http://blogs.najah.edu/author/092942021 An-Najah Blogs :: Publications of Waleed M. Sweileh, en-us Sat, 27 Apr 2024 04:01:13 IDT Sat, 27 Apr 2024 04:01:13 IDT [email protected] [email protected] http://blogs.najah.edu/staff/092942021/article/Pain-Medications-in-Palestinian-Households-Safety-and-Wastage-Analysis-Published ArticlesBackground and Objective: Inappropriate use and storage of pain medications may cause unnecessary wastage and potential harm The objective of this study was to investigate the extent of storage wastage and potential harm of pain medications stored in households in Nablus district Palestine Methodology: This is a cross sectional anonymous questionnaire-based study The drug product inventory in the surveyed households was investigated and family members were interviewed Data were coded entered and analyzed using statistical package for social sciences software SPSS 16 Results: A total of 415 households in Nablus district Palestine were surveyed The total number of medications in the surveyed households was 5505; the mean SD was 133 78 The total number of pain medications stored was 1103 constituting 20 of the stored medications The average number of pain medications was 27 18 per household Pain medication storage was not associated with most of the tested demographic variables More than one third 397 of pain medications were stored in relatively unsafe places around the house within the reach of children The percentages of unused pain medications expired and those with no clear expiration date were 20 149 and 129 respectively Estimated pain medication wastage in the 415 households and in the whole Nablus district was 4000 USD and 384000 USD respectively The most common pain medications encountered in households were: acetaminophen 42 ibuprofen 24 and diclofenac 18 Conclusion: Pain medications were frequently encountered in Palestinian households and relatively large percentage was being wasted Keeping a limited stock of pain medication may avoid overuse of more expensive health services and might thus be cost-saving as well http://blogs.najah.edu/staff/092942021/article/Knowledge-and-practices-of-pesticide-use-among-farm-workers-in-the-West-Bank-Palestine-safety-implicationsPublished Articles Objectives The objectives of this study were to assess the knowledge and practices associated with pesticide use in an agricultural community in Palestine and to determine the prevalence of self-reported health symptoms related to pesticide exposure Methods In this cross-sectional questionnaire study agricultural farm workers in Nablus district Palestine were interviewed on their knowledge and practices of pesticide use Comparisons of knowledge and practices of pesticide use between various groups were performed using the MannWhitney U-test or the KruskalWallis rank test of variance The program of the Statistical Package for Social Sciences SPSS version 15 was used for data analysis Results The questionnaire was completed by 381 farm workers The mean age SD of the participants was 388 118 years The majority 979 of the participants were male The mean participant scores for knowledge and safety procedures were 28 32 out of 8 and 98 24 out of 15 respectively There was a significant positive correlation r = 0323; P 0001 between the knowledge and safety procedure scores Unsafe behaviors were identified as the storage of pesticide products at home the preparation of pesticides in the kitchen inadequate disposal of empty pesticide containers eating and drinking during pesticide application and using inadequate protective clothing The most frequent self-reported toxicity symptoms associated with pesticide use were skin rash 375 headache 37 excessive sweating 249 and diarrhea 213 There was a strong significant negative correlation r = 083; P 0001 between self-reported toxicity symptoms and scores for protective measures Conclusion The results of this study indicate that most farm workers in this district need more educational programs regarding the safety and use of pesticides Legislation promoting the use of safer pesticides is also needed http://blogs.najah.edu/staff/092942021/article/Epidemiological-clinical-and-pharmacological-aspects-of-headache-in-a-university-undergraduate-population-in-PalestinePublished Articles Headache is one of the most common complaints in clinical practice Few studies regarding headache in university students have been conducted in the Middle East The objective of this study was to explore the prevalence clinical characteristics triggering factors and treatment options of headaches in university undergraduate students in Palestine Middle East Data were collected by interviewing a sample of 1900 students The Headache Assessment Quiz was used to measure quality and severity of headache and to collect data on triggering factors and symptom management A total of 1808 952 reported having at least one headache episode in the previous year A positive family history of headache was found in 40 of students The prevalence rate of frequent headache two or more episodesmonth was found in 1096 609 students; 613 women 559 Of those having frequent headaches 228 208 experienced moderate to severe episodes 341 312 had pulsating throbbing and pounding pain and 274 25 had unilateral pain The most common triggering factors among students with frequent headaches were: tensionstress 782 and sleep deprivation 754 Less than 5 of students sought medical assistance during headache episodes Most students 791 reported self-therapy with a single analgesic 534 herbs 102 or combination 155 while 209 reported using no medication of any type to decrease pain Paracetamol 485 followed by ibuprofen 49 were the most commonly used non-prescription analgesic drugs Headache is a prevalent symptom in the college age population Further research is needed to determine the prevalence of specific types of headaches Healthcare providers are required to educate this population as well as to assist students in properly diagnosing and treating headache types http://blogs.najah.edu/staff/092942021/article/Storage-utilization-and-cost-of-drug-products-in-Palestinian-householdsPublished ArticlesInt J Clin Pharmacol Ther 2010 Jan;481:59-67 Storage utilization and cost of drug products in Palestinian households Sweileh WM Sawalha AF Zyoud SH Al-Jabi SW Bani Shamseh FF Khalaf HS; 1College of Pharmacy and 2Poison Control and Drug Information Center PCDIC An-Najah National University Nablus Palestine Background and objective: Appropriate storage and use of medications in households may decrease drug wastage and unnecessary hazard The objective of this study was to investigate storage utilization habits and cost of