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Factors affecting balance and fall risk among elderly people over 60 years in Hebron, Palestine: A Cross–Sectional Study
(Al-Quds Univeersity, 2025-12-15) Safa Arafat Essa Al-Batsh; صفاء عرفات عيسى البطش
Background: Falls among older people pose a serious health issue and have been associated with injuries, disability, and loss of quality of life. It is necessary to have a comprehensive outlook on factors influencing physical, cognitive, psychological, and social domains associated with balance and risk of falls. Objective: To explore factors that affect balance and risk of falls among older adults, above 60 years, living within the community of Hebron, Palestine. Methods: A total of 323 participants were given demographic questionnaires and physically and cognitively assessed with balance measures (Berg Balance Scale [BBS], Timed Up and Go Test [TUG], Single Leg Stance [SLS]) and cognitive function measurement tools (Mini-Mental State Examination), as well as psychosocial tools (Fear of Falling Scale, community participation, and domains of quality of life). Correlation and regression analyses were conducted. Results: The average age was 67.8 ± 6.54 years, and females accounted for 56% of the sample. Balance risk testing showed 64.4%, 20.7%, and 14.9% were at low, medium, and high risk for falls, respectively. A significant association with low balance performance existed for cognitive impairment, assistive device use, physical inactivity, difficulty walking on uneven ground, and loss of functional independence (p < 0.001). The Berg Balance Scale (BBS) predicted fall risk better than any other measure and influenced social participation and falls concern but not overall life satisfaction and fear of falls on the Falls Efficacy Scale-International (FES-I). Regression analysis pointed to physical and cognitive variables, such as problems with memory and assistive device use, as vital determinants of balance. Functional change as measured by Fisher Score significantly predicted balance. Conclusion: Balance among older people requires consideration of physical, cognitive, and functional variables. Strategies that focus on enhancing physical activity levels, cognitive functions, usage of assistive devices, addressing sensory impairments, and encouraging independence with activities of daily living should be promoted among elderly populations within the city of Hebron.
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Establishment of Vitamin D Reference Values in the Palestinian Society And Investigation of Cultural, Behavioral, and Socioeconomic Effects
(Al-Quds Univeersity, 2022-08-21) Mohammed Ibrahim Issa Al-mahariq; محمد ابراهيم عيسى المحاريق
This thesis documents several key contributions made to the vitamin D field. Vitamin D is recognized as a sunshine vitamin with regular sun exposure conditions. Unsurprisingly, vitamin D dietary intake is considered of minor importance in science. However, sun exposure reveals about 90% of vitamin D. In the last decade, vitamin D testing and the use of vitamin D supplements have increased significantly with neither clear nor agreement on blood level recommendation of vitamin D in healthy individuals. The recommended sufficient level of serum vitamin D is ≥30 ng/mL (≥75 nmol/L). In contrast, vitamin D deficiency is defined as 25(OH)D levels ≤ 20 ng/ml (≤ 50 nmol/L), and the serum level between 20 and 30 ng/ml (50-75 nmol/L) indicates insufficiency. The main objective of this study is to establish a population-based reference range of vitamin D in Palestinian society and investigate its associated cultural, socioeconomic, and human behavioural factors. We adopted a cross-sectional study that was conducted on 300 healthy Palestinian individuals from different cities and villages in the West Bank. Those individuals did not report a history of kidney, liver, or malabsorption disorders. The sample consisted of 123 males and 177 female adults aged between 19 and 65 years old. We used a structured questionnaire to obtain demographic and socioeconomic data, and information about health status and risk factors related to vitamin D insufficiency. Moreover, serum 25(OH)D was measured by the Abbott chemiluminescence immunoassay analyzer (ARCHITECT i1000SR) to establish and provide reference values. The mean 25(OH)D serum level was 13.4 ng/ml (5th; 95th percentile, 12.34; 14.5). Notably, 92% of the studied sample had 25(OH)D serum levels below 30 ng/mL, 79.3% below 20 ng/mL and 61% below 12 ng/ml. The younger group (18-28) years of age was reported to have a significantly lower serum 25(OH)D level compared to the other three different age groups (29-40),(41-50),(51-65) years old. Our results also showed that serum 25(OH)D level was not significantly associated with gender, obesity (BMI), sun cream use, sun exposure, and wearing a hijab (head cover). However, no significant differences of serum 25(OH)D level were reported among individuals consuming cheese, yoghurt, egg, fish, milk, bread, and nuts meals intake. In conclusion, according to the lack of correlated evidence of major skeletal and non-skeletal disease conditions with vitamin D levels that are recommended as optimal (≥20 ng/mL, or even ≥30 ng/mL), and in light of our study to establish vitamin D reference level in healthy adults, we recommend to consider levels below 20ng/ml and close to 14 ng/ml as sufficient serum 25(OH)D level for the general population in the West Bank society. However, our study sample is limited with the small number of participants, hence further investigation and research are needed to establish more comprehensive and inclusive conclusions regarding reference levels and related factors.
