http://blogs.najah.edu/author/2396131 An-Najah Blogs :: publication of Ansam Sawalha en-us Thu, 09 May 2024 20:19:42 IDT Thu, 09 May 2024 20:19:42 IDT [email protected] [email protected] http://blogs.najah.edu/staff/2396131/article/Assessment-of-Self-Medication-Practice-among-University-Students-in-Palestine-Therapeutic-and-Toxicity-ImplicationsPublished ArticlesObjective: self-medication is practiced significantly worldwide No data is available on the current status of self-medication practice in Palestine The objective of this study is to assess the extent of self-medication practice among a random sample of An-Najah National University students Methods: this was a cross-sectional anonymous questionnaire-based survey that included 1581 students of different academic levels enrolled at different faculties at An-Najah National University A pre-validated questionnaire with several open-ended and closed-ended questions was administered to the students Data were coded entered and analyzed using SPSS version 13 Results: sixty three percent of respondents were females enrolled at non-medical schools The mean age of respondents was 199 years Ninety-eight percent of respondents reported practicing self-medication There was no statistical difference between respondents who reported practicing self-medication based on gender or type of school medical vs non medical The average number of medications reported by self-medication practitioners was 263 138 medications per respondent Analgesics decongestants herbal remedies and antibiotics were the most common classes reported in self-medication Headache sore throat flu and dysmenorrhea were the most common aliments for which respondents seek self-medication The majority of respondents practiced self-medication because the ailments they had were simple or because they had previous experience The majority of respondents had good medication knowledge but did not posses high self-care orientation Neither medication knowledge nor self-care orientation was a predicting factor associated with the practice of self-medication However in selecting a particular type of medication the type of school gender and self-care orientation were influential Conclusion: self-medication is very common among An-Najah students This practice is common for treating clinical conditions that are either simple or previously experienced Although no significant predictors of self-medication did exist among the studied group levels of self-care orientation and medication knowledge can be of value in analyzing the types of medications employed by self-medication practiceshttp://blogs.najah.edu/staff/2396131/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 ageSD of the participants was 388118years The majority 979 of the participants were male The mean participant scores for knowledge and safety procedures were 2832 out of 8 and 9824 out of 15 respectively There was a significant positive correlation r=0323; P0001 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; P0001 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 neededhttp://blogs.najah.edu/staff/2396131/article/article-5Published Articlesإصلاح التعليم في الدول العربية تأليف: د فاروق الباز ترجمة: د أنســام صوالحـة لمحة تاريخية كانت أول كلمة بدأ بها القرآن الكريم هي إقرأ تأكيدا على أهمية المعرفة، ولأن التعلم يجعل الإنسان أكثر ادراكا وإيماناً بالله، وأكثر