ابحاث علمية صحية..جامعية

Sweileh WM, Sawalha AF, Janem SA, , Abu-Taha AS, Zyoud SH, Sabri IA, Al-Jabi SW, Jaradat NA, Zaid AA.
Medication dosing errors in hospitalized patients with renal impairment: a study in Palestine. Pharmacoepidemiology and drug safety. 2007 Aug;16(:908-12. [Publisher: Wiley, Country where published: England]. Published

Abstract

BACKGROUND AND AIM: Reduced renal function requires dose adjustment for certain drugs to avoid toxicity. The aim of this study was to determine whether appropriate dosage adjustments were made for drugs that are nephrotoxic, excreted, or metabolized (TEM medications) by the kidney in patients with renal impairment. METHODOLOGY: A cross-sectional study of a group of hospitalized patients was carried out at Al-Watni governmental hospital, Nablus, Palestine. All patients with creatinine clearance </=59 ml/min were included in the analysis. Data regarding patients' clinical, laboratory findings and medications whether they were prescribed at hospital or at discharge were collected from patients' medical files. Evaluation of appropriate dosing was based on Physician Disk Reference (PDR). All data were collected for further research and subsequent statistical analysis using statistical package for social sciences (SPSS) for windows version 10. RESULTS: A total of 78 patients had calculated creatinine clearance </=59 ml/min. Those patients were prescribed a total of 1001 lines of prescription medication. Dosage adjustment was necessary for 193 TEM medications. Analysis of TEM medications with guidelines for adjustment indicated that 73.58%(142) were found to be inappropriate and 26.42% (51) were found to be appropriate. The most common inappropriate medications were ranitidine, antibiotics, and digoxin. Approximately 77.5% of the unadjusted medications were prescribed during hospitalization. CONCLUSION: In our study, a wide range of dosing errors was common among patients with renal impairment that was common during hospitalization. Continued medical education in the field of clinical pharmacokinetics is important for physicians.

البحث الثالث:

نمط التداوي بالأعشاب الطبية بين طلبة الجامعة في فلسطين


Sawalha AF, Sweileh WM, Zyoud SH, Al-Jabi SW. Self-Therapy Practices among University Students in Palestine: Focus on Herbal Remedies. Complementary therapies in medicine. 2008;16(6):343-349.[Publisher: Elsevier (Churchill Livingstone), Country where published: England (Scotland)] Published


Abstract

BACKGROUND: Herbal self-therapy is a common practice among Palestinians. However, no published data are available on herbal self-therapy in the Middle East in general, and in Palestine in particular. OBJECTIVE: This study was conducted to

(1) determine the extent of herbal self-therapy among university students,

(2) investigate the different types of herbal remedies used and

(3) investigate the correlates and reasons associated with such practices.



METHODOLOGY: This cross-sectional, descriptive study was carried out using a structured questionnaire that contained five sections:
(1) demographics;
(2) medication knowledge and self-care orientation;
(3) types of herbal remedies used;
(4) clinical conditions treated; and finally,
(5) the reasons reported by students for herbal self-therapy practice. Pearson chi(2), multiple logistic regression and one-way ANOVA were performed using SPSS 13 program. RESULTS: 33.9% of the respondents reported using herbal remedies in self-therapy.
Female gender, students at medical colleges and those with high self-care orientation were significant predictive model for herbal use. Sage (Salvia fruticosa L.), chamomile (Chamaemelum nobile L.), anise (Pimpinella anisum L.), and thyme (Thymus vulgaris L.) were the most commonly utilized herbal remedies. The types of herbal remedies selected were significantly influenced by gender, but not by the level of medication knowledge or self-care orientation. Herbal remedies were used primarily for the treatment of headache, flu, menstrual pain and sore throat. The main motivating factor for using herbal remedies reported for using herbal remedies was simplicity of symptoms.


