Pharmaceutical Sciences

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    Antibiotics Dispensing Patterns in The Community Pharmacies in Gaza Governorate
    (Al-Quds University, 2008-03-01) Mostafa Omar El-Ghosain; مصطفى عمر الغصين
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    Anticancer, Antioxidant, Antimicrobial, and Enzymes Inhibitory Effects of Terfezia Arenaria from Palestine
    (Al-Quds University, 2023-04-29) Ahmed Mutasem Tawfiq Alkhader; أحمد معتصم توفيق الخضر
    Terfezia arenaria belongs to the Terfeziaceae truffle family and is one of the most important desert truffles in Palestine. It is an edible truffle with many medicinal folks uses in the past and present, so the study was designed to consolidate knowledge about this truffle and to validate the medicinal uses of the natural products. In the beginning, we used a variety of extraction methods including Soxhlet extraction, sonication extraction, and exhaustive extraction, as well as various solvents with varying polarity properties including methanol, ethanol, water, acetone, hexane, dichloromethane and ethyl acetate. We relied on sonication extraction with methanol as a solvent because it yielded the highest extract, whereas other solvents yielded negligible amounts of extract. Qualitative tests were performed to investigate the ingredients of the methanolic extract, which revealed the presence of flavonoids, phenols, glycosides, carbohydrates, and steroids. The flavonoids and phenolic compounds were then determined quantitatively, using Folin-Ciocalteu’s method for phenolic contents and aluminum chloride method for flavonoids. This work also investigated the expected effect of these compounds in addition to the discovery of new effects of the T. arenaria. We tested the enzyme inhibition effect on amylase enzyme, which is naturally present in the human intestine and plays an important role in carbohydrates digestion; inhibiting the enzyme may be useful to reduce the absorbed amount of glucose and thus improve the treatment of diabetic patients, so we measure the absorbance using UV spectrophotometer and higher absorbance means higher inhibition, and we use acarbose which is an antidiabetic drug as a positive control. The other enzyme we tested for inhibition effect is lipase enzyme, which is found normally in humans and other mammals and digests lipids, so inhibiting it may also aid in the treatment of obesity, orlistat used as a reference in this test and using UV spectrophotometer same as amylase inhibition. Another important test we carried was the extraction of antioxidant because oxidative stress is a factor in the progression of many diseases, and a positive antioxidation effect may be beneficial in reducing Alzheimer, dementia, cancer, and many other diseases. In our study we used reducing power assay method to determine the antioxidant activity. The antibacterial activity was tested on different bacterial species, gram-positive and gram-negative bacteria, to validate one of the most well-known uses. Cytotoxicity activity was also investigated in order to test the ability to treat cancer cells in vitro, and two different cell lines used, which could be the first step in the discovery of a new lead compound for cancer therapy. In our results we found our desert truffle to have various biochemical compound and good phenolic and flavonoids contents, so this will have positive impact on our results. And also, the results of enzymes inhibition activity were good enough to build on, as it showed good inhibition comparatively with the positive controls. For the anticancer activity there was obvious cell growth inhibition on two different cell lines used, while there was no antibacterial activity.
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    Assesment of Beliefs about Medicines and Adherence among Patients withSchizophrenia at the Primary Care Unit in Ramallah, Palestine
    (Al-Quds University, 2020-06-06) Aroub Salman Mohammad Salman; عروب سلمان محمد سلمان
    Objectives and background: Schizophrenia is a serious mental illness that needs more attention to be paid for. It affects how patients think, feel and behave. The exact causes underlying the problem is still unknown, but a number of risk factors can be identified including genes and environment. The aims of this study were to assess medication adherence to antipsychotic medications and to measure patients’ beliefs about their treatment necessities and concerns, which contribute to their antipsychotics adherence and treatment efficacy.Methodology: One hundred and thirty patients were recruited from the governmental psychiatry clinic in Ramallah in a cross sectional study. The self-reported Morisky-Green-Levine (MGL) scale was used to measure patients’ adherence. Beliefs about medicines questionnaire (BMQ) was used to measure beliefs about medicines.Results: The result in this study indicated that 53.8 % of the sample participants were classified as low-adherent while 46.2% of patients classified as high adherent. The majority of the patients (66.3%) had strong beliefs and necessity in their medications to maintain their good health, more than half of patients (55.4%) were concerned about becoming dependent upon antipsychotics and long-term side effects. The mean score of specific necessity scale of 16.9 (CI 95%, 15.9 - 17.9) and mean score of specific concerns scale of 16.5 (CI 95%, 15.4 - 17.6; P<0.001) were significantly correlated to medication adherence, and the mean of necessity–concern differential was 2.1 (CI 95%, 2.5 – 1.7; p <0.11) . (Extended) Brief .Psychiatric Rating Scale BPRS domains mean scores were: manic 21.4 ± 8.8, depression and anxiety 20.3 ± 6.2, negative symptoms 13.8 ± 4.6 and positive symptoms 17.7 ± 6.3. BPRS mean score was 77.1± 24.9. The multivariate regression model demonstrated that four variables remain significant and associated with non-adherence; no formal education (OR= 2.11; CI: 0.8 – 3.8) (p=0.04), age (OR= 2.88; CI: 1.2 – 4.4) (p = 0.01), having comorbidity (OR= 3.2; CI: 1.9 – 4.3) (p=0.01) and having concerns about side effects (OR= 2.5; CI: 1.2 – 3.9) (p = 0.03); as they are positively correlated to non-adherence.Conclusion: More than half of participants in this study had low adherence to their antipsychotic agents. Most of patients had strong beliefs in the necessity to use their medications. However, high percentage of the patients had concerns about long-term and potential side effects of antipsychotic medications. Therefore, our role as pharmacist is raising patients’ awareness and beliefs about medications for better treatment outcomes; by educating them about anti-psychotics, their adverse events and conducting several interventions regarding patient compliance.