نفعاً للإنسانية ويتساوى اكتساب المعرفة مع البحث عن الحقيقة، وفي هذا السياق قال الفيلسوف ابويوسف الكندي 805-873 ما معناه يجب أن نتقبل الحقيقة ونبحث عنها بغض النظر عن مصدرها، حتى ولو كانت من بلاد بعيدة ودول مختلفة لا شيء أهم من البحث عن الحقيقة إلا الحقيقة نفسها غير أن العرب في العقود القليلة الماضية لم يطبقوا ذلك وانغلقوا عقلياً وفكرياً عن العالم من حولهم، وأصبحوا يعانون من الشعور بالنقص والاحساس بالخوف وعدم الثقة وقد يكون من العوامل الرئيسية لهذا النقص هو الخلل في نظام التعليم وطرقه وأساليبه في مراحله المختلفة يرتكز التعليم المدرسي الحالي غالباً على طريقة الصم الاستظهار من غير فهم مما أدى إلى القضاء على التفكير الذاتي والإبداعي أما في الجامعات فقد أدى التعليم الجامعي المجاني إلى تضخيم عدد الطلبة فى الفصل الواحد إلى درجة يصعب السيطرة عليهم، مما أسهم في قتل الإبداع عند الطلبة والمدرسين على حد سواء وساهمت عقود الإهمال وعدم اتخاذ الخطوات الصحيحة الى إنتاج جيل من الشباب بلا هدف أو طموح، لينضم إلى قطاع كبير من القوى العاملة غير المنتجة والسلبية في الدول العربية لقد خسر العرب مشاركتهم في إنجازات عصر الصناعة ولذلك استمروا في استيراد المعدات والمنتجات اللازمة من الآخرين وحصل الأمر ذاته لاحقاً عندما لم يشارك العرب في العصر النووي، وأخفقوا في المساهمة في حل لغز الذرة، وكذلك استخداماتها السلمية ومر عصر الفضاء بانعدام المساهمات العربية، وتصرف العرب كمن يشاهد مباراة رياضية يجهل قوانينها وكان من أسباب عدم مشاركة العرب هو قناعتهم بأن إنفاق المال على البحث العلمي هو رفاهية لا تستطيع دفع نفقاته إلا الدول الغنية لقد لعبت مصر دورا قياديا في العالم العربي خلال أواسط القرن الماضي، حيث قامت بتوفير الثقافة والعلم، وتخرج منها القادة والمعلمون والمستشارون ولكن الخسارة الكبرى التي تعرضت لها مصر عام 1967 أدت إلى ضعضعة ثقتها بنفسها، مما انعكس سلباً على محاور عديدة وانشغلت مصر برثاء النفس ودخل العالم العربي مراحل ركود ورثاء النفس أيضاً، لذلك يعد اصلاح وضع العرب من الخطوات الضرورية لتمكينهم من العودة للعب دور إيجابي وفاعل في المنطقة والعالم الحاجة إلى التغيير والاصلاح نعيش اليوم في عصر المعلومات، وسيُفوت العرب هذا العصر إذا لم يقوموا بتحديث وسائل التعليم ونُظُمه إن تحسين التعليم والبحث عن المعرفة وزيادتها ونشرها والاستعانة بالمخترعين والمفكرين هي وسائل لازمة للنمو الاقتصادي ولقد قدمت الدول الآسيوية مثل اليابان والصين وماليزيا وكوريا والهند مثالاً ناجحاً أدى فيه التركيز على التعليم إلى تطور اقتصادي ملحوظ وتُمثل كوريا الجنوبية حالة خاصة حيث قامت -ولمدة عقد كامل- بإعطاء الأولوية العليا من الميزانية القومية للتعليم بغض النظر عن الاحتياجات الأخرى وأدى هذا التخطيط إلى إنتاج جيل متعلم، يتميز بعلمه وتدريبه فأنتج بضائع متميزة في العالم بأسره ويستمر هذا النموذج في عصر المعلومات، حيث أن مستخدمي الإنترنت في كوريا الجنوبية يفوق عدد المستخدمين في الولايات المتحدة بينما لا يتجاوز عدد مستخدمي الانترنت من العرب 11 رغم انهم يشكلون 5 من سكان العالم لهذه الأسباب تتعالى الأصوات المطالبة بالتغيير من داخل الوطن العربي وخارجه ولتحقيق ذلك، لا بُد من ممارسة الحرية السياسية والديمقراطية، وخصخصة التجارة، وتحسين أوضاع المرأة هذه الأهداف لن تتحقق طالما وُجدت الفجوة المعلوماتية إن الاصلاح المنشود يبدأ من شعب متعلم يقوم فيه الأفراد بتحمل المسؤولية تجاه مجتمعهم ويتمتعون بالعلم والمعرفة ويتساوى فيه الرجال والنساء في تحمل هذه المسؤولية إن تحليل مشاكل قطاع التعليم على هذا النحو المنفتح يعد ضرورياً لنشر الاصلاح المأمول واستمراريته دور التعليم رغم أن الدول العربية غنية بالبترول، إلا أن كل المؤشرات تدل إلى فقرها بالمعلومات تظهر هذه الحقيقة جليا في تقرير التطور الإنساني للعرب، والذي نشر عام 2003 من قبل برنامج الأمم المتحدة الإنمائي أشار هذا التقرير إلى أن الدول العربية تزحف خلف كل الدول الأخرى