medications in households in Palestine Methods: This is a cross sectional anonymous questionnaire-based study of 465 households in northern Palestine The drug product inventory in the surveyed households was investigated and family members were interviewed Results: A total of 465 households were assessed 50 were excluded The total number of drug products in the 415 households was 5505; the mean - SD was 133 - 78 Level of father\s education presence of chronic disease and insurance coverage were the variables that showed a significant relationship with the amount of drug products found in the households Most of the drug products 434 were stored in relatively unsafe places in the house within the reach of children Approximately one third 325 of the drug products were not in their original container The percentages of unused drug products expired or those with no clear expiry date were 327 177 and 11 respectively Estimated drug wastage in the 415 households and nationwide would be 16100 and 19 million USD respectively The most common drug categories encountered in households were alimentary musculoskeletal and anti-infective agents The most common individual drugs encountered were: paracetamol 85 ibuprofen 49 and diclofenac 37 Conclusion: Medications were stored in large quantities in Palestinian households and a large percentage was being wasted Drug-use assessments and a comprehensive evaluation of the current national drug policies are warranted to curtail this problem http://blogs.najah.edu/staff/092942021/article/Time-Course-Analysis-of-Aminoglycoside-Induced-Elevation-of-Serum-CreatininePublished ArticlesObjective: The present study aimed to determine the time course of aminoglycoside-induced serum creatinine SCr elevation and compare that in patients treated with amikacin AK and those treated with gentamicin GM Methodology: A one-year non-interventional prospective study of patients with normal baseline renal function and were administered either GM or AK The study was carried out at the internal medicine department of Al-Watani governmental hospital Outcome of interest was the time course of serum creatinine elevation during the course of aminoglycoside therapy Data were entered and analyzed using Statistical Package for Social Sciences SPSS 16 Results: The study was performed in 94 patients who had to be administered GM or AK by intravenous injections In both groups the significant rise in SCr was detected on the 4th day of therapy However GM induced up to 32 increase while AK induced up to 195 increase in SCr from baseline levels In the course of AK treatment patients on single dosing frequency and those 65 years of age did not show a significant increase in SCr levels during the 6-day therapy In the course of GM therapy patients on single frequency dosing younger patients and females showed a significant elevation in SCr on the 5th day while elderly males and those on multiple dosing showed a significant elevation on the 4th day of therapy However all patient categories on GM therapy showed similar extent of SCr elevation Conclusion: In patients with normal renal function GM and AK showed similar time course but different extent of SCr elevation Amikacin induced no SCr elevation when given in single dosing frequency or when given to younger patients Such effects were not observed with GMhttp://blogs.najah.edu/staff/092942021/article/Gender-Differences-in-Aminoglycoside-Induced-Nephrotoxicity-A-Prospective-Hospital---Based-StudyPublished ArticlesAim: Impact of gender on aminoglycoside induced nephrotoxicity is still controversial and inconclusive The objective of this study was to investigate the nephrotoxic potential of amikacin AK and gentamicin GM in male and female hospitalized patients Methodology: A one-year non-interventional prospective study of patients administered either GM or AK The study was carried out at the internal medicine department of Al-Watani governmental hospital Nephrotoxicity was defined as a blood creatinine Cr increase of 05 mg dL from the basal normal Cr level Data were entered and analyzed using SPSS 16 Results: A total of 94 patients were identified GM n = 45 and AK n = 49 Male and female patients on GM had comparable characteristics except that males had significantly higher number of co-existing chronic diseases No gender differences were observed in gentamicin induced nephrotoxicity 37 in males versus 333 in females P = 08 Male and female patients on AK were also comparable in demographic and clinical characteristics However significant differences in gender susceptibility were observed with AK induced nephrotoxicity 316 in females versus 67 in males P = 0043 Pattern of serum creatinine changes in patients on GM were comparable between males and females However in females on AK scr levels were rising sharply after the fourth day compared with that in male patients on AK Conclusion: Gender differences in aminoglycoside induced nephrotoxicty were seen with AK where females were more vulnerable to nephrotoxicity Such gender differences did not exist with GMhttp://blogs.najah.edu/staff/092942021/article/Target-blood-pressure-attainment-in-diabetic-hypertensive-patients-need-for-more-diureticsPublished Articles OBJECTIVE: To determine target blood pressure attainment and to evaluate blood pressure control relative to type of therapy among diabetic hypertensive patients METHODOLOGY: An observational retrospective study of all diabetic hypertensive patients visiting Al-Watani governmental medical center from August 01 2006 until August 01 2007 The blood pressure BP measurement made during the patient\s recent visit and documented in the medical files was used in the study Controlled BP values for hypertensive patients with diabetes mellitus were defined per JNC 7 guidelines: 13080 mmHg or lower Proportions of use of 5 different antihypertensive drug classes were compared between patients with controlled and uncontrolled BP RESULTS: Of the 311 patients 79 254 had their BP controlled No significant differences in age gender body weight duration of hypertension or diabetes renal function average number of anti-hypertensive medications and doses of most commonly reported antihypertensive medications were found between controlled and uncontrolled BP groups ACE-IARB was the most commonly used drug class in both groups Overall the use of ACE-IARB beta-blockers calcium channel blockers alpha-blockers and multi drug regimens were also not significantly different between the controlled and uncontrolled groups However overall use of diuretics was significantly higher in controlled group than uncontrolled group 595 versus 457 p 0001 CONCLUSION: Despite the common use of ACE-I