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    Assessment of Patient’s Satisfaction with Pharmaceutical Care Services in Community Pharmacies in west bank: A cross sectional study
    (Al-Quds University, 2023-05-20) Sujood Theab Nemer Mashaala; سجود ذياب نمر مشاعلة
    The provision of pharmaceutical services to the community and the care of patients are significant responsibilities of pharmacists. It is unclear if the general public completely understands the important role that pharmacists play in the healthcare system. This study aim was to examine general public perception about community pharmacy services, and how satisfied they are with pharmaceutical care services utilizing the health beliefs model (HBM).Methods A cross-sectional study was carried out on a randomly chosen sample population (n = 400) in West Bank from January through June 2022 for a period of six months. A standardized, self-administered questionnaire with 35 items was used to gather information on the respondents' demographics and satisfaction with pharmacy services utilizing (HBM). Results:The response rate of the survey was 87%. The majority of the respondents perceived benefit of utilizing pharmaceutical care services with mean score (24.5 ± 4.6). There was a significant differences between mean perceived benefit and perceived barriers (24.5 vs. 17.5, p <0.05). Participants generally did not express a high level of agreement on the four susceptibility-assessing items (mean = 11.55 ± 2.44, range 4-20). However, the four questions measuring perceived severity had better agreement (mean = 13.3 ± 3.0, range 4-20). The participants express modest satisfaction with pharmaceutical services and managing therapy, the mean (± SD) score on the satisfaction scale was (24.1±7.1, range 10 - 50). The items regarding lack of privacy and explain side effects of drugs had the highest dissatisfaction percentages (91% and 55%, respectively). Multiple linear regression demonstrated four variables to be significantly correlated with satisfaction with pharmaceutical care services included perceived susceptibility (β = .157, p = .002), residency (β = -.203, p = 0.001), number of medications (β = -.237, p = .001), and perceived barriers (β = -.132, p = .012). Indicating, that participants with higher number of medication and those perceived susceptibility were more satisfied and those perceived barriers were less satisfied with pharmaceutical care provided by community pharmacies. Conclusion: The majority of the participants express modest satisfaction with pharmaceutical care services. The community pharmacists in ideal position to and have the ability to improve the benefit patients perceive by providing comprehensive pharmaceutical care services and managing medication therapy.
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    Design of Novel Gabapentin Prodrugs by Computational Methods
    (AL-Quds University, 2021-01-05) هنادي عبد الكريم حسني سنقرط; Hanadi A H Sunoqrot; رفيق قرمان; صالح جبور; حاتم حجاز
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    Design of Novel Raloxifene Prodrugs by Computational Methods
    (Al-Quds University, 2021-12-22) Nermeen Nader Ibrahim Hajjaj; نيرمين نادر إبراهيم حجاج
    A number of Kirby ̓s enzyme models for six Raloxifene prodrugs on both sides (left and right sides) are designed based on molecular orbital of DFT at B3LYP 6-31G (d, p) level and molecular mechanics (MM2) calculations of the intramolecular proton transfer which run in the gas and water phase for right side and in the gas phase for left side to provide a medicine of controlled release for Raloxifene to enhance the bioavailability than its parent drug. Results proves thatRaloxifene ProD1-ProD6processes on two sides aremajor affected and depended on two factors of the global minimum (GM) which includes the distance between the two reactive centers, rGM, and the angle of attack α that also affected on the rate of a proton transfer for Raloxifene where lower ∆G‡(higher rates) refer to system of low rGM and high α values for example ProD4 andProD6at left side and ProD5 and ProD6at right sidealso, the system of higher∆G‡(lower rates) refer to high rGM and low α values, for example (ProD1, ProD2,ProD3, ProD5) at leftand (ProD1, ProD2,ProD3, ProD4) at right.Thus, it is recommended that RaloxifeneProD4,ProD6 at left side and ProD5 and ProD6 at right side shouldbe entered and tested in vitro and in vivotrials steps of synthesis. Moreover, it was found that the internal conversion rate of Raloxifene prodrugs is significantly affected by the strain energy of each value which refers to the difference between the strain energy of tetrahedral intermediate and the reactant, since the higher the strain the lower the internal conversion rate, and vice versa. تم إنجاز هذه الأطروحة باستخدام المدار الجزيئي DFT عند مستوىB3LYP 6-31G (d, p) وحسابات الميكانيكا الجزيئية (MM2) لنقل البروتون داخل الجزيء في عدد من نماذج إنزيم Kirby لتصميم العقاقير الأولية من الرالوكسيفينعلى الجانبين (اليسار واليمين). لتوفير دواء لديه القدرة على إطلاق للرالوكسيفين بطريقة قابلة للبرمجة والتحكم مع توافر بيولوجي أعلى من الدواء الأصلي. هناك ستة عقاقير أولية من رالوكسيفين على الجانبين (الجانب الأيسر والأيمن) تم تصميمها اعتمادًا على نموذج إنزيم نقل البروتون في كيربي. بطريقة DFT عند B3LYP / 6-31G (d,p)تم إجراء حسابات مستوى في الطور الغازي وفي ثابت العزل الكهربائي 79.38 (طور الماء) للجانب الأيمن وفي الطور الغازي للجانب الأيسر. تم الكشف عن أن معدل نقل البروتون في عمليات ProD1-ProD6الرالوكسيفينعلى الجانبين يعتمد إلى حد كبير على الاختلافات الهندسية للمتفاعل (GM) بشكل أساسي المسافة بين المركزين المتفاعلين(rGM) وزاوية الهجوم (α). لاستنتاج أن الأنظمة التي تحتوي على قيم rGM منخفضة وقيم α عالية في هياكلها الدنيا العالمية ، مثلProD4 و ProD6 في الجانب الأيسر ProD5 و ProD6 في الجانب الأيمن تظهر معدلات أعلى بكثير (أقل G ‡) من هذه مع قيم rGM عالية وقيم α منخفضة ، مثل ProD1 و ProD2وProD3 و ProD5 على اليسار ProD1وProD2 وProD3وProD4 على الجانب الأيمن. وبالتالي ، فمن المستحسن أن الرالوكسيفين ProD4 و ProD6 في الجانب الأيسر و ProD5 و ProD6 على الجانب الأيمن يجب أن تسبق الاختبار في المختبر وفي الجسم الحي. علاوة على ذلك،لقد وجد أن معدل التحويل الداخلي للرالوكسيفينprodrug يتأثر بشكل كبير بقوة strainلكل من رباعية الاسطوح المتوسطة، حيث ان من تملك strain اعلى يكون معدل التحويل الداخلي أقل ، والعكس صحيح.