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Enhanced solubility and dissolution profile of Poorly Water-Soluble Clotrimazole by Recrystallization/Cocrystallization methods
(Al-Quds Univeersity, 2026-01-10) Ola Adel Mustafa Abu Jamal; علا عادل مصطفى ابو جمال
Introduction: Clotrimazole is a widely used antifungal agent classified as a Bio pharmaceutics Classification System (BCS) class II drug, characterized by poor aqueous solubility and consequently limited oral bioavailability. These physicochemical limitations restrict its potential for systemic administration despite its favourable therapeutic profile. The present study aims to enhance the solubility and dissolution behaviour of clotrimazole through solid-state modification using recrystallization and Cocrystallization techniques. Methodology and results: Recrystallization was carried out using different organic solvents in an attempt to induce polymorphic transformation and improve solubility. However, the obtained recrystallized forms did not exhibit significant changes in melting point or aqueous solubility compared to the pure drug, and therefore this approach was deemed ineffective. In contrast, Cocrystallization was performed using various pharmaceutically acceptable co-formers, including Fumaric acid, polyvinyl pyrrolidone, polyvinyl alcohol and Carbomer 940 , employing a mechanical grinding method with different solvents and molar ratios. The prepared cocrystals were characterized using Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetrey (DSC), and melting point analysis to confirm cocrystal formation and investigate intermolecular interactions. Solubility studies were conducted using HPLC analysis. Several cocrystal formulations demonstrated reduced melting points and significantly enhanced aqueous solubility compared to pure clotrimazole, indicating successful modification of the solid-state properties. In conclusion: The findings of this study demonstrate that Cocrystallization is an effective and promising strategy for overcoming the solubility limitations of clotrimazole, whereas recrystallization showed no significant benefit. The improved Solubility and dissolution behaviour observed for selected cocrystals highlight their Potential for the development of oral dosage forms with enhanced bioavailability and improved therapeutic performance.
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Enhanced solubility and dissolution profile of Poorly Water-Soluble Clotrimazole by Recrystallization/Cocrystallization methods
(Al-Quds Univeersity, 2026-01-10) Ola Adel Mustafa Abu Jamal; علا عادل مصطفى ابو جمال
Abstract Introduction: Clotrimazole is a widely used antifungal agent classified as a Bio pharmaceutics Classification System (BCS) class II drug, characterized by poor aqueous solubility and consequently limited oral bioavailability. These physicochemical limitations restrict its potential for systemic administration despite its favourable therapeutic profile. The present study aims to enhance the solubility and dissolution behaviour of clotrimazole through solid-state modification using recrystallization and Cocrystallization techniques. Methodology and results: Recrystallization was carried out using different organic solvents in an attempt to induce polymorphic transformation and improve solubility. However, the obtained recrystallized forms did not exhibit significant changes in melting point or aqueous solubility compared to the pure drug, and therefore this approach was deemed ineffective. In contrast, Cocrystallization was performed using various pharmaceutically acceptable co-formers, including Fumaric acid, polyvinyl pyrrolidone, polyvinyl alcohol and Carbomer 940 , employing a mechanical grinding method with different solvents and molar ratios. The prepared cocrystals were characterized using Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetrey (DSC), and melting point analysis to confirm cocrystal formation and investigate intermolecular interactions. Solubility studies were conducted using HPLC analysis. Several cocrystal formulations demonstrated reduced melting points and significantly enhanced aqueous solubility compared to pure clotrimazole, indicating successful modification of the solid-state properties. In conclusion: The findings of this study demonstrate that Cocrystallization is an effective and promising strategy for overcoming the solubility limitations of clotrimazole, whereas recrystallization showed no significant benefit. The improved Solubility and dissolution behaviour observed for selected cocrystals highlight their Potential for the development of oral dosage forms with enhanced bioavailability and improved therapeutic performance.
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Investigation of Enalapril Maleate Hydrolysis Kinetics in Extemporaneous Solution Using Infrared Spectroscopy (FTIR)
(Al-Quds Univeersity, 2026-01-14) Aya Ameen Ali Halabiya; آية أمين علي حلبية
This study investigates the hydrolytic stability and degradation kinetics of enalapril maleate in extemporaneous oral liquid formulations, focusing on the stabilizing effect of propylene glycol and the application of Fourier Transform Infrared Spectroscopy (FTIR) as a rapid analytical tool. Enalapril maleate, a commonly used ACE inhibitor, demonstrates chemical instability in aqueous media, resulting in rapid hydrolysis to enalaprilat and, under specific conditions, cyclization to diketopiperazine (DKP). Calibration curves indicated excellent linearity for both FTIR (R² > 0.99) and HPLC (R² > 0.999). Under alkaline conditions (0.1 M NaOH), water based solutions degraded within 60 minutes. In contrast, the presence of 10% propylene glycol allowed for the detection of the enalapril maleate peak signal, with approximately 103% recovery by HPLC at the 60-minute mark. Homogeneity testing revealed significant stratification in water based suspensions, where the upper layer lacked detectable drug (0%), while the lower layer contained approximately 12.5% (FTIR), with HPLC confirming variability (upper 84.64%, central 109.03%, lower 129.5%). In contrast, PG-based suspensions, and PG + syrup formulations demonstrated uniform concentrations, even when samples were obtained exclusively from the upper layer, the practical site of dose withdrawal for patients. FTIR indicated approximately 100% drug content for PG (upper: 100%, lower: 101.7%), while HPLC confirmed nearly complete uniformity (upper PG: ~98.9%; upper PG + syrup: ~95.5%). This indicates that propylene glycol ensures dose consistency at the clinically relevant point of administration, unlike water based systems that risk sub-therapeutic dosing. FTIR effectively monitored the disappearance of the ester carbonyl band at 1741 cm⁻¹, yielding degradation profiles consistent with HPLC results. This validates FTIR as a rapid, cost-effective screening method, while HPLC remains the confirmatory reference method. In conclusion, this research demonstrates that enalapril maleate is physiochemically unstable in aqueous extemporaneous formulations. Propylene glycol significantly enhances stability and ensures homogeneity, establishing it as a practical stabilizer. The validated application of FTIR in conjunction with HPLC provides a robust analytical framework for improving the safety, efficacy, and reliability of extemporaneous enalapril suspensions.