pain.Results300 patients were included in the study, 229(76.3%) were females, the mean ± standard deviation age was 49 ± 13.10 years, and the median RA duration (lower–upper quartiles) was 6 (4–12) years. The median EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) scores were 0.56 and 60, respectively. There was a significant strong positive correlation (R = 0.773; p < 0.001) between the EQ-5D-5L index values and the reported EQ-VAS scores. The median HAQ-DI and HAQ-VAS were 0.94 and 40, respectively. The results of multiple linear regression showed that treatment with biological DMARD (Etanercept), having work, higher income, absence of night pain, and absence of comorbid diseases were significantly associated with higher EQ-5D-5L index score (better HRQoL) and lower HAQ-DI scores (less disability). On the other hand, older age and the presence of morning stiffness were significantly associated with higher HAQ-DI scores (more disability).ConclusionsThis study revealed the impact of treatment, clinical variables, and socio-demographic factors on disability and HRQoL in RA patients. Healthcare providers should be aware of the association between treatment with biological DMARD and improved HRQoL and functional status to make early interventions that reduce disability and improve HRQoL in susceptible patients.

Risk Factors Associated With Diabetic Retinopathy: A Cross-Sectional Study Within Palestinian Patients in Northern West Bank.

Risk factors associated with diabetes mellitus (DM) have been widely researched worldwide, but the determinants of these factors among diabetic retinopathy (DR) in Palestine are currently unclear. We aimed to assess the prevalence of DR among DM in Northern West Bank and identify factors associated with DR natural history. Patients with Type 2 diabetes (T2D) (n = 300, age > 18 years) from a main diabetic center covering all northern provinces of Palestine were enrolled to this cross-sectional research. Demographic information including age, sex, and duration of T2D was obtained. Moreover, HbA1C, BMI, hypertension (HTN), controlled T2D, current smoking, and total cholesterol level were assessed. Potential correlations between these factors and DR diagnosed by ophthalmologist were evaluated using different tests on SPSS version 22. Prevalence of DR among our population was 30%; 47.8% of these patients showed mild non-proliferative DR (NPDR), 23.3% moderate NPDR, 16.7% severe NPDR, and 12.2% proliferative DR (PDR). Univariate logistic regression analysis showed age (p = 0.007), HTN (p = 0.022), uncontrolled T2D (p = 0.025), and duration of T2D (<0.001) were mostly associated with DR while multivariate logistic regression showed duration of T2D as the major and solely risk factor for prevalence of DR (p < 0.0001) and were positively correlated with severities of NPDR and being a strong predictor in the PDR (p = 0.001). We identified several important risk factors that affect DR, which could assist to develop effective strategies for metabolic disease prevention among populations in Palestine. Furthermore, our data suggest a necessity to control sugar serum levels and HTN.

Plasma Lipids and Lipoproteins in Sickle Cell Disease Patients in the Northern West Bank, Palestine

Background Lipid metabolism may be altered in red cell genetic disorders. The erythrocyte and plasma lipids are defected which may increase the risk of cardiovascular disease. In the present study, we hypothesized a possible link between severity of anemia and altered lipid profile in SCD. Methods A total of 151 SCD patients, including 62 patients with sickle cell anemia (SS), 54 patients with sickle β-thalassemia (ST), and 35 individuals with sickle cell trait (AS), were studied. The control group consisted of 160 healthy individuals. Total cholesterol (TC), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) were enzymatically measured. Results Total cholesterol and LDL-C were significantly lower (P value < 0.001) in SS and ST patients compared to AS individuals and AA controls. However, LDL-C was significantly lower in AS individuals (both males and female) compared to AA controls (P value < 0.001). The HDL-C in SS and ST patients (both males and females) was significantly lower than that in AS individuals (P value < 0.001). In addition, the HDL-C was significantly higher in SS and ST males and AS (males and females) compared to AA controls (P value < 0.001). The HDL-C was also significantly higher in SS males (P value < 0.001) and females (P value < 0.05) compared to ST patients. The HDL-C was significantly higher in AS individuals (P value < 0.001) compared to AA controls. The triglycerides in SS males was significantly lower than that in ST patients (P value < 0.001), but there was no significant difference when compared to AS individuals and AA controls. In contrast, triglycerides in SS females were significantly lower than those in ST (P value < 0.05), AS (P value < 0.001), and AA controls (P value < 0.001). In males of ST patients, triglycerides were significantly higher than those observed in AS males and AA males (P value < 0.001). In contrast, females of ST patients have a significantly lower triglycerides compared to AS and AA females (P value < 0.001). Conclusions In SCD, the plasma is affected in some way, especially the plasma cholesterol that was investigated in this study. Further prospective studies should examine the contribution of an altered lipid profile to the severity and clinical complications in SCD patients.