CONCLUSIONS: Herbal self-therapy was a common practice among university students. Health care providers need to be aware of the students' self-therapy practices and need to have sufficient knowledge regarding herbs not simply because of the widespread use, but also because of significant reported side effects. Academics need to consider offering courses about herbal remedies to students in both the medical and non-medical faculties to broaden their treatment capabilities during this time of increased unregulated medical interventions such as herbal therapy.

مقارنة تحليلية لنمط بطاقة البيان لمضادات الأمراض المعدية ما بين الأدوية المحلية والمستوردة


Sawalha AF, Sweileh WM, Zyoud SH, Al-Jabi SW. Comparative Analysis of Patient Package Inserts of Local and Imported Anti-Infective Agents in Palestine. Accepted for publish at Libyan Journal of Medicine.2008; 3(4). [Publisher: Directory of Open Access Journals, Country where published: Libya] Published.

Abstract

Background and Objective: The patient package insert is an important source of drug information. The aim of this study was to evaluate and compare the PPI of the anti-infective agents manufactured in Palestine with the imported equivalents.
Method: The selection criteria generated 15 different anti-infective agents available as 36 locally manufactured products and 15 imported equivalents.
The design of the patient package insert was evaluated in terms of the number of words used in eight main headings and the presence or absence of certain information regarding nine statements. Results: Inserts of locally manufactured products have significantly fewer words than those of imported products with respect to warnings, dosage and administration, and side effects. The most significant difference was found in the warnings.
Moreover, differences were found between inserts of local and imported products in terms of the presence of the nine informative statements. Locally manufactured products did not mention inactive ingredients, clinical pharmacology or date of last revision, but all of them provided information on the use of the drug during pregnancy and lactation and on the duration of therapy. However, in general they provided less information than the imported equivalents.


Conclusion: Palestinian authorities and local manufacturers should implement appropriate measures to regulate the quality and quantity of information in the patient package insert of locally produced anti-infective agents. PPI improvement will better direct health practices to the benefit of the patients.

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نمط الأدوية المستخدمة لمرضى الجلطة الدماغية


Sweileh WM, Sawalha AF, , Zyoud SH, Al-Jabi SW, Abaas MA. Discharge Medications among Stroke Survivors: A Study in Palestine. Accepted for publish at Journal of stroke and cerebrovascular disease. 2008; 18(1): [Publisher: Elsevier (Saunders), Country where published: United States]. In press

Background: The aim of this study was to analyze the types and cost of medications prescribed at discharge for ischemic stroke survivors. Methods: This is a descriptive study of medications prescribed for ischemic stroke survivors admitted to Al-watani hospital during a 6-month period. Results: A total of 95 consecutive stroke patients were included in the study period; 78 (82.1%) survivors were having ischemic stroke subtype and were designated the study group.
The average age of the survivors was 66.9 6 12.7 years. Survivors had prevalent risk factors such as diabetes mellitus (70%), hypertension (68%), and ischemic heart disease (34.6%). On average, survivors experienced a minimum of 0.73 complications (range 0-3) with the most common being infections (n 5 35, 44.8%).
Forty-two per cent of the ischemic stroke survivors were taking antiplatelet drugs prior to the current attack. At discharge, ischemic stroke survivors were prescribed an average of 4.9 medications from 4.3 different drug classes. All ischemic stroke survivors were prescribed antiplatelet therapy at discharge. Aspirin monotherapy was prescribed for 61 survivors while the combination of aspirin/clopidogrel antiplatelet therapy was prescribed for 17 survivors. The average monthly cost for prophylactic therapy and for medications used to treat post-stroke complication was approximately 52 USD per survivor.


Conclusion: Most of the patients in the study group were having the traditional risk factors for ischemic stroke and were suffering form typical post-stroke complications. Lack of medical insurance will impose a heavy financial burden on stroke survivors in Palestine.
Key Words: Medications—ischemic—stroke—Palestine.

