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- ItemClinical Significance of KRAS Mutation in Colorectal Cancer (CRC) Patients(Al-Quds University, Deanship of Scientific Research, 2020-12-22) Makhamra, Sajeda; Al-Assa, Rawan; Hallak, HusseinBackground: According to 2018 Palestinian statistics, CRC is the second most common type of cancer; it contributes significantly to cancer-related deaths despite the continuous progress in diagnostic and therapeutic methods. One of the advances in CRC is the introduction of EGFRI that increased the treatment options available for a patient with mCRC, two EGFEI agents are approved for the treatment of mCRC: pantinumab and cetiximab. KRAS is the most frequently mutated oncogene in cancer. KRAS gene mutation in CRC is a well-established biomarker for predicting tumor responsiveness towards the use of EGFEI. KRAS gene mutation is available at Palestinian MOH, testing started in 8/2019 for patients at Stage 4 metastatic CRC (because in Stage 1 to 3 even if KRAS mutation was positive this did not result in a change in therapeutic regimen). Oncologists can make the clinical decision regarding therapy according to KRAS test results, where if the result shows wild type KRAS, the therapy is Avastin and/or EGFRI. However, patients with mutant KRAS, EGFRI are known to be not effective. So, all metastatic CRC patients must undergo genetic testing to differentiate between the wild type and mutant KRAS in order to avoid side effects of EGFRI and save drug cost. Objectives: Compare outcome between lab testing results and patient records in order to determine if the input provided from the lab is implemented in patient treatment protocol and to evaluate if international treatment protocols are being implemented in a colon cancer patient with KRAS mutation. Methods: The study involved 88 patients diagnosed with CRC and treated between 2016-2020 in Beit Jala, Alwatani, Refedia and Thabit Hospitals. 40 patients had genetics analysis in the national blood bank Ramallah- Palestine. Results: A total of 88 CRC patients were included in the study, 45 were female, 43 were male. 37.5% of patients were above 60 years old. The study included a random sample of 48 CRC patients, 29/48 (60.42%) received chemotherapy, 6/48 (12.5%) received biological (Avastin) and chemotherapy 8/48 (16.66%) underwent radiotherapy and 29/48 (60.42%) underwent surgery. Out of the 48 randomized CRC patients, 16/48 (33.33%) had metastasis. Out of the 88 CRC patients, 40 had KRAS gene test results, 27 (67.5%) were found to have KRAS mutation; all are Stage 4 metastatic (32.5% metastasis to the liver). 33 patients underwent therapy, 11 of them had wild type KRAS while 22 had mutant KRAS. All treated patients received chemotherapy, 9 of them (27.27%) underwent surgery; 3 (9.09%) underwent radiotherapy. Biological drugs were administered to 21 (63.63%) patients, 7 of them had wild type KRAS (2 patients received bevacizumab (Avastin®), 4 patients received cetuximab and 1 received trasuzumab). The remaining 14 patients had mutant KRAS, 13 patients of them receive Avastin and 1 patient received cetuximab with chemotherapy. Conclusions: The introduction of KRAS mutation test at Palestinian MOH is an important advance in mCRC treatment that can directly influence medical decision-making and selection of the appropriate biological treatment. The data collected also indicates that a high percentage (67.5%) of mCRC Palestinian patients have mutant KRAS.
- ItemA Comparative Study of Antipsychotic Drugs Use Among Psychiatric Patients in Palestine Quality of Life (QOL) and Long-acting Injectable (LAI) Assessment(Al-Quds University, Deanship of Scientific Research, 2020-12-22) Sughaiar, Sarah; Alkurde, Basema; Zaro, Ibrahim; Ebido, Hamzeh; Shaheen, Muamarpast decade and were used mainly for long-term treatment of schizophrenia. However, their role in short term intermittent use and for other psychiatric conditions were not elucidated clearly. Objectives: To compare the quality-of-life improvement for patients on LAIs comparing to conventional treatment and whether the improvement was clinical or psychosocial in nature. Methods: A retrospective cohort study was run on psychiatric patients who are taking LAIs and/or conventional treatment at Mohammad Said Kamal hospital for mental illness in Bethlehem and Mental Health Clinic of The Ministry of Health in Hebron city from September 2019 to March 2020. GAF score was calculated for each patient among other mental scale scores such as CGI-S and DIEPSS to determine the quality of life and other aspects of improvement. Patients were categorized into LAIs-taking only or LAIs and conventional treatment groups. A previously used and standardized questionnaire with some modifications was used to collect information about relapse and enhancement of their status. Results: Fifty-one patients were included in this study, 74 % were males, age 30-89 years old (42% were 50-59 years old). Ten percent of patients only were on LAIs alone and the rest were taking a combination of both LAIs and conventional treatment. Patients' GAF scores ranged from 11-20 to 91-100 with a spectrum of patients on all GAF score scale range. Thirty-seven percent of patients fell in the GAF score 51-60; Moderate symptoms (flat affect and circumlocutory speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning. Patients were taking one to six drugs at a time. There was a negative relationship between taking many drugs along with LAIs and scoring badly on GAF scale. One patient was on Haloperidol IM depot injection scored 91-100 on GAF and was stable and improving. The main reasons for substitution to LAIs from highest to lowest, were as follows; adherence (24 patients), no reason at all (14), patient dissatisfaction (7), adherence and patient dissatisfaction (3), then side effects, convenience (ease of use), and availability of the drug at the same level (1 patient each). Conclusions: Erratic drug supply especially during crises times (COVID-19) for crucial drugs such as LAIs plays a major role in adherence and prognosis of psychiatric conditions. Dealing with LAIs as emergency use only in some practices was the main reason for relapse and instability in psychiatric conditions and will affect social improvement.