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    EEffect of Pharmaceutical Marketing Practice on Physicians’ Prescribing Behavior in the Gaza Strip
    (Al-Quds University, 2021-06-10) Rafat Subhi Abd Elftah Aburedwan; رأفت صبحي عبد الفتاح أبو رضوان
    Pharmaceutical Companies (PCs) are using different marketing activities to influence physicians’ prescribing behavior. However, the interaction between physicians and PCs is a real leading factor for conflicts of interest that negatively impact physician prescribing behaviors worldwide. The aim of this study is to identify the effect of pharmaceutical marketing practice on physicians’ prescribing behavior in the Gaza Strip (GS). To fulfill the aim of the study, the researcher followed a mixed approach that utilizes quantitative and qualitative data. For quantitative data, a cross-sectional, descriptive-analytical survey was utilized among specialist physicians working in the governmental hospitals as well as the private hospitals and clinics in the GS in 2020. A self-administered well-structured questionnaire was used. For the qualitative part, focus groups and in-depth interviews were used for data collection from physicians, pharmacists, and pharmaceutical medical representatives (PMRs). Data were analyzed using SPSS. The questionnaire response rate is 91.3% (347 returned questionnaires) was achieved. This study revealed that many physicians prefer the internet (82.4%) the medical, textbooks (80.2%), and academic journals (74%) as sources of drug information rather than commercial sources of medical information However, nearly (64.2%) of physicians depend on detailing as a source of drug information. Also, 70.8%, 68.6% of physicians agreed on the importance and credibility of information provided through PMRs about the new and old drugs respectively. Results highlighted the complex correlated factors that impact physicians’ prescription behavior. These factors were categorized into drug characteristics (80.1%), organizational factors (79.1%), physician factors (75.8%), patient contexts (69.3%), and the least influential factor was pharmaceutical company factors (59.9%). However, results showed that there is an active interaction between physicians and the PCs. Findings revealed that 96% of the study sample had been visited by PMRs at least once a month. Almost all of the physicians (98.3%) received at least one of the marketing tools offered by (PCs). PMRs detailing has become prevalent in health facilities in the GS with 96.2% of physicians received skillful detailing. The provision of promotional printed material (95.7%), free medical samples (93.9%), and inexpensive gifts (74.6%) were the major prescribing inducement tools used by PMRs. The study results revealed that the current marketing tools have a considerable effect on drug choice decisions (64.2%), motivating physicians to prescribe promoted drugs (65.2%) and new drugs (66.8%). However, the influence of these tools was not similar in their effect. The most effective tools used were detailing and discussions with PMRs (73.4%). The following characteristics were significantly associated with the effect of pharmaceutical marketing on physicians’ prescription behavior: age, years of practice, average monthly income, income satisfaction, graduation country of bachelor. Also, results confirm that physicians (61.73%) are prepared to implement regulations and ethical codes that govern physicians – PMRs interactions. In conclusion, there is an active interaction between physicians and the pharmaceutical industry in the GS in both private and public sectors. These interactions had a considerable role in affecting physicians’ prescription behavior. An agreed drug prescribing policy, as well as a comprehensive guideline for physicians’ interactions with pharmaceutical companies along with follow-up mechanisms for its enforcement, should be created. Also, should promote the concept of essential drug list of medicines and developing clear protocols and guidelines and applying them. Also establish comprehensive formal training courses for physicians on their prescribing behavior. Promoting the concept of rational use of medicines and developing protocols and guidelines and enforcing them.
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    The Efficiency of FLAIR-Weighted BLADE in image Quality Parameter Correction for Moved Patient
    (Al-Quds University, 2023-03-11) maram mohammad motee ghazawna; مرام محمد مطيع غزاونة
    Magnetic resonance imaging (MRI) is a medical tool that can provide detailed information about the inner structure of a person's body. The use of the fluid-attenuated inversion recovery (FLAIR) sequence in imaging the brain is very useful, as it can help identify subtle changes in the brain's structure and function. Due to the sensitivity of MRI to artifacts, it is not always possible to achieve high-quality imaging. The presence of motion artifacts can affect the overall diagnostic value. In this study dipole filling for k-space (BLADE) was implemented for 46 different images with different motion types including right rotation, left rotation, right bending, left bending, flexion, extension, and combination. In this work, we aimed to measure signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and percentage of signal ghosting (PSG). RADIANT DICOM viewer was used to calculate signal intensity (SI) and its standard deviation (SD), the SD is used as the noise index. ImageQC was used to calculate PSG while these measurements are plotted in Microsoft Excel. In this research, we used a control group of 46 patients who have standard images which use the cartesian filling for k-space for comparing the measurements with standard FLAIR sequence. Results showed using BLADE lead to a significant improvement in SNR, CNR, and ghosting in almost all types of motion while failing to correct ghosting from severe patient motion. The mean value of SNR was 1.08 for the dipole filling (BLADE) sequence and significantly reduced to 0.92 for the routine sequence (p<0.05). While the mean CNR was 0.75 for dipole filling and significantly reduced to 0.49 for routine sequence (p<0.05). Finally, the mean PSG for dipole filling was 0.75 and significantly reduced to 0.18 for routine sequence (p<0.05). In conclusion, the dipole filling sequence enhances SNR, and CNR due to flow and eye motion. Although BLADE reduced ghosting artifacts in most types of motion, BLADE was unable to eliminate ghosting appearance from the severe patient motion.