Assessment of the influence of Facebook on eating out at fast food restaurants: a cross-sectional study of Palestinian college students

BackgroundEating at fast food restaurants has become a worldwide phenomenon. To understand the factors that influence such behaviour is an important part of modern nutritional research. Social media may influence human eating behaviours in ways that have yet to be investigated. This study tests the possible relationship between two modern trends: social media usage and eating at fast food restaurants. FindingsA cross-sectional study was conducted in April, 2017. Undergraduate students aged 17–30 years in the West Bank, occupied Palestinian territory, completed a self-administered online Google Forms survey of 18 questions. Four universities were chosen to represent the four areas of interest; Birzeit University (central West Bank), Al-Quds University (East Jerusalem), An-Najah University (northern West Bank), and Hebron University (southern West Bank). Permission was sought from the administrators of the two most popular Facebook groups for each university (those with the highest number of members). After permission was granted, the survey was posted on each Facebook group. We used convenience sampling; students were requested to complete the survey on a voluntary basis. The surveys were closed when 150 students had filled forms or when the completion rate stagnated despite the survey being re-posted up to five times. The settings on Google Forms were adjusted so that every question had to be answered to complete the survey. The survey aimed to measure the types of social media that students used (use of Facebook services, and of the four other most popular social media platforms), the time spent on social media, and behaviour relating to eating at restaurants. A five-point Likert-type scale was used to record responses to the questions. Descriptive statistics were gathered, and Pearson's chi squared test was used to test for associations. Ethical approval for the project was obtained from Birzeit University, and informed written consent was obtained from all participants. FindingsIn total, 399 students completed the survey; a completion rate of 67% (399 of 600). 26% (105 of 399) were male and 76% (294) were female. There were 150 participants at Birzeit University, 136 participants at Al-Quds University, 83 participants at An-Najah University, and 32 participants at Hebron University. Significant associations were found between using Facebook Messenger to call or message Facebook friends to invite them to eat at fast food restaurants, and uploading pictures of fast food meals (p=0·0010), and eating out at fast food restaurants (p=0·027). Furthermore, there was a significant association between time spent on Facebook and eating at restaurants (p=0·050). However, there was no significant association between time spent on Facebook and eating at fast food restaurants (p=0·21). InterpretationThe findings suggest that aspects of food-related lifestyle for students, such as eating at restaurants, are influenced by their use of Facebook as both a communication tool and as a visual platform. Whether social media can be used in interventions to promote healthy eating should be investigated. FundingNone.

Assessment of drug interactions and their associated factors among patients with cardiovascular diseases: a cross-sectional study from the occupied Palestinian territory

BackgroundCardiovascular diseases (CVDs) are the leading cause of death in the West Bank and worldwide. Potential drug–drug interactions (pDDIs) contribute to a significant proportion of adverse drug reactions, which have been shown to be a major cause of morbidity and mortality. Patients with CVD require more attention regarding these interactions owing to the complexity of their conditions and therapeutic regimens. The purpose of this study was to assess the prevalence and types of pDDIs, and their associated factors in patients with CVD. MethodsA cross-sectional study was conducted at two large referral hospitals for patients with CVD in the northern West Bank. Inpatients who were diagnosed with any CVD during the period of the study (from Sept 1, 2016, to Feb 28, 2017) were selected by convenience sampling. Data were collected from patients’ medical records and in a face-to-face interview with each of the patients (by use of a standardised data collection form). The sample size was calculated using the Raosoft calculator. pDDIs between medications prescribed at discharge were identified using the Lexicomp interaction checker. Data were analysed with SPSS version 16. FindingsThe study included 400 patients with CVDs. According to the Lexicomp interaction checker, 94% (375 of 400) of the patients were discharged with medications with pDDIs. Patients had an average of 3·14 (SD 1·41) diseases, and were prescribed 1–16 medications on discharge (mean 7·08, SD 2·76). The most common comorbid disease was diabetes (in 51% of patients; 205 of 400), followed by chronic kidney disease (in 14% of patients; 56 of 400). Aspirin was the most frequently prescribed medication. The most frequent pDDI was furosemide and aspirin, which were prescribed simultaneously for 37% of patients (148 of 400), followed by angiotensin-converting-enzyme inhibitor and aspirin, which were prescribed simultaneously for 33% of patients (131 of 400), and statins and proton pump inhibitors, which were prescribed simultaneously for 32% of patients (129 of 400). The number of pDDIs was associated with the number of diseases (p<0·0001), the total number of discharge medications (p<0·0001), and the length of hospital stay (p=0·0012). InterpretationThe prevalence of pDDIs is very high among discharge medications for patients with CVDs. These interactions were associated with the number of diseases, the number of medications prescribed, and the length of hospital stay. Monitoring for pDDIs should be performed regularly. To prevent the risks of pDDIs, work is required to raise awareness, and clinical pharmacists should be involved in reviewing medications at discharge. FundingNone.

NEW CHRONOLOGICAL INFORMATION FROM RADIOCARBON DATING OF HUMAN REMAINS AT JACOB’S WELL, NABLUS, PALESTINE

ABSTRACTJacob’s Well, located in modern city of Nablus and ancient Shechem (Tall Balata) in the northern West Bank of Palestine, attracts modern day tourists and pilgrims. It is found in the eastern suburbs of the city. Since 333 AD, pilgrims have been writing accounts of the well, and it has been venerated by both Christian and Jewish communities throughout its history. It is believed to be the well referred to in the New Testament, where Jesus conversed with a Samaritan woman, the orthodox saint, Photini. It now forms the central feature in the crypt of the St Photini Greek Orthodox church in the walled grounds of a monastery. In order to gain more information on the chronology of the site, we analyzed human skeletal remains found at the site in 1997. These consist of three skulls and a femur. One of the skulls was found in a sarcophagus alongside the church and the two other skulls and a femur were found in a burial ground alongside the monastery, north of the church, over which a room has now been built. Radiocarbon analysis reveals that the remains date to four historical periods or events: the early Christian period, before structural additions to the well by Constantine the Great in the fourth century; the Samaritan Revolts (AD 529 and 556), the Sassanid Invasion (AD 614–628), and Abbasid rule (AD 750–1258). Dating of one skull suggests it may have been that of Germanus, a fourth century bishop of Nablus, and that there may have been a very early structure, shrine, or burial chamber at the site before the fourth century. We provide contextual information based on historical and contemporary literature.