ARB as recommended per JNC 7th report the majority of the patients had uncontrolled BP Diuretics is an important drug class in attaining target BP Use of diuretics in combination with ACE-I as well as drug compliance needs to be emphasized and encouraged http://blogs.najah.edu/staff/092942021/article/Predictors-of-ldquoWorsening-Renal-Functionrdquo-in-Patients-Hospitalized-in-Internal-Medicine-DepartmentPublished ArticlesWaleed M Sweileh1 Ansam F Sawalha2 Hanadi M Jayousi1 Saed H Zyoud2 Samah W Al-Jabi1 Accepted for publication on January 2009 Current Drug Safety Bentham UK Aim: The aim of this study was to identify predictors of worsening renal function WRF among hospitalized patients in the internal medicine department Settings and Design: A one-year hospital-based prospective study Methods and Material: This study was carried out at the internal medicine department of Al-Watani governmental hospital Palestine Inclusion criteria were: hospitalization for at least 48 hours and availability of at least three serum creatinine Scr measurements WRF was defined per hospital stay as an elevation in Scr of 05 mgdL from baseline value if baseline Scr value was 3mg dL and 1mgdL if the baseline value was 3mgdL Baseline measurements were made at hospital admission Statistical Analysis: Regression analysis enter method was carried out on two sets of variables: non-medication variables Model I and medication variables Model II Statistics was performed using SPSS version 15 Results: Three hundred and sixty one patients were included in this study The prevalence of WRF among those who met the inclusion criteria was 402 In the majority of cases WRF started within the first 48 hrs of admission Analysis of data indicated that eight variables were significantly associated with WRF: renal dysfunction P 00001 diabetes mellitus P= 0005 hypertension HTN P 00001 congestive heart failure CHF P= 0021 elderly being 65 years P= 0003 number of diagnosis P 0001 furosemide P = 0001 and calcium channel blockers P= 001 administration at admission Regression analysis indicated that HTN P =0033 and renal dysfunction P= 0007 were predictors of WRF in model I while furosemide administration P= 001 was the only predictor of WRF in model II Conclusion: Hypertension renal dysfunction and furosemide administration at hospital admission are predictors of WRF among hospitalized patients Clinical characteristics available at hospital admission can be used to identify patients at increased risk for WRF Patients receiving certain medications especially loop diuretics require close observation for potential development of WRF Key Words: Renal functionSerum creatinine elevation Drugs at admission http://blogs.najah.edu/staff/092942021/article/Patterns-of-Antihypertensive-Therapy-in-Diabetic-Patients-with-and-without-Reduced-Renal-FunctionPublished ArticlesSweileh 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 SJKDT2010 [Publisher: Saudi Center for Organ Transplantation Country where published: Saudi Arabia] In press AbstractBackground: 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 andor 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 408 calcium channel blockers 251 and -blockers 125 The majority 55 of patients were either on mono or no drug therapy Patients on monotherapy were mostly receiving ACEIARB 60 In patients with reduced renal function use of diuretics but not ACEIARB or CCB was higher and 418 of the patients were on monotherapy compared to 466 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 ACEIARB 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 Functionhttp://blogs.najah.edu/staff/092942021/article/Evaluation-of-Antihypertensive-Therapy-in-Diabetic-Hypertensive-PatientsPublished ArticlesSweileh WM Sawalha AF Zyoud SH Al-Jabi SW Tameem EJ Shraim NY Evaluation of Antihypertensive Therapy in Diabetic Hypertensive Patients: Impact of Ischemic Heart Disease Journal of pharmacy practice; 2009 [Publisher: Directory of Open Access Journals Country where published: Spain] Accepted for publication Abstract Background and Objective: Macrovascular complications are common in diabetic hypertensive patients Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication The objective of this study was to evaluate utilization patterns of antihypertensive agents and blood pressure BP control among diabetic hypertensive patients with and without ischemic heart disease IHD Methodology: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007 Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1 2 3 or 4 or more drugs and separately among patients with and without IHD Blo od pressure control 130 80 mmHg was compared for patients receiving no therapy monotherapy or combination therapy and separately among patients with and without IHD Results: 255 patients were included in the study; their mean age was 644 114 years Sixty one 239 of the included patients was on target BP Over 60 of the total patients were receiving angiotensin-converting enzyme inhibitors ACEI angiotensin receptor blocker ARB followed by diuretics 408 calcium channel blockers 251 and -blockers 125 The majority 55 of patients were either on mono or no drug therapy More than 55 of patients with controlled BP were using ACE-I More than half 508 of the patients with controlled BP were on combination therapy while 423 of patients with uncontrolled BP were on combination therapy; P = 024 More patient in the IHD achieved target BP than those in non-IHD group P = 0019 Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines Areas of improvement include increasing ACE-I drug combinations decreasing the number of untreated patients and increasing the proportion of patients with controlled BP in this population Clinical pharmacist can play a role in achieving this Key Words: Hypertension control; Diabetes mellitus; Drug regimens; Prescribing patterns; JNC 7th report http://blogs.najah.edu/staff/092942021/article/Predictors-of-in-Hospital-Mortality-after-Acute-StrokePublished Articles 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 2x:xxx-xxx2009 [Publisher: e-Century Pub Corp Country where published: United States] PublishedAbstractAbstract: 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 15A total of 186 acute stroke cases 95 females and 91 males were included in the study Hypertension 699 and diabetes mellitus 452 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 = 0004 number of post-stroke complications P= 0037 and stroke subtype P = 0015 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 mortalityIJCEM811001 Key Words: Predictors hospital mortality acute stroke gender Links: http:wwwijcemcom811001Ahtml