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    Evaluation of antibiotics resistance including fosfomycin in Pseudomonas aeruginosa isolates from cystic fibrosis patients in Palestinian Hospital over 5 years
    (Al-Quds University, 2021-06-07) Bayan Asad “Mohammad Rajab” Subb Laban; بيان أسعد محمد رجب صب لبن
    Background: Antipseudomonal agents, like other antibiotics, will develop a resistance when taken continuously for many years. In diseases like cystic fibrosis (CF),the most dangerous pathogen colonizing the lungs is Pseudomonas aeruginosa and antibiotic resistance has a high chance to occur. In Palestine, there is no accurate data about resistance in these bacteria among CF patients. The increased prevalence of multi-drug resistant strains, allergic reactions, nephrotoxicity and other side effects of antibiotic used among patients with CF limits the number of antibiotics available to treat pulmonary exacerbations. Fosfomycin, a unique broad spectrum bactericidal antibiotic, might offer an alternative therapeutic option in such cases. Objectives: The aim of this study was to determine the level and change in the rates of resistance over the years for mostly commonly used antibiotics in Pseudomonal infection in CF patients. In addition, the study evaluated the effect of fosfomycin on this bacteria. Methods: To study antibiotics resistance tested in sputum samples over the past 5 years, a retrospective study was carried out in the Department of Microbiology at Caritas Baby Hospital. Clinical and microbiological data were extracted from medical database for pediatric CF patients. The results were analyzed using Microsoft Excel Software 2010 and Statistical Package for Social Sciences (SPSS) program version 20. In addition, 129Pseudomonas aeruginosa sputum samples from CF patients were tested for fosfomycin sensitivity by using two different methods minimum inhibitor concentration (MIC) and disc diffusion(DD). Results: The sensitivity to commonly used antibiotics in treatment P.aeruginosa infection in CF pediatric patients in Palestine was92.3%, 91.9%, 89.1%, 87.7%, 76.5% and 73.5% for ciprofloxacin, ceftazidime, piperacillin-tazobactam, meropenem, amikacin and gentamicin; respectively. Over the past 5 years, the sensitivity was oscillating slightly with no deterioration in sensitivity toward these antibiotics. The vast majority of patients are from the south of the west bank (70.1%), and also the resistance in this area is higher for all antibiotics. Males are slightly more sensitive than females. Regarding ages, as the age increased, resistance to antibiotics increased. In vitro, due to the lack of susceptibility breakpoint of fosfomycin for P.aeruginosa in CLSI and EUCAST, sensitivity to fosfomycin according to MIC results was determined based on the existing CLSI breakpoints for the Enterobacteriaceae; ≤64 is sensitive. MIC method showed good activity for fosfomycin toward P.aeruginosa isolates from CF patients; nearly 40% sensitive, the most sensitivity was in mucoid type (57.5%). DD method showed a strong correlation with MIC method, Pearson Correlation between MIC and DD 200 μg was -0.889, between MIC and DD 50 μg was -0.768, and also 0.932 between DD 200μg and DD 50μg. Conclusions: In Palestine, the sensitivity to commonly used antibiotics in treatment P.aeruginosa infection in CF pediatric patients was stable, and there was no deterioration in sensitivity toward these antibiotics over the past 5 years. Fosfomycin showed a good sensitivity towards Palestinian P.aeruginosa isolates in CF patients, so it can be considered as a choice in the antibiotics used in treating P.aeruginosa infection (particularly the mucoid type) in CF patients in the future, but it still needs more research. Keywords: Cystic Fibrosis, Pseudomonas Aeruginosa , Fosfomycin, Bacterial Resistance.
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    Investigate Factors that Influence Dispensing Non- Prescription Antibiotics from Community Pharmacies in West Bank, Palestine
    (Al-Quds University, 2023-05-20) Yazan Nael Aref Nofal; يزن نائل عارف نوفل
    Objectives and Background: Antibiotic resistance (ABR) is considered one of the most risky problems with respect to human health, in which several pathogens are no longer sensitive to current antimicrobials and still have the ability to cause infections. Major bacterial infectious diseases kill over 11 million people per year. The aims of this study were to determine if respondents' proposed provision of antibiotics for URIs, diarrhea, and mild wounds is appropriate, and to examine the association between variables pertaining to respondents' prescription of antibiotics and demographic information about the pharmacies where they work, such as the pharmacy's type (independent or chain) and geography, and to look at the elements that are associated with respondents prescribing antibiotics and their demographic information, such as age, gender, years of experience, position within a pharmacy, and highest degree of education. In addition, the study aimed to examine respondents' perspectives about ABR and the connection between the characteristics that affect how respondents dispense antibiotics and how they feel about ABR. Moreover, the study aimed to gather respondents' opinions about prospective developments in the sensible use of antibiotics from community pharmacies. All these domains were examined to choose measures to increase the rationale use of antibiotics in the community. Methodology: A total of 314 respondents were recruited in this study by a quantitative research method using a cross-sectional survey with a self-completing online questionnaire. The questionnaire was developed from the literature, and combined both closed-ended questions with tick boxes and statements with a Likert scale as well as open-ended inquiries. Three sections made up the questionnaire: the first section of the questionnaire covers case studies, information about resistance to antibiotics, and strategies for influencing the sensible use of antibiotics. In the second section, respondents are asked to provide demographic data regarding their local pharmacy, including its location and type. In the third section, questions are posed iii regarding the respondents' history, including his or her age, gender, educational background, job title, and amount of pharmacy experience. The questionnaire was tested for content validity and reliability and was measured in our setting by Cronbach's alpha. Data collected online using Google forms were then exported to IBM SPSS version 22 to be evaluated and analysed regarding the tendency to supply inappropriate antibiotics and associated factors. Results: According to the study, the highest rate of inappropriate supply of antibiotics was particularly for URIs from respondents. Employees and full-time pharmacists (p value=0.047), morning shift workers (p value=0.033) and bachelor of pharmacy degree holders (p value=0.044) were more likely to supply inappropriate antibiotics. Additionally, when the age variable was increased by one unit inappropriate antibiotic supply decreased by approximately 4.8 times and when the experience variable was increased by one unit, providing inappropriate antibiotics decreased by approximately 0.25 according to logistic regression analysis. With respect to diarrhea cases, employees and part-time pharmacists (p value=0.035), evening shift workers (p value=0.023), male pharmacists (p value=≤0.001) and pharmacy workers in rural areas (p=≤0.001) were more likely to supply inappropriate antibiotics. Regarding wound cases, owners and full-time pharmacists (p value= 0.03), both shift workers (p value=≤0.001), male pharmacists (p=0.002), bachelor of pharmacy degree holders (p value=0.018) and those working in chain pharmacies (p=≤0.001) were more likely to supply inappropriate antibiotics. Logistic regression regarding all cases combined revealed that when the gender variable was female, the inappropriate antibiotic supply decreased by approximately 8 times compared with males. Conclusion: This study has effectively demonstrated that respondents' provision of antibiotics is not always appropriate and is impacted by clinical circumstances and demographic factors as well as their knowledge and awareness of antibiotics and ABR. These results indicate the need for a plan to enhance the proper supply and use of antibiotics, aimed at policymakers and healthcare professionals.