مدى التطبيب الذاتي بالمضادات الحيوية في فلسطين






Poison Control and Drug Information Center (PCDIC) An-Najah National University, Nablus, Palestine
Abstract



Objective: The objective of this study was to investigate self-medication practices with antibiotics among school teachers in Palestine. Methods: A survey was conducted via a structured questionnaire among governmental school teachers regarding their practices and attitude toward antibiotics. All data were entered and analyzed using SPSS 15. Results: A total of 1039 teachers completed and returned the questionnaire; giving a response rate of 64.9%. Respondents were divided as follows: group I (19.4%) were those who used antibiotics through self-medication only, group II (12.4%) used antibiotics by prescription only, group III (44.7%) used antibiotics by self-medication and prescription while those in group IV (23.3%) were those who did not report using antibiotics in the past six months. Antibiotic utilization among respondents was 76.7% in the past six months. Respondents in the 4 groups had comparable demographic characteristics. Respondents in group I were more likely (42.2%) to administer antibiotics to children without medical consultation, store antibiotic leftover (52.3%) for further use, stack antibiotics at home (59.7%) to be used whenever needed and had the least attitude to finish the entire antibiotic course when prescribed to them (59.9%). Across the four groups, male and female respondents had comparable attitude toward antibiotic use except that males tend to store antibiotic leftover more than females while females tend to finish the entire antibiotic course when taken by self-medication more than males. Respondents in groups I and III mainly consulted pharmacists on self-medication and obtained the antibiotics mainly from community pharmacy.
Penicillin was the major class utilized by respondent either by self-medication or by prescription in groups I (74.3%), II (70.5%) and III (68.9%). Sore throat was the most common (30.3%) clinical condition that respondents self-treat with antibiotics, followed by symptoms of common cold (24.4%).


Conclusion: Our study showed that self-medication practices with antibiotics are common and that most of these practices were inappropriate.
These results should trigger health policy makers in Palestine to take action in order to prevent antibiotic misuse.
Public awareness about proper use of antibiotics is needed. Furthermore, strengthening pharmacy laws and pharmacy control over non-prescription sale of antibiotics is highly recommended.


Keywords
Self-medication, antibiotics, pharmacy, left-over, Palestine, teachers


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مركز السموم والمعلومات الدوائية و التجربة ( الخبرة) الفلسطينية



Sawalha AF.Poison Control and the Drug Information Center: the Palestinian experience. Isr Med Assoc J. 2008 Nov;10(11):757-60


Abstract


Poison Control and Drug Information Center, An-Najah National University, Nablus, Palestine. ansam@najah.edu

BACKGROUND: The Palestinian Poison Control and Drug Information Center was established in 2006 to provide up-to-date information on medications and to help in the early diagnosis and management of poisoning cases.


OBJECTIVES: To summarize the activities carried out by the PCDIC in the past 2 years.

METHODS: Documented inquires received at the PCDIC were analyzed and the Center's activities were extracted from the files.


RESULTS: During the first 2 years of the Center's existence, 323 enquiries were received, mainly (67.2%)from physicians; 70% of the calls were from the city of Nablus. Unintentional poisoning was the leading type of call (62.8%) followed by suicidal poisoning (20.7%). Medications were the major category of toxicants encountered (48.9%), followed by pesticides (23.5%). In 67.9% of the cases, the calls were initiated before any treatment was provided. The advice provided by the PCDIC was based on the nature of the call. During these 2 years the PCDIC has conducted both academic and non-academic activities. The Center introduced the concept of poison prevention weeks in Palestine and has conducted two so far. The PCDIC has published several articles in the fields of toxicology, rational drug use, complementary and herbal therapy, pharmacoepidemiology, and self-medication.


CONCLUSIONS: Documentation of all enquiries is mandatory for analysis, evaluation, comparative purposes and quality assurance. More information campaigns are needed to encourage people to use the services provided by the PCDIC.

نمط استخدامات ومأمونية الطب التكميلي والبديل في فلسطين


Sawalha AF.Complementary and alternative medicine (CAM) in Palestine: use and safety implications.J Altern Complement Med. 2007 Mar;13(2):263-9.