http://blogs.najah.edu/staff/092942021/article/Optimal-dosing-of-angiotensin-converting-enzyme-inhibitors-in-patients-with-chronic-heart-failurePublished ArticlesSweileh WM Sawalha AF Reno Tamara M Zyoud SH Al-Jabi SW Optimal dosing of angiotensin-converting enzyme inhibitors in patients with chronic heart failure: a cross-sectional study in Palestine Submitted to journal of Annals of Saudi Medicine 2008 [Publisher: King Faisal Specialist Hospital and Research Centre Country where published: Saudi Arabia] In pressAbstractBACKGROUND AND OBJECTIVE: Because high-dose angiotensin-converting enzyme ACE inhibitor therapy is desirable in patients with chronic heart failure CHF we sought to determine the usage and dosing patterns of ACE inhibitors in CHF patients at a governmental hospital in Palestine METHODS: This cross-sectional study was conducted between September 2006 and August 2007 All patients admitted with a confirmed diagnosis of CHF and an ejection fraction 40 were evaluated After excluding patients with a cautioncontraindication to ACE inhibitor use or not taking an ACE inhibitor we determined the number of patients receiving optimal captopril = 150 300 mgday; enalpril = 20 40 mgday; ramipril = 5 10 mgday and suboptimal doses We then conducted statistical analyses to evaluate associations between ACE inhibitor use and dosing and various demographic and clinical factors RESULTS: Of the 165 patients initially evaluated 69 418 had cautioncontraindication 28 406 or were not using an ACE inhibitor 41 594 Of the remaining 96 patients 701 4996 51 were given an optimal dose while 4796 49 were given a suboptimal dose Of all patients with CHF and no contraindication 88 642 were either receiving no ACE inhibitor or a suboptimal dose Only the presence of hypertension was significantly associated with the use of an ACE inhibitor P=009 odds ratio=27 The use of an optimal dose was not significantly associated with any of the tested factors age gender presence of hypertension diabetes mellitus renal dysfunction ischemic heart disease or number of diagnosis CONCLUSION: Underutilization and suboptimal dosing of ACE inhibitors was common Since there is an abundance of evidence in favor of using high-dose ACE inhibitor therapy in patients with CHF physicians need to be educated about proper dosing of these agentshttp://blogs.najah.edu/staff/092942021/article/Prevalence-of-Reduced-Renal-Function-among-Diabetic-Hypertensive-PatientsPublished Articles Waleed M Sweileh 1 Ansam F Sawalha1 2 Saed H Zyoud2 Samah W Al-Jabi11 Nasr Y Shraim1 1College of Pharmacy Clinical Pharmacy Graduate Program An-Najah National University Nablus Palestine; 2Poison Control and Drug Information Center PCDIC An-Najah National University Nablus Palestine Received October 12 2008; accepted November 4 2008; available online November 20 2008 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 CockcroftGault 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 355 distributed as follows: 635 had stage 3 CKD 217 had stage 4 and 13 had stage 5 CKD b Patients with reduced renal function were elderly had a higher number of chronic diseases and had a 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 the 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 http://blogs.najah.edu/staff/092942021/article/Discharge-Medications-among-Stroke-SurvivorsPublished ArticlesSweileh 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; 181: [Publisher: Elsevier Saunders Country where published: United States] In pressBackground: 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; 78 821 survivors were having ischemic stroke subtype and were designated the study group The average age of the survivors was 669 6 127 years Survivors had prevalent risk factors such as diabetes mellitus 70 hypertension 68 and ischemic heart disease 346 On average survivors experienced a minimum of 073 complications range 0-3 with the most common being infections n 5 35 448 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 49 medications from 43 different drug classes All ischemic stroke survivors were prescribed antiplatelet therapy at discharge Aspirin monotherapy was prescribed for 61 survivors while the combination of aspirinclopidogrel 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: MedicationsischemicstrokePalestine link: http:linkinghubelseviercomretrievepiiS1052305708002139http://blogs.najah.edu/staff/092942021/article/A-prospective-comparative-study-of-gentamicin--and-amikacin-induced-nephrotoxicity-in-patients-with-normal-baseline-renal-functionPublished ArticlesThe aim of this study was to compare the nephrotoxic potential of amikacin AK and gentamicin GM in patients with normal baseline renal function This study was a 1-year non-interventional prospective study of patients administered either GM or AK The study was carried out at the internal medicine department of Al-Watani governmental study Nephrotoxicity was defined as a serum creatinine SCr increase of 05mgdL from the basal normal SCr level The two groups GM n=45 and AK n=49 were similar in population composition and underlying pathological and infectious processes requiring antimicrobials No significant difference in age was found between patients in the GM and AK groups P=083 Patients in the GM group received comparatively lower doses than those in the AK group mean=25mgkgday and 144mgkgday respectively but the duration of treatment was similar Sixteen of 45 patients receiving GM 356 and eight of 49 patients receiving AK 163 developed nephrotoxicity P=0033 Single daily dosing with GM regardless of the total daily dose produced less nephrotoxicity than multiple dosing In contrast AK given at a total dose of 1g daily showed no benefit of single dosing compared with multiple dosing In patients with initial normal renal function GM was significantly more nephrotoxic than AK Multiple dosing of GM was more nephrotoxic than single dosing AK-induced nephrotoxicity was not significantly dependent on dosing frequencyhttp://blogs.najah.edu/staff/092942021/article/Pharmacy-Education-and-Practice-in-West-Bank-PalestinePublished Articles The West Bank is a landlocked territory on the west bank of the Jordan River in the Middle East Since 1967 most of the West Bank and Gaza Strip has been under Israeli military occupation In 1993 the Oslo accords declared both West Bank and Gaza Strip to be partially under the administration of the Palestinian National Authority PNA Before 1967 there were no universities in the West Bank Since there were no universities in West Bank at that time Palestinians could obtain degrees only by travelling abroad to places such as Jordan Lebanon or Europe After 1967 several educational institutions began offering