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    Living with Medicines and its Impact on Quality of Life in Dialysis Patients in West Bank, Palestine.
    (Al-Quds University, 2023-08-19) Reem Hasan Abdel Majeed Natsheh; ريم حسن عبد المجيد نتشه
    Background: End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD), characterized by an irreversible loss of kidney function. Globally, the prevalence of ESRD is increasing, resulting in a significant economic and health burden for patients and the health system. This study aims to investigate the impact of medication burden and adherence on health-related quality of life (HR-QOL) for patients who received hemodialysis in the West Bank, Palestine. Methods: A cross-sectional study was conducted to assess HR-QOL through the KDQOL-36TM questionnaire, medication-related burden through the LMQ-3 scale, and medication adherence using the ARMS questionnaire in 120 hemodialysis (HD) patients. The sample was recruited from two dialysis units at the Ministry of Health Hospital (the Palestinian Medical Complex (PMC) in Ramallah and the Hebron Governmental Hospital in Hebron). Results: The majority of HD patients were between 50 and 69 years old (30.8%), resided in villages (62.5%), were married (83.3%), and had a relatively even distribution between males (47.5%) and females (52.5%). The overall HR-QOL global score was 1958.5 (IQR= 2007.50) out of a possible 3600, indicating a moderate level of quality of life. Among the HR-QOL dimensions, symptoms and problems of kidney disease had the highest mean score, while burdens of kidney disease had the lowest. The majority of HD patients (45.8%) experienced a moderate burden. Patient-doctor relationships, effectiveness, and cost-related burden have been shown to be the most significantly influencing factors in medication burden. According to the ARMS scale, the majority of participants (73.3%) had low adherence to their medicine. Correlation tests revealed significant negative relationships between medication-related burden and HR-QOL (R= -0.431, p-value < 0.05), indicating higher medication-related burden is associated with poorer quality of life. Additionally, a positive relationship between medication-related burden and non-adherence (R= 0.61, p-value < 0.05) indicates that higher medication-related burden is associated with higher non-adherence. Conclusion: This study reveals significant insights about the HR-QOL, medication burden, and adherence of HD patients in the West Bank. The study shows that among HD patients, medication burden significantly lowers HR-QOL and increases medication non-adherence. The findings highlight the importance of addressing medication burden as a component of comprehensive treatment to improve patients' quality of life and enhance medication adherence among HD patients.
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    Pharmacist perception of pharmaceutical care practice in West Bank : A cross sectional study.
    (Al-Quds University, 2023-05-20) Ali Mohammad Musaitef Ghazawna; علي محمد مصيطف غزاونة
    Objective and Background :Pharmaceutical care is an important aspect of modern pharmacy practice, yet little is known about how pharmacists perceive and implement it in their daily work. This cross-sectional study to examine the perspectives of community pharmacists in Palestine regarding the concept of pharmaceutical care, the frequency of its application, and the obstacles to its application. Methodology: A self-administered survey was conducted among pharmacists working in community pharmacies. The survey assessed describe the community pharmacists’ expectation to provide pharmaceutical care practice. A total of 310 pharmacists completed the survey. Pharmaceutical Care Intention scale was used to assess Pharmacuetical care expectation among community pharmacists. Results: The result of our study indicated that the most Drug Related Problems reported by the participant pharmacists were adverse drug reactions (46.0%), followed by dose related problem (44.0%), need for additional drugs for untreated conditions (33.0%), and patients did not receive the drug (26.0%). One third of the pharmacist expect to “Ask patient information about their medications, diseases and medical history” in 40-60 % of the patients. More than half of the respondents (53%) “Discuss the appropriate use, side effects of drugs to prevent potential drug-related problems” in 60-100% of their patients. Comparatively, the pharmacists directly contact the primary physician to solve drug related problems and monitor patients’ outcomes in only 0-20% and 20-40% of the patients.In terms of the variable perceived moral obligation , the pharmacist felt very responsible to identify any potential drug related problems and prevent it (mean= 4.0±1.14) and intervene to solve any exist drug related problem (mean= 3.9 ±1.28). To a less extent pharmacist felt responsible to collect patient-specific information (mean= 3.1 ±1.1). For subjective norm, pharmacists were somewhat more likely to agree that physicians and other healthcare would approve of them providing pharmaceutical care services. However, 30 % still agreed that patients would approve of them providing pharmaceutical care services. Fewer respondents agreed that other pharmacists they knew how to provide pharmaceutical care services to their patients. In terms of attitude, the respondents tended to agree that providing pharmaceutical care services was very likely for the pharmacist to attract more patients to their pharmacy (4.15 ±1.06), it would be a significant benefit to patients’ health outcomes (4.40 ±0.84) and it was a valuable opportunity for profession to contribute to the community, even if this increased their workload (3.97 ±1.12). They were less likely to agree that patient’s appreciation of the pharmacist’s value (3.87± 1.43). The multivariate analysis found only the constructs of attitude (β = 0.399, P = 0.001), and perceived behavioral control (β = 0.410, P = 0.001) to be significant predictors of pharmacists’ intention to provide pharmaceutical care. Education level was the only demographic variable that was found to be significant predictors of pharmacists’ intention to provide pharmaceutical care (β = 0.812, P = 0.032). None of the other demographic or practice setting variables was significant at P < 0.05. The adjusted R2 value was equal to 0.684, which means that 68.4% of the variation in intent was explained by the independent variables. Conclusion: The respondents showed a moderate intention to practice pharmaceutical care. However, some barriers to the implementation of pharmaceutical care were identified, including lack of time, workload, and lack of space. The findings suggest that there is a need for more education and training for pharmacists to enhance their knowledge and skills in providing pharmaceutical care. :