Abstract


AIM: Utilization of complementary and alternative medicine (CAM) is exponentially rising. There are no published data available about the attitude and use of CAM in Palestine. The purpose of this study was to investigate the attitude, pattern of use, and reasons for CAM utilization among a random sample of people in north Palestine.


METHODS: A questionnaire was used to carry out the objective of the study. The questionnaire was distributed to a random sample of people in north Palestine during the month of October 2005. The questionnaire included three sections: demographic factors and attitude toward CAM, types of CAM encountered by the respondents in the last year, and reasons that motivated CAM use. Data collected from the returned questionnaire were coded and entered into the Statistical Package for Social Sciences program (SPSS) version 10 (SPSS Software, Inc., Chicago, IL).


RESULTS: 72.8% of respondents have used at least one type of CAM in the last year. CAM users were mainly middle-aged, low-income, educated women. Herbal therapy, prayers, and honey were the most commonly utilized types of CAM. Respondents have used CAM mainly to treat respiratory and gastrointestinal disorders. Respondents have utilized CAM mainly because they believed that it is all natural and safe.


DISCUSSION AND CONCLUSIONS: CAM utilization in Palestine is very common. Some of the types of CAM used in Palestine are common elsewhere, whereas other types were unique to this area. The herbal products used by the respondents were mainly collected from nature. Safety of such products is questionable, and contamination cannot be ruled out. Awareness of potential adverse effects and proven benefits of various types of CAM needs to be raised.

نمط استخدامات ومأمونية الطب التكميلي والبديل في فلسطين




Sawalha AF.Complementary and alternative medicine (CAM) in Palestine: use and safety implications.J Altern Complement Med. 2007 Mar;13(2):263-9.

Abstract


AIM: Utilization of complementary and alternative medicine (CAM) is exponentially rising. There are no published data available about the attitude and use of CAM in Palestine. The purpose of this study was to investigate the attitude, pattern of use, and reasons for CAM utilization among a random sample of people in north Palestine. METHODS: A questionnaire was used to carry out the objective of the study. The questionnaire was distributed to a random sample of people in north Palestine during the month of October 2005. The questionnaire included three sections: demographic factors and attitude toward CAM, types of CAM encountered by the respondents in the last year, and reasons that motivated CAM use. Data collected from the returned questionnaire were coded and entered into the Statistical Package for Social Sciences program (SPSS) version 10 (SPSS Software, Inc., Chicago, IL). RESULTS: 72.8% of respondents have used at least one type of CAM in the last year. CAM users were mainly middle-aged, low-income, educated women. Herbal therapy, prayers, and honey were the most commonly utilized types of CAM. Respondents have used CAM mainly to treat respiratory and gastrointestinal disorders. Respondents have utilized CAM mainly because they believed that it is all natural and safe. DISCUSSION AND CONCLUSIONS: CAM utilization in Palestine is very common. Some of the types of CAM used in Palestine are common elsewhere, whereas other types were unique to this area. The herbal products used by the respondents were mainly collected from nature. Safety of such products is questionable, and contamination cannot be ruled out. Awareness of potential adverse effects and proven benefits of various types of CAM needs to be raised.

معدل الأصابة بالفشل الكلوي المصاحب لمرضى السكري وضغط الدم




Sweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Nasr Y. Shraim. Prevalence of Reduced Renal Function among Diabetic Hypertensive Patients. Accepted for publish at International Journal of Physiology, Pathophysiology and Pharmacology.2009; 1(1): 23-29. [Publisher: e-Century Pub. Corp, Country where published: United States] Published

Abstract:
Patients with diabetes mellitus and hypertension are at high risk of vascular complications, particularly, renal deterioration. This study aimed to evaluate the prevalence and the risk factors of reduced renal function corresponding to chronic kidney disease (CKD) stages 3 – 5 among diabetic hypertensive patients. This is a retrospective cohort study of diabetic hypertensive patients attending A-Watani governmental medical center from August 2006 until August 2007. Creatinine clearance (CrCl) was estimated using the Cockcroft–Gault equation. Those with CrCl< 60 ml/ min, corresponding to CDK stages 3 – 5, were considered to have reduced renal function. The prevalence of reduced renal function was calculated, and the risk factors associated with it were evaluated using multiple logistic regression.