في المؤشرات التكنولوجية باستثناء دول جنوب الصحراء الكبرى هذه المؤشرات تشمل عدد الكتب، الجرائد، محطات الإذاعة والتلفزة، خطوط الهاتف وأجهزة الحاسوب الشخصية والانترنت اتخذت بعض الدول العربية خطوات حقيقية لتغيير هذا النمط، والإمارات العربية المتحدة هي مثال على ذلك حيث يستخدم 30 من مواطنيها أجهزة حاسوب، وهو رقم يفوق عشرة أضعاف معدل استخدام الحاسوب في مصر وبشكل عام، يُظهر العالم العربي ضعفاً وعدم كفاءة في السعي للمعرفة واكتشافها والمؤشر على ذلك هو قِلة الترجمة ففي تقرير الأمم المتحدة الإنمائي 2003، كان عدد الكتب التي تمت ترجمتها في 22 دولة عربية في بدايات الثمانينيات يساوي جزءاً من خمسة مما تُرجم إلى اليونانية أما بالنسبة للمساهمة في اكتشاف المعرفة فليست بحال أحسن حيث يشكل العرب 5 من سكان العالم ولكنهم يُنتجون 08 فقط من الأدب والعلم الجديد أما فيما يتعلق بالبحث العلمى فالوضع أكثر سوءا، تُنفق الدول العربية أقل من 02 من ميزانيتها على البحث والتطوير في العلوم والتكنولوجيا هذا الرقم يعتبر أقل بعشر مرات مما تنفقه الدول المتقدمة تتاكد هذه الأرقام عندما ننظر إلى الأبحاث التي تم نشرها أو المخترعات التي تم تسجيلها فالدول العربية نادراً ما تتمكن من نشر أبحاثها في مجلات علمية محكمة وكذلك كان عدد الاختراعات المسجلة من العرب جميعاً ضئيلاً بحيث لا يساوي 2 من ذلك الذي قامت بها كوريا الجنوبية على سبيل المثال إن إصلاح التعليم من شأنه أن يلعب دوراً مهماً في التطور الاقتصادي، لأن التعليم يؤدي إلى تطوير عقل الجيل الناشئ ليصبح افراده مواطنون نافعون هذا الإصلاح يشمل تعليم الصغار التفكير الذاتي والثقة بمعلوماتهم، والجرأة لطرح أفكارهم والمدافعة عنها من أجل ذلك، يجب أن يتوفر لدينا معلمون يمتلكون العلم والطموح ومتمكنون من التواصل مع الطلبة ويجب إبقاء المعلمين مطلعين على أحدث الوسائل التكنولوجية في التعليم والاختراعات العلمية والحديث من الأدب وتُعد سياسة تقديم الجوائز والمحفزات للمعلمين المتميزين من الأساليب الناجحة لإبقائهم مثابرين وفي الخلاصة، فإن إعداد المعلمين وتدريبهم باستمرار هو جزء لا يتجزأ من الإصلاح المنشود طريق المستقبل هناك دائماً مجال لإصلاح التعليم ولا يعد الوقت متأخراً خاصة عندما نتكلم عن مستقبل أمة فالمصنع الذي تصبح أدواته قديمة يتم تجديده، وبالطريقة نفسها فإن هدف التعليم ورسالته في العالم العربي يجب تجديدها، ويجب معالجة المشكلة بدءاً من جذورها قد تكون البداية هي التعليم في البيت ثم في رياض الأطفال، ثم في المدرسة فمفهوم الطفل للتعليم وتطوير نظرته للمعرفة يبدأ في سن مبكر ويمكن زرع مبدأ التفكير التحليلي والبحث عن المعرفة عند الأطفال من خلال الحوار الهادىء معهم إن تقدير المعرفة واحترام مصادرها يُزرع في الأطفال منذ الصغر ويتذكر المؤلف في سنوات طفولته الأولى مشهد والده وهو يستخرج الكتاب من مكانه ويحمله بكل تقدير واهتمام ويفتح صفحاته بكل رقة واحترام لقد كان لهذا المشهد تأثيراً ايجابياً على حياته في أغلب البلدان العربية، يتم حشو المعلومات في عقول الأطفال ولا يخصص وقت للمناقشة ومعرفة الأسباب، وهذا يعزز طريقة التلقين والحفظ صحيح أن هناك معلومات يجب حفظها مثل جدول الضرب والأشعار والقواعد اللغوية، ولكن يجب أن يتعلم الطالب آلية النقاش والتطبيقات المحتملة لهذه النوعية من المعلومات ويجب خلق موازنة بين تعليم الطلبة وتشجيع الإبداع فوظيفة المعلمين أن يشجعوا مشاركة الطلبة عبر التفكير الحر والنقدي، وهذا من شأنه أن يثير اهتمام الطلبة واستمتاعهم بالوقت الذي يقضونه في المدرسة أما التعليم الجامعي فيتطلب إصلاحاً أكبر بكثير يجب تعليم الطلاب آلية البحث عن المعرفة، وتحديث معلوماتهم باستمرار وأن يتم تحدي عقول الطلبة للوصول إلى مستويات جديدة من المعرفة كما يجب توجيه طاقاتهم في مجالات نافعة ولإنجاح ذلك يجب إعطاء القائمين على التدريس بعض الاستقلالية، مع استعمال نظام تقييم ومتابعة مستمرة وتدريب متواصل كذلك يجب عدم إهمال أهمية تطوير المكتبات ووسائل التكنولوجيا، والحاسوب، للاستفادة