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    Salicylhydroxamic acid based azo dyes, synthesis, characterization, and properties
    (Al-Quds University, 2023-06-13) Hala Ramzi Mohammad Alsheibat; هالة رمزي محمد الشعيبات
    The synthesis and characterization of a novel azo dye derived from naphthionic acid and salicylhydroxamic acid are presented in this research. The synthesis process involves the diazo coupling reaction between naphthionic acid and salicylhydroxamic acid, forming the azo dye. The chemical structure and purity of the synthesized dye are confirmed using various characterization techniques, including ultraviolet visible spectroscopy (UV-Vis), infrared spectroscopy (IR), nuclear magnetic resonance (NMR), and high-performance liquid chromatography (HPLC). The properties of the newly synthesized azo dye, such as color, solubility, reactivity, and antimicrobial activity are thoroughly investigated. The dye exhibits a unique color profile and solubility in polar solvents. The reactivity of the dye allows for potential modifications and derivatizations to enhance its versatility. This research provides valuable insights into the synthesis, characterization, and properties of the novel azo dye, offering prospects for its utilization in various applications. The main result showed that the azo dye had an antifungal activity but three types of bacteria, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa were resistant to the dye. Also, from the calculations, the pka was 3.9and the dye could be used as a chemical indicator.In addition, the prepared dye was investigated as an acid-base indicator for its effect in titrimetric analysis using acid-base titration techniques. In basic media, the color changed from pink to orange. The dye acted as an active acid-base indicator, and the color change occurred in the pH range (5-8).
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    Synthesis, Characterization, and Evaluation of Potentially Useful Quinine Prodrugs
    (Al-Quds university, 2022-08-17) T asneem Mohammad Mahmoud Abudayyah; تسنيم محمد محمود أبودية
    Abstract A prodrug is an active drug that has been disguised and is intended to be activated through an enzymatic or chemical reaction in the body as a pharmacologically inactive component that then goes through biotransformation to become its therapeutic activity. The prodrug method has also been utilized to improve the medications' target-specific selectivity. The prodrug can get past obstacles like low bioavailability, poor aqueous solubility, chemical instability, insufficient oral absorption, quick pre-systemic metabolism, insufficient brain penetration, toxicity, unpleasant taste and odor, local irritation, and change the physical form of the drug by chemically altering the active agent. Quinine is a drug with a strong bitter taste that has a negative effect on its acceptance by patients, whether for the treatment of malaria or muscle spasms and others. In this study, we aimed to mask the intensely bitter taste of quinine by synthesizing prodrugs with suitable linkers that can release the parent drug (quinine) when exposed to a physiological environment. The prodrugs were synthesized by esterification of their free hydroxyl groups using different linkers (1, 2-cyclohexanedicarboxylic anhydride, succinic anhydride, maleic anhydride) instructions through (HPLC, Melting Point, LC- MS, FT-IR, H-NMR) to check the purity of the manufactured compounds. In vitro kinetic studies for the prodrugs were tested and analyzed in the laboratory using the HPLC apparatus at a constant temperature of 37 o C and various pHs such as 0.1 N HCl, pH 2.2, pH 5.5, and pH 7.4, which are similar to the pH of the human body. Unfortunately, the results of the hydrolyzing of the prodrugs at all pH levels were stable and did not release the parent drug (Quinine). This could be a result of the quinine anion's (R-O-) poor leaving group properties. The ester link could be broken by blood enzymes such esterase to furnish the parent drug in the near future. تصنيع ودراسة مواصفات طلائع الأدوية لمركب الكواينين والتي يمكن أن تكون مفيدة. إعداد: تسنيم محمد محمود أبودية إشراف: أ.د.رفيق قرمان الملخص: الكواينين: دواء ذو طعم مر قوي يؤثر تأثير سلبي في تقبل المرضى له سواء لعلاج الملاريا او التشنج العضلي وغيره . هدفنا في هذه الدراسة هو اخفاء الطعم المر لدواء الكواينين وتحويله الى دواء طالع (prodrug) بلا طعم مر ومقبول لدى المرضى وذلك بإستخدام روابط أو مركبات مختلفة ترتبط عليه. تم تصنيع طلائع الأدوية هذه او prodrug عن طريق ربط بعض الاحماض الانهيدرتية (1,2 - cyclohexanedicarboxylic anhydride, succinic anhydride, maleic anhydride) ,وذلك للحصول على طلائع الأدوية وتم دراسة مواصفات هذه الادوية المساعدة المقترحة عن طريق (melting point HPLC, LC-MS, FT-IR,H-NMR,) للتأكد من نقائها. وتم كذلك اختبار وتحلل طلائع الأدوية هذه (prodrugs) داخل المختبر ودراسة تحويلها الى الدواء الاصلي دون اي انزيمات بإستخدام جهاز الHPLC على درجة حرارة ثابتة 37oCودرجات الحموضة المختلفة مثل0.1 N HCl ,pH 2.2, pH 5.5 pH 7.4 التي تطابق درجات الحموضة في جسم الانسان. وكانت نتائج التحلل لطلائع الأدوية هذه للأسف في جميع الدراسات على درجات الحموضة ثابتة ومستقرة ولم تتحلل و تتحول الى الدواء الاصلي.