undergraduate courses while others opened up as entirely new universities In December 2007 an official Census conducted by the Palestinian Authority found that the Palestinian population of the West Bank including Israeli-annexed East Jerusalem was 2345000 In terms of health insurance more than half of the Palestinian population have governmental insurance and can obtain medications from governmental medical centers http://blogs.najah.edu/staff/092942021/article/The-Epidemiology-of-Stroke-in-Northern-PalestinePublished ArticlesSweileh WM Sawalha AF Al-Aqad M Sana Zyoud SH Al-Jabi SW The Epidemiology of Stroke in Northern Palestine: A One-Year Hospital-Based Study Journal of stroke and cerebrovascular disease 2008; 176: 406-411 [Publisher: Elsevier Saunders Country where published: United States] Published Abstract BACKGROUND: Although stroke is one of the leading causes of morbidity and mortality worldwide no studies on stroke were reported from Palestine The objective of this study was to identify the risk factors and incidence rates of stroke in a well-defined area in north Palestine ie the district of Nablus with 362159 native Palestinian inhabitants METHODS: All patients admitted to Al-Watani governmental hospital from September 2006 to August 2007 and given the diagnosis of acute stroke were included in the study Diagnosis of stroke was confirmed by computerized tomography scan Demographic characteristics and clinical data pertaining to the patients were obtained from their medical files RESULTS: A total of 186 patients with stroke 95 female and 91 male were identified during the study The average age of the patients was 6909 - 109 years Among the total patients 112 had a first-ever stroke FES and 74 had recurrent stroke RS Hypertension diabetes mellitus and renal dysfunction were the most common risk factors with comparable prevalence in both FES and RS The majority of patients 153; 823 had ischemic stroke subtype whereas 33 177 had hemorrhagic stroke subtype The overall FES RS annual crude incidence rate of stroke was 514 per 100000 persons whereas the annual crude incidence rate of FES was 31 per 100000 persons The age-adjusted incidence rates were 545 FES and 898 FES and RS The overall inhospital mortality was 21 and was higher in patients with RS than in those with FES CONCLUSION: Modifiable risk factors were common among patients with stroke Better control of these risk factors might decrease incidence of stroke and all consequences thereafter Incidence rate and inhospital mortality of stroke reported in this study were within the range reported from other Arab countries Link: http:linkinghubelseviercomretrievepiiS1052-30570800148-1http://blogs.najah.edu/staff/092942021/article/Gender-differences-in-pharmacological-and-clinical-associates-of-kidney-diseasePublished ArticlesSweileh WMGender differences in pharmacological and clinical associates of kidney disease A hospital-based studyMed Princ Pract 2008;172:102-7Abstract 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 6425 mlmin and females with GFR 5925 mlmin were designated as kidney group and those above were considered the reference group GFR was estimated using Cockroft-Gault equation; chi2 and multiple logistic regressions were used to test for significance using statistical package for social sciences program RESULTS: Of the 340 patients 185 545 were males and 155 456 females; mean age was 604 - 17 years Of the 185 males 58 314 and of the 155 females 41 266 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-Idiuretic 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-Idiuretic 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 BaselLinks: http:contentkargercomproduktedbprodukteasp?typ=fulltextfile=000112962http://blogs.najah.edu/staff/092942021/article/Self-Therapy-Practices-among-University-Students-in-PalestinePublished ArticlesSawalha 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;166:343-349[Publisher: Elsevier Churchill Livingstone Country where published: England Scotland] PublishedAbstract 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 chi2 multiple logistic regression and one-way ANOVA were performed using SPSS 13 program RESULTS: 339 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 therapylink: http:linkinghubelseviercomretrievepiiS0965-22990700118-5http://blogs.najah.edu/staff/092942021/article/articlePublished ArticlesSawalha 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 Medicine2008; 34 [Publisher: Directory of Open Access Journals Country where published: Libya] PublishedAbstract 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 patientsLink: http:wwwljmorglymodulesphp?name=Newsfile=articlesid=1354http://blogs.najah.edu/staff/092942021/article/Predictors-of-in-hospital-mortality-after-acute-strokePublished ArticlesSweileh WMPredictors of in-hospital mortality after acute stroke: impact of renal dysfunctionInt J Clin Pharmacol Ther 2008 Dec;4612:637-43Abstract Objective: The objective of this 1-year hospital-based study was to identify the impact of renal dysfunction on in-hospital mortality after acute stroke Methodology: All patients admitted to Al-Watani governmental hospital and diagnosed with acute stroke from September 2006 to August 2007 were included in the study Data were obtained from patients\ medical files Creatinine clearance CrCl was calculated using Cockcroft-Gault equation Patients with CrCl 60 mlmin were designated as Group 1 while those with CrCl = 60 mlmin were designated as Group 2 The main outcome measure in this study was vital status at discharge Pearson chi2 and independent Student\s t test were used in the univariate analysis while multiple logistic regression analysis was used to identify independent predictors of in-hospital mortality Statistical testing and graphics were carried out using SPSS 15 Results: A total of 186 acute stroke cases were included Hypertension HTN 699 and diabetes mellitus DM 452 were the most prevalent risk factors Patients in Group 1 were significantly older than those in Group 2 7411 - 946 versus 6653 - 1074 years Thirty nine 21 of the stroke patients died during their hospital stay In the total stroke patients three predictors of in-hospital mortality were identified: CrCl p = 0004 number of post-stroke complications p = 0001 and type of stroke p = 0034 In Group 1 CrCl p = 0012 was the only independent predictor of mortality with patients who died having significantly lower CrCl than those who survived However in Group 2 CrCl level was not a predictor of mortality and was not significantly different p = 026 between those who died and those who survived In Group 2 no predictors of mortality were identified Conclusion: Screening and better control of renal dysfunction is required to decrease the risk of in-hospital mortality among patients after acute stroke Our study also shows that the lower the CrCl the greater is the risk of in-hospital mortality after acute attack This finding needs to be considered in preventive and therapeutic strategies of acute strokeLinks: http:wwwdustricomncjournals-in-englishmagint-journal-of-clinical-pharmacology-and-therapeuticsvolvolume-46issuedecember-12htmlhttp://blogs.najah.edu/staff/092942021/article/article-1Published Articles أفاق جديده لمهنة الصيدله في فلسطين بعد اعتماد برنامجالتاريخ: 2007-05-28 17:52:05 أفاق جديده لمهنة الصيدله في فلسطين بعد اعتماد برنامج دكتور صيدله في جامعة النجاح الوطنيه د وليد صويلح استاذ مشارك في علم الادويه السريري عميد كلية الصيدله جامعة النجاح الوطنيه بدأت السلطة الوطنية الفلسطينية في استلام مهامها ومسؤولياتها عن الأمور الصحية في فلسطين منذ عام 1994 حيث عملت منذ ذلك الوقت على تطوير وتحديث قطاعي الصحة والتعليم لما لهما من اثر ايجابي مباشر على حياة ومستقبل حوالي أربعة ملايين نسمه يعيشون في الضفة الغربية وقطاع غزه وحسب التقديرات الاحصائيه الفلسطينية الحالية فان حوالي 55 من سكان الضفة الغربية وقطاع غزه أعمارهم دون سن التاسعة عشر مما يجعل إعداد الطلبة المتوقع التحاقهم بالجامعات الفلسطينية في تزايد مستمر حيث يبلغ عدد الطلبة المسجلين في مؤسسات التعليم العالي الفلسطينية حاليا حوالي 150274 ويوجد في فلسطين حاليا 10 جامعات أهليه موزعه في جميع مناطق فلسطين ومنذ عام 1992 وحتى الآن قامت 3 جامعات فلسطينيه بافتتاح كليات لتعليم العلوم الصيدلانية وهذه الجامعات هي: جامعة الأزهرغزه، جامعة النجاح الوطنية نابلس وجامعة القدس ابوديس وجميع هذه الجامعات تمنح درجة بكالوريوس في العلوم الصيدلانية بعد أن يقوم الطالب بإنهاء المساقات المقررة وفترة تدريب صيدلاني تحدده الكلية ويستغرق الحصول على هذه الدرجة حوالي 5 سنوات دراسية يمنح في نهايتها الخريج شهادة بكالوريوس في العلوم الصيدلانية بالاضافه إلى وجود برنامج لمنح درجة البكالوريوس في جامعة النجاح فقد بدأت أيضا منذ عام 2003 ببرنامج دراسات عليا في الصيدله السريريه بحيث تمنح درجة ماجستير في الصيدله السريريه للطالب الذي يجتاز 24 ساعة معتمده نظريه وتدريبا سريريا لمدة 32 أسبوع في الأقسام المختلفة في المستشفيات 12 ساعة معتمده وامتحانا شاملا ولقد تم البدء بهذا البرنامج بالتعاون والتنسيق مع وزارة الصحة تقوم بموجبه الجامعة بتقديم 3 منح سنويا لصيادلة ترشحهم وزارة الصحة للحصول على درجة الماجستير مقابل أن يقوم طلبة برنامج ماجستير الصيدله السريريه بالتدريب السريري في المستشفيات الحكومية لقد تميزت سنوات الثمانينيات بقله في أعداد الصيادلة الخريجين ولكن شهدت أواخر التسعينيات من القرن الماضي ازديادا في أعداد الصيادلة الخريجين أنظرالرسم البياني ويمكن تفسير ذلك بعدة اسباب منها: افتتاح كليات صيدله في الجامعات الخاصه في الاردن مما شجع الطلبه على الالتحاق بها زيادة عدد طلبة التوجيهي الراغبين في اكمال دراستهم الجامعيه قناعة الكثيرين ان مهنة الصيدلة كانت وما زالت تتمتع بمستقبل واعد ماديا ومعنويا ومما لا شك فيه ان الخريجين الجدد من حملة بكالوريوس العلوم الصيدلانيه عملوا على سد حاجة فلسطين من الكوادر الصيدلانيه وخصوصا في مجال صيدليات المجتمع حيث ان معظمهم يقومون بالاستثمار في الصيدليات الخاصه وحسب الاحصائيات الفلسطينيه المتوفره من نقابة الصيادله مركز القدس فان عدد صيدليات المجتمع العامله حاليا في محافظات الضفه الغربيه والقدس هو 959 صيدليه ان هذا العدد يجعل نسبة الصيدليات الى عدد السكان هو 1: 2880 نسمه أما بالنسبه لعدد الصيادلة المزاولين لمهنة الصيدله في الضفه الغربيه والقدس فهو 2122 مما يجعل نسبة الصيادله لعدد السكان هو 1: 1302 نسمه بالنسبه للصناعه الدوائيه فهناك 5 مصانع في مجال الصناعه الدوائيه في الضفه الغربيه ولقد قامت هذه المصانع باستيعاب العديد من الصيادله الجدد وخاصة في مجال الدعايه الدوائيه ولقد قام الصيادله بدورهم باثراء مواقع عملهم باسلوب علمي ومهني متميز اما بالنسبه للقطاع الحكومي فقد استوعب أعداد كبيره من الصيادله الجدد للعمل في صيدليات المستشفيات والعيادات الحكوميه ومجال التفتيش الصيدلاني ان المجالات التي يعمل بها الصيادله في الوقت الحالي تتميز بما يلي: 1 تراجع دور الصيدلي في تركيب وتحضير الادويه لصالح الصناعه الدوائيه واقتصاره على صرف الأدويه 2 معظم مجالات العمل الصيدلاني المتوفره حاليا لا تظهر القدرات العلميه والطاقات الابداعيه للصيدلاني ان هذه المميزات تكاد تطغى على العمل الصيدلاني ليس في فلسطين فحسب وانما في معظم دول المنطقه ولقد ادت هذه العوامل وعوامل غيرها الى ضرورة احداث تغيير في التعليم والممارسه الصيدلانيه الأمر الذي أدى ال استحداث برنامج تخصصي جديد يسمى دكتور صيدله Pharm D في الولايات المتحده المريكيه في أوائل الثمانينات من القرن الماضي ولقد كان الهدف من هذا البرنامج هو تخريج صيادله ذوي قدرات علميه صيدلانيه سريريه عاليه تجعلهم اكثر قدره على العمل ضمن الفريق الطبي في المستشفيات بحيث يكون الدكتور الصيدلاني مرجعا في الامور الدوائيه والعلاجيه كما ان هذا البرنامج ادى الى خلق فرص عمل كثيره للصيادله في المجال السريري في المستشفيات الحكوميه والخاصه وجعل مهنة الصيدله أكثر قربا من المريض من حيث التثقيف الدوائي ومتابعة العلاج وساعد على توظيف معلومات وقدرات الصيادله في رفع كفاءة الرعايه الصحيه ولقد لاقى هذا البرنامج نجاحأ كبيرا في الولايات المتحده الامريكيه لما كان له من اثر ايجابي على عمل الفريق الطبي والمرضى بشكل خاص وعلى النظام الصحي بشكل عام ولقد قامت جميع الجامعات الامريكيه تقريبا بالانتقال من النظام التقليدي العلوم الصيدلانيه الى النظام الجديد دكتورصيدله ليس هذا فحسب وانما طلبت نقابة الصيادله الامريكيه من جميع الصيادله اللذين يحملون بكالوريوس علوم صيدلانيه على تطوير ذاتهم والتجسير مع البرنامج الجديد من اجل الحصول على شهادة دكتور صيدله وفي المنطقه العربيه، كانت الاردن جامعة العلوم والتكنولوجيا والجامعه الاردنيه ولبنان الجامعه الامريكيه من أوائل الدول التي ادخلت هذا البرنامج للتعليم الصيدلاني ثم تبعتهم المملكه العربيه السعوديه جامعة الملك فيصل واخيرا في فلسطين جامعة النجاح الوطنيه ان هذا البرنامج الجديد على فلسطين وعلى المنطقه العربيه يتطلب تضافر جهود كل من وزارة الصحة ووزارة التعليم العالي ونقابة الصيادلة والجامعات الفلسطينيه حتى يتسنى لهذا البرنامج ان ينجح على المستوى المهني والعملي فوزارة الصحه ووزارة التعليم العالي مطالبه باعطاء خريج هذا البرنامج حقه مستانسين بتجارب الدول العربيه والاجنبيه التي سبقتنا في استحداث هذا التخصص واخيرا فان نقابة الصيادلة وكليات الصيدلة في فلسطين عليها ان تعمل على تطوير المناهج حتى يصبح هذا الخريج قادرا على القيام بدور مميز في العمل الصيدلاني السريري ان نجاح هذا البرنامج سيغير الكثير في مهنة الصيدله بحيث يبرز السمات السريريه الدوائيه، ليس هذا فحسب وانما سيجعل البرنامج مهنة الصيدلة اكثر انسانية بقربها وتناغمها مع مهنة الطب والتمريض والمهن الطبيه الأخرى ومن الواجبات والمهام الملقاه على الدكتور الصيدلي ما يلي: 1 الحصول على التاريخ العلاجي والدوائي للمريض وتسجيله ضمن نموذخ خاص بالصيدلي، 2 المشاركه في التقرير الصباحي والمرور الطبي، 3 المشاركه في اختيار العلاج الاكثر ملائمة من ناحية الجرعة وطريقة تناولها والفترة الزمنية ومراقبة سير العلاج، 4 الاشراف على خدمات التغذيه والعلاجات الوريديه وتحضيرها واعطائها للمرضى المنومين، 5 مناقشة الأمور المتعلقه ببعض الفحوصات المخبرية ومدى تأثرها بالأدوية، 6 الاشراف على الفحوصات المخبريه المتعلقه بمراقبة تراكيز الادويه في الجسم، 7 ترشيد استهلاك الأدويه بما لا يتعارض مع الخطة العلاجيه، 