The following were the results found in this study:
(a) the prevalence of reduced renal function among the study patients was 35.5% distributed as follows: (63.5%) had stage 3 CKD, 21.7% had stage 4 and 13% had stage 5 CKD.
(b) Patients with reduced renal function were elder, had higher number of chronic diseases and had longer duration of diabetes and hypertension than those with CrCl≥ 60ml/ min.
(c) Men had a higher prevalence of reduced renal function than women.
(d) Significant predictors of reduced renal function were older age, duration of diabetes and number of chronic diseases based on logistic regression analysis. Early and continuous screening of renal function among diabetic hypertensive patients is required to implement preventable strategies of end stage renal disease (ESRD).
Better control of blood pressure and diabetes mellitus are important. (IJCEM811001).


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المؤشرات السريرية للوفيات داخل المستشفيات الناتجة عن الجلطة الدماغية الحادة وعلاقتها بعامل الجنس


Sweileh WM, Sawalha AF, Al-Aqad M Sana , Zyoud SH, Al-Jabi SW. Predictors of in-Hospital Mortality after Acute Stroke: Impact of Gender. Accepted for publish at International journal of clinical and experimental medicine. 2(x):xxx-xxx,2009. [Publisher: e-Century Pub. Corp, Country where published: United States] Published

Abstract

Abstract: The purpose of this study was to identify predictors of in-hospital mortality after acute stroke and investigate the impact of gender on stroke mortality. All patients admitted to Al-watani governmental hospital in Palestine from September 2006 to August 2007 and diagnosed with acute stroke were included in the study.
Diagnosis of stroke was confirmed by computerized tomography scan. Demographics and clinical data pertaining to the patients were obtained from their medical files. The main outcome measure in this study was vital status at hospital discharge. Multiple logistic regression analysis was used to identify the independent predictors of in-hospital mortality.
Statistical analysis was carried out using SPSS 15.A total of 186 acute stroke cases (95 females and 91 males) were included in the study. Hypertension (69.9%) and diabetes mellitus (45.2%) were the most common risk factors among the patients. Thirty nine (21%) of the stroke patients died in hospital.
Multiple logistic regression analysis indicated that chronic kidney disease (P = 0.004), number of post-stroke complications (P= 0.037), and stroke subtype (P = 0.015) were independent predictors of in-hospital mortality among the total stroke patients.

Conclusion:

Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke. The study showed that gender was not an independent predictor of mortality after acute stroke. More research is required to understand gender differences in stroke mortality.(IJCEM811001).


Key Words: Predictors, hospital mortality, acute stroke, gender

الأختلافات السريرية والدوائية لمرضى الفشل الكلوي وعلاقتها بعامل الجنس


Sweileh WM.Gender differences in pharmacological and clinical associates of kidney disease. A hospital-based study.Med Princ Pract. 2008;17(2):102-7.

Abstract


OBJECTIVE: The objective of this study was to identify the pharmacological and clinical associates of kidney disease among males and females. SUBJECTS AND METHODS: This is a cross-sectional retrospective study.
All patients admitted to the Department of Internal Medicine at Al-Watani Hospital were included in the study. Medical data were obtained from patients' medical records. Kidney disease was defined as a glomerular filtration rate (GFR) less than the published cutoff points. Males with GFR <64.25 ml/min and females with GFR <59.25 ml/min were designated as kidney group and those above were considered the reference group. GFR was estimated using Cockroft-Gault equation; chi(2) and multiple logistic regressions were used to test for significance using statistical package for social sciences program.