من مصادر المعرفة الضخمة الموجودة فى الإنترنيت المساعدات الدولية يُعد إصلاح التعليم عملية طويلة الأمد تتطلب تحديد الأهداف ومراقبة تطبيقها وأخذ العبرة من تجارب الآخرين والاستناد على ممارسات صحيحة لا يوجد حرج لأي شخص أو أمة اذا اتبعوا أساليب نجحت عند غيرهم فلقد قامت الولايات المتحدة بنقل أساليب من اليابان عند حاجتها لتلك الأساليب وقد جربت الدول العربية وسائل وأنواع مختلفة من المؤسسات التعليمية ويجب عليها جميعا ان تُناقش وتراجع تجاربها بعقلية متفتحة، ليتم استنباط الأفضل فيما يتعلق بكل منطقة إن تقدم العرب سيكون له أثر كبير في تطوير التعليم في العالمين العربي والإسلامي خلال محاولاتنا لإصلاح التعليم، يجب أن نستفيد من تجارب الدول الأخرى التي أعادت هيكلة القوى العاملة فيها في وقت زمني قياسي، وهذه الدول تشمل كوريا، الهند، الصين، كوستاريكا، ماليزيا وتركيا ويجب أن لا يكون هدفنا نسخ تجربتهم وإنما تعلم كيفية تنفيذ الإصلاح بطرق فعّالة وعند الحديث عن مواضيع التعليم، يجب أخذ تجربة الغرب بعين الاعتبار فبلدان صغيرة مثل فنلندا خطت خطوات عظيمة الشان في تعليم ابنائها العلوم والتكنولوجيا لقد رفعتهم هذه الخطوة إلى درجة القيادة في الاختراعات والإنتاج، وزيادة دخل الفرد واليوم تصدر فنلندا بضائع تعادل كل ما تصدره 22 دولة عربية باستثناء النفط والغاز على الدول الغربية أن تدعم الدول العربية وتساعدها في اكتساب المعرفة لكي تلحق بالعالم المتطور هذا من شأنه أن يقلل من ضغوط هجرة الأعداد الكبيرة من الشباب من المناطق العربية إلى الغرب، وكذلك يُقلل من تنامي التمييز الذي بات يهدد العالم كله ومن شأنه ايضا أن يجعل العالم يستفيد من النهضة العلمية العربية، ومن المتوقع أن تلعب الولايات المتحدة الدور الرئيسي في هذه العملية والتعليم في الولايات المتحدة يحظى باحترام في العالم العربي بالإضافة لذلك، تتربع الولايات المتحدة على عرش القمة في مجالات العلوم والتكنولوجيا منذ نجاح رحلات أبولّو والهبوط على سطح القمر منذ أربعة عقود من الزمان وبالنسبة للمؤسسات التعليمية الأمريكية، فهي تتمتع بسمعة متميزة في العالم العربي وذلك بسبب وجود فروع للجامعة الأمريكية في بيروت والقاهرة والشارقة وغيرها، كذلك فالأغلبية العظمى من الأساتذة البارزين والقادة الحكوميين والمفكرين ورجال الأعمال الناجحين هم من خريجي الولايات المتحدة وثمرة أساليبها التدريسية المتقدمة وعلى سبيل المثال للاستفادة من هذه الخاصية في التعليم الأمريكي، قررت دولة قطر أن تنفق جزءاً كبيراً من عائدات البترول على التعليم والصحة ففي عام 1996 تم افتتاح الأكاديمية القطرية يليها برنامج الجسر الأمريكي لإعداد الطلبة لتعليم جامعي عالي المستوى ثم قامت قطر بتوجيه دعوة إلى عدد من الجامعات الأمريكية لفتح فروع لها على أراضها مثل كورنل، فيرجينيا كومنولث، تكساس ايه اند ام، وكارينيجى ميلون كان الهدف هو الاستفادة من التعليم الأمريكي لتحسين الجامعات الحكومية في قطر وحديثاً قامت جامعة بوسطن بافتتاح كلية لطب الأسنان في دبي ومن الجدير ذكره أن مؤسسات التعليم الأمريكية لم تُخفض شروط القبول أو تُقلل من مستوى المنهاج الذي يتم تدريسه خـــا تــمة إصلاح التعليم في الدول العربية من شأنه أن يُساهم في الاستقرار السياسي والنمو الاقتصادي ورفع مستوى الشعوب لذلك هناك متطلبان رئيسيان : أولاً، الاعتراف بشجاعة بأن الوضع القائم حالياً لا يساهم في تنمية عقول الجيل الناشئ ليقوموا بما هو مطلوب منهم، وثانياً، الرغبة السياسية والوطنية بتطبيق التغييرات المقترحة من أجل هذا لابد و أن تكون هناك شراكة مستدامة بين الحكومات والقطاع الخاص والمجتمع المدني ويجب أن يقوم المفكرون والقائمون على التدريس بالعمل جنباً إلى جنب لإنجاح هذه الشراكة هناك بُعد اجتماعي مهم لهذا كله ألا وهو نظرة المجتمع إلى أهمية التعليم والمعلومات فقد بُنيت الحضارة الإنسانية على المعرفة والعلم وتطبيقاتهما أما في العالم العربي، فقد أدى انتشار الثروات المادية إلى إعطاء أولوية للمال أكثر من العلم والمعرفة هذا