8 تدقيق وتوثيق التداخلات الدوائيه والاعراض الجانبيه، 9 اطلاع الفريق الطبي على الخطط العلاجية الحديثه المبنيه على الادله Evidence Based Therapy، 10 المشاركه في التعليم والبحث الصيدلاني الدوائي 11 والعمل على التواصل مع المرضى وتعليمهم ما له علاقه بالادويه وامام هذه التغيرات في مهنة الصيدلة تظهر عدة تساؤلات منها كيفية تطوير الصيادله من حملة بكالوريوس العلوم الصيدلانيه، ومستقبل مختلف البرامج الاكاديميه الصيدلانيه في فلسطين بالنسبه لتطوير الصيادله فان وجود برامج دراسات عليا في الصيدله والعلوم الصحيه الأخرى في فلسطين والخارج ستفتح الفرصه امامهم لتطوير انفسهم في شتى المجالات وخصوصا تلك التي تعتبر ندره في فلسطين مثل الصيدله السريريه والممارسه الصيدلانيه والبيوتكنولوجيا الصيدلانيه أما بالنسبه لمستقبل التعليم الصيدلاني فانه من المتوقع ان تستمر البرامج الاكاديميه الصيدلانيه العلوم الصيدلانيه، ودكتور صيدله جنبا الى جنب وقد يكون من الافضل للتعليم الصيدلاني في فلسطين ان يستمر العمل بالبرنامجين معا حتى تتضح الصوره حول طبيعة التغييرات في ممارسة مهنة الصيدله خلال السنوات القادمه http://blogs.najah.edu/staff/092942021/article/Contraindications-to-metformin-therapy-among-patients-with-type-2-diabetes-mellitusPublished ArticlesSweileh WM Contraindications to metformin therapy among patients with type 2 diabetes mellitusPharm World Sci 2007 Dec;296:587-92AbstractOBJECTIVE: The biguanide metformin is a commonly prescribed oral antihyperglycemic agent However there are several clinical conditions that are considered as contraindications to the use of metformin among patients with type 2 diabetes mellitus The aim of this study was to investigate the presence and nature of contraindications to metformin therapy among patients with type 2 diabetes mellitus METHOD: A retrospective study of the medical files of diabetic patients available at Alwosta clinic north Palestine was carried out Information about disease and medication profile of the patients was retrieved and analyzed using SPSS during the study period in 20042005 Focus was on metformin users who have contraindications to metfromin therapy MAIN OUTCOME MEASURE: Presence and number of contraindications to metformin therapy RESULTS: Two hundred and seventy-two type 2 diabetic patients were identified One hundred and twenty four of those diabetic patients were metformin users Approximately 60 of patients in the metformin group had a least one contraindication Congestive heart failure and renal impairment were the most quantitatively present contraindications CONCLUSION: Contraindications to metformin therapy are common among type 2 diabetic patients and mostly disregarded Patients have to be critically assessed before starting therapy and in case of metformin prescribing; dose should be adjusted based on the presence of risk factors for metformin adverse effectsLinks: http:wwwspringerlinkcomcontentu01j82v62318t8u0http://blogs.najah.edu/staff/092942021/article/Potential-adverse-effects-of-a-low-dose-aspirin-diuretic-combination-on-kidney-functionPublished ArticlesSweileh WM Potential adverse effects of a low-dose aspirin-diuretic combination on kidney function Int J Clin Pharmacol Ther 2007 Nov;4511:601-5Abstract OBJECTIVE: Low-dose aspirin and diuretics are commonly co-utilized in patients with cardiovascular diseases The objective of this study was to investigate the effects of a low-dose aspirin-diuretic drug combination on renal function METHODS: In this cross-sectional retrospective study all patients excluding those on renal dialysis admitted to the Internal Medicine Department of the Al-Watani Hospital Nablus Palestine were included in the study Medical data were obtained from patients\ medical files Estimation of creatinine clearance was carried out using the Cockcroft-Gault equation Patients on the target drug combination were compared with patients who were not receiving the target drug combination An independent paired t-test and 1-way ANOVA were used to test for significance between groups Statistics were carried out using the Statistical Package for Social Sciences SPSS version 13 RESULTS: A total of 340 subjects 544 men were included in the study There were 90 patients on the target drug combination and designated as the study group Of the remaining 250 patients comprising the control group 114 received none of the target drugs and 136 received only one target medication There was a significant p 0001 difference in the levels of creatinine clearance between the two groups Patients on the target drug combination had significantly lower creatinine clearance levels than those in the control group Men in the study group had lower creatinine clearances than men in the control group and similar results were found for women Patients in the study group with or = 2 chronic diseases had lower creatinine clearances than patients in the control group with or = 2 chronic diseases Similar results were found in patients with 2 chronic diseases CONCLUSION: Administration of a low-dose aspirin-diuretic drug combination was associated with significantly lower creatinine clearance levels This finding was independent of gender and the number of chronic diseases present Monitoring kidney function in patients receiving this drug combination is recommendedLinks: http:wwwdustricomncjournals-in-englishmagint-journal-of-clinical-pharmacology-and-therapeuticsvolvolume-45issuenovember-10htmlhttp://blogs.najah.edu/staff/092942021/article/Utilization-of-Anti-infective-Agents-Measured-in-Published ArticlesWaleed M Sweileh Ansam F Sawalha Rami M AL-HajAbed Abdullah Kh Rabba Utilization of Anti-infective Agents Measured in Defined Daily Dose DDD: A Study in Palestine The Islamic University Journal Series of Natural Studies and Engineering Vol15 No 2 pp 59-66 2007AbstractOver utilization of anti-infective agents is a worldwide problem The Anatomical Therapeutic Chemical ATC classificationDDD system is adopted by the world health organization WHO for drug utilization research to compare the pattern of drug usage at international level This is the first study in Palestine that uses this methodology The study was carried out for 30 consecutive days 23102005-23112005 in the internal wards at Al-Watani governmental hospital in Nablus-Palestine Data collected included age sex diagnosis anti-infective agents prescribed dosage regimen and number of doses of antibiotic administered Data were analyzed using SPSS version 12 DDD100 bed-days were calculated for the anti-infective agents using the international formulaDuring the study period 442 patients were admitted to the internal wards The patients were 193 females 437 and 249 males 563 Among these patients 191 432 were prescribed anti-infective agents Cefuroxime ceftriaxone and metronidazole were the most frequently prescribed with the percentages