RESULTS: Of the 340 patients, 185 (54.5%) were males and 155 (45.6%) females; mean age was 60.4 +/- 17 years. Of the 185 males, 58 (31.4%) and of the 155 females, 41 (26.6%) had low GFR kidney disease. Stepwise forward multiple logistic regression in males identified age, hypertension, and diabetes mellitus (DM) as associates of low GFR. In females, DM and angiotensin-converting enzyme inhibitors (ACE-I)/diuretic utilization were identified as significant associates of having low GFR. As the number of clinical conditions present in the patient increased, the odds ratio of having low GFR increased, in a similar and parallel way in both genders.


CONCLUSION:

Diabetes mellitus, but not hypertension or advancing age, was significantly associated with low GFR in both males and females. Utilization of the ACE-I/diuretic combination was significantly associated with low GFR among females but not males. Patients, regardless of gender, who had multiple clinical conditions, had higher risk of having low GFR. (c) 2008 S. Karger AG, Basel.

نمط معالجة ضغط الدم لمرضى السكري المصاحب و الغير مصاحب لنقص الكفاءة الكلوية


Sweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Tameem EJ. Patterns of Antihypertensive Therapy in Diabetic Patients with and without Reduced Renal Function. Accepted for publish at Saudi Journal of Kidney Diseases and Transplantation (SJKDT)(2010) [Publisher: Saudi Center for Organ Transplantation, Country where published: Saudi Arabia]. In press.

Abstract

Background: Renal deterioration is a common complication in patients with diabetes mellitus and hypertension. Appropriate use of antihypertensive agents and tight control of blood pressure (BP) can minimize and delay such complications. Objective: To investigate the utilization patterns of antihypertensive agents and to evaluate blood pressure control among diabetic hypertensive patients with and without reduced renal function. Methodology: Retrospective cohort study.
All diabetic hypertensive patients attending Al-Watani medical governmental center from August 01, 2006 until August 01, 2007 were considered in the study. Patients with a history of congestive heart failure and/or end stage renal disease were excluded. Proportions of use of 5 different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 drugs, and separately among patients with and without reduced renal function. Results: Over 60% of patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and β-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. Patients on monotherapy were mostly receiving ACEI/ARB (60%).


In patients with reduced renal function, use of diuretics but not ACEI/ARB or CCB was higher and 41.8% of the patients were on monotherapy compared to 46.6% in patients with normal renal function.
The proportions of patients achieving BP control were 20% and 28% for patients on monotherapy versus those on combination therapy respectively. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACEI/ARB and diuretic use, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.


Running Title: Antihypertensive Therapy in Diabetic Patients.

Kew Words: Antihypertensive Therapy, Diabetes Mellitus, Renal Function

تأثير الأدوية والأمراض على التغيير في جرعة الميتفورمين


Waleed M. Sweileh. Influence of Disease and Drug Risk Factors on Metformin Dose Adjustment: A Retrospective Study of Outpatients in Nablus.The Islamic University Journal (Series of Natural Studies and Engineering) 2007; 15(1): 137-146.

Abstract:

Background: Metformin may, in the presence of certain risk factors, cause serious lactic acidosis. The aim of this study was to investigate the presence of risk factors for lactic acidosis among diabetic patients and to determine whether metformin daily dose was influenced by the presence of these risk factors or not. Methods: This is a retrospective study of one hundred and eighteen diabetic patients receiving metformin. Information about disease status and medication profile of the patients were retrieved from patients’ medical files. Data were coded and entered using SPSS for analysis and graphics. Results: Approximately, two thirds (74/118, 62.7%) of the included patients had a least one disease risk factor for lactic acidosis. Of those patients, (48/74; 64.9%) had a dose adjustment, with congestive heart failure and renal impairment being the risk factors most likely to result in a dose adjustment. More than one third (38%) of metformin patients were co-prescribed ACE-I or NSAIDs. The dose of metformin was insignificantly influenced by the co-administration of drug risk factors. Conclusion: Metformin total daily dose was significantly influenced by the presence of disease risk factors and was insignificantly influenced by the co-administration of drug risk factors.

Short running title: Risk Factors and Metformin Dose.



Key words: metformin, risk factors, dose, lactic acidosis.



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