- ItemObstructive Sleep Apnea in Bethlehem Diabetic Patients(Al-Quds University, Deanship of Scientific Research, 2020-12-22) Hemeid, Eman; Bannoura, Natalie; Hallak, Husseinsleep specialists have dealt with this disease as a simple closure of the upper airway that was treated mainly by Tracheostomy surgery. After 1981, specialists wanted to introduce other effective, easier, and more compliant methods to treat this disease. The continuous positive airway pressure (CPAP) device fulfilled this intention by supplying a constant air pressure to prevent the airway from collapsing. This method became the gold standard for treating OSA. Obstructive sleep apnea-hypopnea is a sleep disorder that includes cessation in airflow in the presence of breathing effort, characterized by recurrent episodes of upper airway collapse leading to hypoxia during sleep, so the brain wakes the body to restart breathing. Apnea occurs 1-2 times per minute every night in patients with severe OSA. The estimated prevalence has been 4% for men and 2% for women. This disease is strongly related to serious co-morbidities including cardiovascular diseases, metabolic disorders and sleepiness-related accidents. Untreated OSA can lead to a 15-fold increase in traffic accidents so treating OSA can save lives. Objective: The Purpose of this study was to evaluate the awareness of obstructive sleep apnea in Palestinian Diabetes patients. Method: A cross-sectional study used convenience sampling to collect data from 80 diabetic patients in the Bethlehem area. The questionnaire consisted of two parts; the validated Berlin questionnaire for Sleep Apnea was part 1 and sociodemographic factors and disease status in part 2. Based on Berlin Questionnaire, DM patients were divided into high or low risk of having sleep apnea. The second part investigated these people’s knowledge/awareness about the disease and the Device used for treatment. Results: Our sample consists of 80 Palestinian diabetic patients in the Bethlehem district, it includes 39 men and 41 women; their age ranged from 35 to 95 years in which the major percentage was taken from 41 to 65 years. The data indicates that 52 of the patients (65%) have a high risk of developing obstructive sleep apnea (OSA), and the other 28 patients (35%) have a low risk of developing the disease. It appears that 2.5 % already suffers from OSA. The core of our study is to test awareness and knowledge in Bethlehem; results indicate that 70% of patients have no clue what OSA is, while only 30% of the sample heard about this disease. Conclusion: Our study confirmed our main concern; the level of awareness of the condition called obstructive sleep apnea was quite low even though 65% of the diabetic patients tested are at high risk. This may be attributed to a lack of sleep specialists nor centers in the West Bank to diagnose or treat these patients.
- ItemSelf-medication by Using Online and Other Methods in Palestine(Al-Quds University, Deanship of Scientific Research, 2020-12-22) Salameh, Iman; Awwad, Shahd; Hallak, HusseinBackground: Advertisements of medical products on social media networks has become increasingly common. This is also associated with online shopping in order to self-medicate. Such practicehighlights the influence of social media and advertising on individuals to use medicinal products without instructions of physicians. Objectives: To assess the probable reasons, the extent of use, sources of advice and consequences of online self-medicate practice among University students in Palestine. Methods: A descriptive cross-sectional study was carried out using a" pretested questionnaire", which was prepared in the Arabic language, among 700 students involved in face-to-face interviews, from three public universities in Palestine (Al-Najah, Al-Quds and Bethlehem university). The study was conducted over three months (Nov2019—Jan2020), including all years universities students of both medical and nonmedical faculties. Data were collected,coded, entered,analyzed and summarized by statistical package for social sciences program (SPSS) version 22. Descriptive results were expressed as frequency, percentage, and mean±SD. Results:(94.2%) students reported that they keep seeing medical ads while scrolling their social network accounts. Younger age (20-29 years), female (87.6%), medical students (57.4%) tented to use online self-medication practice more than their peers did. In addition, (52.7%) of the respondents reported that they use the internet for more than six hours per day, (65.7%) reported that they use online products without consulting a physician or a pharmacist. The most commonly used products among the surveyed students were skincare products (76.7%), followed by hair products (72.2%), and vitamins (58.8%). The most frequently reported dosage form was cream and ointments (71.3%). Moreover, (54.7%) students reported not using the product again after their first trial. The Principle reasons for seeking online self-medication were, “I don’t have time to visit doctors (50.4%)”, and “to save money” (49.8%). The most-reported sources for self-medication were the internet (45.3%), and (16.7%) reported using the product according to the great propaganda campaign by the social networks. The majority (64.1%) reported that their experience was “bad” and “not healthy”. (50.8%) students reported having experienced side effects, in addition to this, 33.6% is the proportion of the students who stopped using the product because of side effects and so they gave it to one of their family members or friends. (29.6%) did not have any instructions for use and (35.3%) reported trusting what the seller said about the product, and (65.3%) reported searching on the internet before using it. Conclusions: Online self-medication is a commonly used practice by young Palestinian University students; this constitutes a health problem that needs intervention to minimize risk. We emphasize the important role of a pharmacist in educating the community especially the youth category (20-29 years) regarding online medication practicesthat may have harmful side effects.