الوضع يجب أن يتم عكسه ويجب إعطاء أولوية أعلى لأولئك الذين يستفيد من عِلمهم المجتمع المحلي والإنساني من المكونات الرئيسية لإصلاح التعليم في الجامعات هو التركيز على البحث العلمي وتخصيص ميزانية أعلى لدعمه أما في الدول العربية، فإن الحكومات تتعرض لضغوط ملحه لتوفير الطعام والمأوى لشعوبها، ولذلك يصبح الإنفاق على البحث العلمي في أسفل قائمة الأولويات وتكاد تكون ميزانية البحث العلمي من القطاع الخاص معدومة بينما في الدول المتقدمة، فالحال غير ذلك، حيث يساهم القطاع الخاص بنسبة كبيرة من ميزانية البحث العلمي على سبيل المثال، ينفق القطاع الخاص في أمريكا ضعف ما تنفقه الحكومة على البحث العلمي والتطوير إن الإنفاق على البحث العلمي ليس رفاهية، إنه الضمان للتنمية المستدامة التي تعزز النمو الاقتصادي وتساعد على إبراز أي دولة إلى قائمة الدول الرائدة لا يوجد شيء في الشخصية العربية يمنعها من التطور والتحصيل بل على العكس، فإن الحضارة العربية الإسلامية استمرت لثماني قرون على أكتاف الباحثين والعلماء والمخترعين في المجالات المختلفة لقد قام القادة العرب والمسلمون بفتح قلوبهم وعقولهم وحدود بلادهم لكل من ساهم في تطوير حضارتهم لقد بنوا المؤسسات التعليمية على كل المستويات، ودعموا مراكز الأبحاث لتضيف المزيد إلى كنوز المعرفة في كل المجالات وكان هناك تقدير للباحثين بسبب إضافاتهم للعلم بغض النظر عن عرقهم أو دينهم أو موطنهم ومن ضمن هؤلاء الباحثين برز مسلمون ومسيحيون ويهود من بلاد مختلفة ويجب على الذين يؤمنون بالعداء الطويل الأمد بين العرب واليهود مراجعة هذه الحقيقة التاريخية فعلى سبيل المثال، كان الفيلسوف موسى بن ميمون 1135-1204 يهودياً ولكن اسمه خُلِّد بِجدارة في التاريخ العربي والاسلامي لقد ولد في قرطبة، ودعمه الخلفاء وكتب أغلب روائعه باللغة العربية، وقد استُقبل بحفاوة عندما قدم إلى القاهرة ليمارس عمله طبيباً لصلاح الدين الأيوبي ولا تزال مؤلفاته مرجعاً حتى يومنا هذا لقد كانت المحافظة على المعرفة وزيادتها ونشرها السبب الرئيسي خلف نجاح الحضارة العربية الإسلامية واستمراريتها فبالنسبة لهم كانت المعرفة والعلم أمران عزيزان ويشكلان قيمة كبيرة بغض النظر عن منشأهما، وكانتا حقاً لكل إنسان إنه لمن الحتمي علينا تعلُم هذه الدروس المهمة من أجل تمهيد الطريق للجيل الجديد من العرب لتحقيق الحلم بمستقبل أفضل، ليساهموا في تطوير الحضارة الإنسانية المعاصرة ومن الضروري أن نتعلم من دروس الدول الناجحة، وأن نمضي للمستقبل بخطى ثابته وهذا النهج لن يكون ممكنا الا بالعلم والمعرفة إن تطويرنا لأمتنا العربية هو واجب وطني وقومي يضاهي في أهميته الدفاع عن الاوطان وحمايتها أيها العربانهضوا ---------------------------------------------------------- المراجع: United Nations Development Program 2003 The Arab Human Development Report 2003: Building a Knowledge Society New York: Regional Bureau for Arab States المؤلف: د فاروق الباز، عالم مصري معروف عالميا بانجازاته ومساهماته في برنامج أبوللو وذلك بتدريب رواد الفضاء وإخيار مواقع الهبوط على سطح القمر وكذلك دراساته لصحاري العالم من خلال الصور الفضائية والزيارات الميدانية عمل في عدة مؤسسات أبرزها وكالة الفضاء الامريكية ناسا وهو حاليا يعمل رئيسا لمركز الاستشعار عن بعد في جامعة بوسطن في الولايات المتحدة الامريكية وقد تم نشر النسخة الانجليزية لهذا المقال في مجلة The Journal of Education 2009 by the Trustees of Boston University ترجمة: د أنسام صوالحة، المدير المؤسس لمركز السموم والمعلومات الدوائية وأستاذ مشارك في علم الأدوية والسموم في كلية الصيدلة في جامعة النجاح الوطنية نابلس فلسطينhttp://blogs.najah.edu/staff/2396131/article/Discharge-Medications-Among-Ischemic-Stroke-SurvivorsPublished ArticlesBackground 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 669 127 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 = 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 