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    Synthesis, Characterization, and In Vitro Conversion Kinetics of Novel Atorvastatin Prodrugs
    (Al-Quds University, 2022-12-20) Buthaina Amjad Taleb Al-Jubeh; بثينة أمجد طالب الجعبة
    Hypercholesterolemia is a risk factor for the development of atherosclerotic disease. Atorvastatin is a mainstay in the prevention and treatment of hypercholesterolemia and atherosclerotic cardiovascular disease. Atorvastatin efficiently lowers increased plasma cholesterol by inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. Due to significant presystemic metabolism, atorvastatin has low oral bioavailability (14 %). By transiently modifying the structure of a substance via prodrug synthesis, low bioavailability, and other pharmacokinetic and/or physicochemical disadvantages, can be resolved. The synthesis of novel atorvastatin prodrugs as possible candidates for atorvastatin delivery with improved bioavailability and fewer side effects is described in this thesis. Based on Bruice's enzyme model of intramolecular reactions, three atorvastatin prodrugs were synthesized in high yield by conjugating dicarboxylic anhydride linkers (maleic anhydride, succinic anhydride, and phthalic anhydride) to the hydroxyl groups of atorvastatin; in order to create prodrug systems with intramolecular hydrolysis ability. The prodrugs are expected to have greater bioavailability, because they hide the metabolically labile functional groups, and increased water solubility. Melting point, FT-IR, LC-MS, and 1H-NMR analyses were used to confirm the identity of the produced prodrugs. The intramolecular hydrolysis of the three prodrugs in different media was studied in vitro and found to have varying conversion rates or no conversion. The prodrug containing the maleate linker (proD1) was completely hydrolyzed in 0.1N acid solution, pH 3 buffer, and human plasma, at half-lives of 102 hours, 161 hours, and 198 hours, respectively. The succinate-linked prodrug (proD2) was degraded in acidic medium exclusively (pH 3) and had a half-life of 216 hours. The pH of the medium influenced prodrug intraconversion, which was quicker in acidic conditions. Furthermore, prodrug intraconversion was dependent on the structural characteristics of the connected prodrug linker, iii and the intramolecular reaction was achieved in a strained prodrug system with a favorable proximity orientation.
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    Synthesis, in vitro and Biophysical Studies of Novel Fluorescent Platinum(IV) Prodrug Derivatives and their Delivery by Fusogenic Liposomes as Nano-carriers into Cancer Cells
    (Al-Quds University, 2022-08-17) Zeinab Khalid Mohammad Breijyeh; زينب خالد محمد بريجية
    In spite the wide spread of treatment for cancer, patients still suffer from serious side effects. Platinum(II) complexes such as Cisplatin, Oxaliplatin and Carboplatin are used to treat several types of cancer but due to general toxicity and intrinsic/acquired chemo-resistance their therapeutic application is restricted. On the other hand, Platinum(IV) prodrugs with two additional axial ligands, are more stable inert form of Pt(II) compound with less side effects and have the ability to deliver Pt(II) to cancer cell by introducing targeted or lipophilic ligand to the axial position. Few platinum(IV) complexes have advanced to clinical trials, therefore, several mechanisms such as fluorescent imaging and others have been used to understand Pt(IV) mechanism of action intracellularly by the conjugation of lipophilic fluorophore to the axial ligand of platinum compounds. In this project a series of fluorescent labeled platinum(IV) prodrugs were synthesized and characterized. Platinum(IV) complexes was conjugated to high lipophilic fluorescent long chain carboxylate ligandsat the axial hydroxide ligand via a cleavable ester linkage to produce a fluorescent labelled platinum(IV) prodrugs.Fluorescent lipophilic amino acid derivatives and platinum(IV) prodrugs were characterized by melting point, fourier transform infrared spectroscopy, proton and carbon nuclear magnetic resonance spectroscopy, Ultra-performance liquid chromatography, electrospray ionization mass spectrometry (ESI-MS) analytical techniques. Stability study for fluorescent platinum(IV) prodrugs were investigated using Ultra-performance liquid chromatography (UPLC) at constant temperature (37°C) using 7.4 pH bufferto resemble pH of blood. على الرغم من الانتشار الواسع لعلاج السرطان، لا يزال المرضى يعانون من آثار جانبية خطيرة. يتم استخداممركبات الجيل الثانيمن البلاتينمثل سيسبلاتين وأوكساليبلاتين وكاربوبلاتين لعلاج عدة أنواع من السرطان ولكن بسبب السمية العامة والمقاومة الكيميائية الجوهرية/المكتسبة، يتم تقييد تطبيقها العلاجي. من ناحية أخرى، فإن الجيل الرابع من مركبات البلاتين ذات الروابط المحورية الإضافية، هي عبارة عن شكل خامل أكثر استقرارًا من مركبات الجيل الثانيمع آثار جانبية أقل ولديها القدرة على تسليمالشكل الفعال وهو الجيل الثاني إلى الخلايا السرطانية عن طريق ربط مركبات دهنية او مركبات تستهدف الخلايا السرطانية إلى الروابط المحورية. تقدم عدد قليل من المركبات البلاتينيةالجيل الرابع إلى التجارب السريرية، لذلك، يجب استخدام العديد من الآليات مثل التصوير الفلوري وغيرها لفهم آليةعملها داخل الخلية وذلك عن طريق اقتران مركبات مضيئةدهنية إلى الروابط المحورية الجديدة. في هذا المشروع، تم تصنيع سلسلة من طلائعالمركبات البلاتينية المضيئة حيث تم ربط المركبات البلاتينية باحماض أمينيةدهنية مضيئة طويلة. تم تشخيص طلائع الأحماض الأمينية الدهنية المضيئةعن طريق، نقطة الانصهار،التحليل الطيفي للأشعة تحت الحمراء، والرنين المغناطيسي النووي، وكروماتوجرافيا سائلة فائقة الأداء، وتقنياتقياس الطيف الكتلي للتأين بالرش الكهربائيللتأكد من المركبات المصنعة. وتم دراسةهذه الطلائع داخل المختبر باستخدام كروماتوجرافيا سائلة فائقة الأداءعلى درجة حرارة ثابتة(37 درجة مئوية) ودرجة حموضة7.4 مشابهة لدرجة حموضة الدم.