of 278 61 and 57 respectively The total amount of anti-infective agents prescribed was 3899 DDD100 bed days The DDDpatientday was 04 compared to 1 DDDpatientday as the optimum The results of this study reflect a deviation from the optimum use of anti-infective agents Optimizing anti-infective therapy is necessaryLinks: http:wwwiugazaedupsenresearcharticleaspx?article_id=1292http://blogs.najah.edu/staff/092942021/article/Influence-of-Disease-and-Drug-Risk-Factors-on-Metformin-Dose-AdjustmentPublished ArticlesWaleed M Sweileh Influence of Disease and Drug Risk Factors on Metformin Dose Adjustment: A Retrospective Study of Outpatients in NablusThe Islamic University Journal Series of Natural Studies and Engineering 2007; 151: 137-146Abstract: 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 74118 627 of the included patients had a least one disease risk factor for lactic acidosis Of those patients 4874; 649 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 Links: http:wwwiugazaedupsararesearcharticlesnatural1512007pp137-146pdfhttp://blogs.najah.edu/staff/092942021/article/Medication-dosing-errors-in-hospitalized-patients-with-renal-impairmentPublished Articles 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 59mlmin 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 59mlmin 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 7358142 were found to be inappropriate and 2642 51 were found to be appropriate The most common inappropriate medications were ranitidine antibiotics and digoxin Approximately 775 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 Copyright 2007 John Wiley Sons Ltd Received: 9 August 2006; Revised: 21 February 2007; Accepted: 19 March 2007http://blogs.najah.edu/staff/092942021/article/Admission-blood-glucose-level-as-a-potential-indicator-for-short-term-mortality-and-morbidity-after-myocardial-infarctionPublished ArticlesAims : Hyperglycemia is common among patients with acute myocardial infarction AMI and is associated with high risk of mortality and morbidity However the relationship between admission plasma glucose APG levels and mortality in diabetic and nondiabetic patients with AMI needs further investigation The aim of this study was to investigate the relationship between APG level and short-term mortality and morbidity after AMI Materials And Methods : This is a prospective study of 79 consecutive patients with AMI followed up for 90 days Medical history as well as demographic and clinical baseline characteristics of the patients was obtained from Al-Watni Governmental Hospital medical records The patients were divided into four groups based on APG levels Patients health status was followed up by phone call interviews with the patients and their families Follow-up data were further confirmed using patients medical records at the hospital The phone interviews investigated all causes of death or congestive heart failure CHF or re-infarction Results : The mean age of patients was 619 123 years At the time of hospital admission the median PG level was 162 mgdl During the 3-month follow-up overall mortality was 203 and was increased to 563 in patients with glucose levels 200 mgdl Mortality was comparable 219 vs 191; P 005 between diabetic and nondiabetic patients Nonfatal adverse outcomes in the form of combined CHF and re-infarction were highest in group IV and lowest in group I Conclusion :Our study demonstrates that high APG level is common in patients with AMI and is associated with high risk of mortality and morbidity among patients with or without diabetes mellitus In fact our study showed that nondiabetic patients with high APG have higher risk of mortality than patients with a known history of diabetes mellitushttp://blogs.najah.edu/staff/092942021/article/ATTITUDES-TOWARD-MEDICATIONS-A-PILOT-STUDY-IN-PALESTINEPublished Articles Waleed M Sweileh Reem T Arafat ABSTRACT: Aims: The effectiveness of drug therapy is largely influenced by noncompliance which is believed to be affected by attitude toward drugs The aim of the this study was to evaluate the attitudes toward drugs from an epidemiological perspective in Palestine Methodology: A cross-sectional study based on questionnaire survey randomly distributed to individuals in Palestine in the period starting November 2004 to January 2005 Data collected were entered and analyzed using Statistical Package for Social Sciences Program SPSS version 11 for windows ATTITUDES TOWARD MEDICATIONS 22 Results: Out of 573 respondents 799 considered drugs as positive a help; 154 viewed medication as necessary evil; 47 considered medication as negative danger Self-Care oriented people viewed medications more positive than others Differences in attitude were observed among users of different types of drugs; those using antihypertensive or asthmatic psychotropic drugs viewed medication more negatively than others Patients medication knowledge greatly affects attitude toward drugs and thus patients compliance and drug effectiveness Discussion and Conclusion: The majority of the study sample viewed http://blogs.najah.edu/staff/092942021/article/Drug-Interactions-and-Risk-of-Bleeding-among-Patients-with-Atrial-Fibrillation-AF-Discharged-with-Warfarin-Published Articles Drug Interactions and Risk of Bleeding among Patients with Atrial Fibrillation AF Discharged with Warfarin Waleed Sweileh Nidal Jaradat Moueen Elawee Asaad Al-Shakhsheer Ansam Sawalha Rawa Al-Ramahi Abed Al-Naser Zaid Faculty of Pharmacy An-Najah University Nablus Palestine E-mail: waleedsweileh@najahedu Received: 2572005 Accepted: 592006 Abstract The objective of this study was to examine and evaluate the frequency of bleeding and serious drug interactions among patients with atrial fibrillation AF treated with oral anticoagulant [Warfarin] A random sample of 59 patients from Al-Watni government hospital in Nablus with a principal or secondary discharge diagnosis of AF was identified All drug and clinical data were abstracted from the patient\s files We excluded patients who were less than 65 years of age or left the hospital against medical advice and those whose AF was transient or could not be confirmed Of the original 59 AF patients 19 were cliagnosed who were discharged on Warfarin The mean age for these patients was 717 years Among the patients discharged on Warfarin 947 had one or more drug drug interactions that could lead to increase risk of bleeding Many patients discharged on Warfarin were having multiple interacting drugs Patient counseling and follow-up monitoring are essential and should be carried out to minimize the risk of bleeding and other complications Key Words: atrial fibrillation warfarin drug interactions bleeding stroke