http://blogs.najah.edu/staff/2396131/article/pharmacy-education-and-practices-in-West-Bank-Published ArticlesSweileh WM Sawalha AF Zyoud SH Al-Jabi SW Pharmacy education and practices in West-Bank Palestine Accepted for publication American Journal of Pharmaceutical Education2008 [Publisher: American Association of Colleges of Pharmacy Country where published: United state] In presshttp://blogs.najah.edu/staff/2396131/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 Blood 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 http://blogs.najah.edu/staff/2396131/article/Optimal-dosing-of-angiotensin-converting-enzyme-inhibitors-in-patients-with-chronic-heart-failurePublished ArticlesAnnals 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/2396131/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] PublishedAbstract 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 countriesLink: http:linkinghubelseviercomretrievepiiS1052-30570800148-1http://blogs.najah.edu/staff/2396131/article/Analysis-of-prescription-dispensed-at-community-pharmacies-in-Palestine-1Published ArticlesSawalha AF Sweileh WM Zyoud SH Al-Jabi SW Bni Shamseh FF Odah AA Analysis of Prescription dispensed at Community Pharmacies in Palestine Accepted at Eastern Mediterranean Health Journal 2009 [Publisher: Eastern Mediterranean Regional Office of the World Health Organization Country where published: Egypt] Accepted 18 January 2009 Abstract Background and Objective: Rational prescribing is a key element in clinical practice The present study investigated the prescription quality and prescribing trends of private clinicians in Nablus governate Palestine Method: Prescriptions were collected from a random sample of community pharmacies Data regarding a checklist of elements in the prescription as well as the types of drug classes prescribed were entered and analyzed using SPSS Result: A total of 363 prescriptions were collected from 36 community pharmacies during a study period of 288 working hours Physician related variables were mostly present However patients address and weight were absent in all prescriptions Less than half of the prescriptions included information regarding age and gender of the patient Information regarding strength of the medications prescribed was deficient in most prescriptions However other drug related variables like frequency and instruction of use were present in the majority of prescriptions Antimicrobial agents were the most commonly prescribed followed by NSAIDsanalgesics class Of the antimicrobial agents amoxicillin alone or in combination was the most commonly prescribed followed by cefuroxime Conclusion: In general prescription writing quality in Nablus Palestine is deficient in certain aspects and improvement is required Areas of further improvement include writing age and sex of patient as well as the importance of prescribing drugs by generic name Over-prescribing of antibiotics as well as other drug classes require close monitoring A pharmaco-epidemiology center is needed to monitor and enhance rational drug use http://blogs.najah.edu/staff/2396131/article/Self-Medication-with-AntibioticsPublished ArticlesSawalha AF Self-medication with antibiotics: A study in Palestine The International Journal of Risk and Safety in Medicine 2008; 204: 213-222Poison Control and Drug Information Center PCDIC