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    التركيب الكيميائي والخصائص والقوى المحركة المخبرية لدوائيْن أوليّيْن جديديْن مبتكريْن من مضادات البكتيريا؛ الأموكسيلين والسيفالكسين
    (AL-Quds University, 2014-02-22) غدير عبد مطر دقماق; GHADEER ABED MATAR DOKMAK; رفيق قرمان; د. أحمد عمرو; Nasr Shraim
    Marketed antibacterial drugs suffer several problems, such as bitter taste and low stability which lead to patient incompliance. Prodrug technology for solving such problems is extremely exciting. Based on previously reported density functional theory calculations, amoxicillin ProD 1-2 and cephalexin ProD 1-2 were designed and synthesized. For the intraconversion of both antibacterial prodrugs the kobs and t1/2 values in different media were calculated from the linear regression equation obtained from the correlation of log concentration of the residual prodrug versus time. At constant temperature and pH the hydrolysis reaction for the above mentioned prodrugs displayed strict first order kinetics as the kobs was quite constant and a straight line was obtained. Kinetic studies in 1N HCl, pH 2.5 and pH 5 were selected to examine the intraconversion of both prodrugs to their parent drugs. The acid-catalyzed hydrolysis of the prodrugs was found to be much higher in 1N HCl than in pH 2.5 and pH 5. The experimental t1/2 values of amoxicillin ProD 1 in 1N HCl, pH 2.5 and pH 5 were 2.5, 7 and 81 hours respectively and for cephalexin ProD 1 in 1 N HCl and pH 2.5 were 2 and 14 hours respectively. In contrast, t1/2 values of amoxicillin ProD 2 in 1N HCl and pH 2.5 were 8 and 44 hours respectively and for cephalexin ProD 2 in 1 N HCl was 6 hours. On the other hand, at pH 7.4, the four prodrugs were quite stable and no release of the parent drugs was observed. At pH 5 the hydrolysis of the prodrugs was too slow. The four antibacterial prodrugs were found to be bitterless. The bitter taste masking by the prodrugs is believed to be via altering the ability of the drug to interact with bitter taste receptors.
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    السلوك القيادي للمديرين وعلاقته بالنمو المهني للمعلمين من وجهة نظر معلمي المدارس الحكومية في محافظة الخليل
    (AL-Quds University, 2013-06-26) هناء سعيد سليم شاهين; hana said saleem shaheen; محمد شعيبات; د. محمد عابدين; د. أحمد فتيحة
    This study aimed at identifying the degree of principals’ leadership behavior and its relationship to teachers' professional development at governmental schools from the point of view of teachers at Hebron governorate during the academic year 2012-2013. The population of the study consisted of all teachers in Hebron (7962); a stratified random sample of 5% was chosen (399). However, statistical analysis was applied on 381 teachers. To achieve the objectives of the study, a questionnaire consisted of (33) items was developed to measure the principals’ leadership behavior distributed on three domains namely: administrative, technical and humanitarian. Another questionnaire consisted of (29) items was developed to measure professional development of teachers distributed on three domains: methods of teaching, evaluation and scientific materials. Validity and reliability of the study were verified by appropriate statistical methods. The results revealed that the estimates of teachers about the degree of the principals’ leadership behavior is medium at a mean of (3.56) and of a standard deviation (0.511). The administrative domain was the highest while the humanitarian was the lowest, and there were no significant statistical differences due to the variables of gender and experience while there were significant statistical differences due to the variable of qualification in the domains of administrative and technical in favor of teachers holding a degree of less than BA and directorate in favor of the north Hebron. Also it revealed that the estimates of teachers about the degree of professional development for teachers in government schools, came with a high degree a mean of 3.87 and a standard deviation of 0.80, and there were no significant statistical differences due to the variable of gender and qualification and experience, while there were differences due to the variable of directorate in the domain of scientific material in favor of the north Hebron. There was a weak positive correlation-i.e., Berson correlation coefficient (0.20) -between the variables of principals’ leadership behavior and the degree of their professional development. the researcher recommend that setting up criteria for choosing principals based on their leadership characteristics, and the necessity of continuing the process of development forteacher, especially in the field of teacher Evaluation by doing training courses for teachers and the school principal together.
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    الفعالية المضادة للكائنات الدقيقه لدوائيْن أوليّيْن جديديْن مبتكريْن من مضادات البكتيريا؛ الأموكسيلين والسيفالكسين
    (AL-Quds University, 2015-06-02) ساميه صلاح الدين عبد الغني كرد; samia salahaldeen abdalgani kord; رفيق قرمان; احمد عمرو; حاتم سلامة
    The two novel prodrugs of amoxicillin and cephalexin were synthesized to improve the stability and bitter taste of their parent drugs. The in vitro susceptibility for both prodrugs was determined against Escherichia coli, staphylococcus epidermidis, staphylococcus aureus, Klebsiella pneumonia, streptococcus group A, streptococcus group B, and compared to that of their parents. The results revealed that both novel prodrugs have antibacterial activity on most bacterial strains with about the same potency as their parent drugs, In addition, Klebsiella pneumonia, and staphylococcus epidermidis showed resistance to both amoxicillin drug and its prodrug. Since klebsiella is gram negative bacteria and staphylococcus epidermidise is beta lactamase positive . It is worth noting that those two novel prodrugs are among a small number of prodrugs that have activity themselves before undergoing conversion via enzymatic or chemical processes to their corresponding parent drugs. The novel prodrugs exhibit their antibacterial activity against different types of bacterial strains due to the presence of beta lactam ring in their structures. In addition, it is expected that the novel two prodrugs will be much more stable in aqueous media than their corresponding parent drugs due to the fact that the sensitive amine group exists in the parent drugs was replaced with a more stable group, amide.
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    القوة العاملة الفلسطينية في الصيدلية :الممارسة والرضا الوظيفي والاتجاهات نحو دورهم كمختصين في الرعاية الصحية
    (AL-Quds University, 2018-05-05) جوناء غسان عبد العزيز سرحان; Jawna Ghassan Abdul Aziz Sirhan; ماهر خضور; Hussein Hallak; Samah Jabi