An-Najah National University Nablus Palestine Abstract Objective: The objective of this study was to investigate self-medication practices with antibiotics among school teachers in Palestine Methods: A survey was conducted via a structured questionnaire among governmental school teachers regarding their practices and attitude toward antibiotics All data were entered and analyzed using SPSS 15 Results: A total of 1039 teachers completed and returned the questionnaire; giving a response rate of 649 Respondents were divided as follows: group I 194 were those who used antibiotics through self-medication only group II 124 used antibiotics by prescription only group III 447 used antibiotics by self-medication and prescription while those in group IV 233 were those who did not report using antibiotics in the past six months Antibiotic utilization among respondents was 767 in the past six months Respondents in the 4 groups had comparable demographic characteristics Respondents in group I were more likely 422 to administer antibiotics to children without medical consultation store antibiotic leftover 523 for further use stack antibiotics at home 597 to be used whenever needed and had the least attitude to finish the entire antibiotic course when prescribed to them 599 Across the four groups male and female respondents had comparable attitude toward antibiotic use except that males tend to store antibiotic leftover more than females while females tend to finish the entire antibiotic course when taken by self-medication more than males Respondents in groups I and III mainly consulted pharmacists on self-medication and obtained the antibiotics mainly from community pharmacy Penicillin was the major class utilized by respondent either by self-medication or by prescription in groups I 743 II 705 and III 689 Sore throat was the most common 303 clinical condition that respondents self-treat with antibiotics followed by symptoms of common cold 244 Conclusion: Our study showed that self-medication practices with antibiotics are common and that most of these practices were inappropriate These results should trigger health policy makers in Palestine to take action in order to prevent antibiotic misuse Public awareness about proper use of antibiotics is needed Furthermore strengthening pharmacy laws and pharmacy control over non-prescription sale of antibiotics is highly recommended http://blogs.najah.edu/staff/2396131/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/2396131/article/Predictors-of-in-Hospital-Mortality-after-Acute-Stroke-1Published ArticlesSweileh 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 mortalityIJCEM811001http://blogs.najah.edu/staff/2396131/article/Characterization-of-Hospitalized-Ischemic-Stroke-PatientsPublished ArticlesSawalha AF Characterization of Hospitalized Ischemic Stroke Patients in Palestine Accepted for publish at Libyan Journal of Medicine2008; 41 [Publisher: Directory of Open Access Journals Country where published: Libya] PublishedPoison Control and Drug Information Center PCDIC An-Najah National University Nablus Palestine Received for publication on 20 August 2008 Accepted in revised form 7 September 2008 Key words: ischemic stroke risk factors in-hospital mortality Palestine ABSTRACT Objective: Stroke is a major health problem yet no studies on stroke have been reported from Palestine This one-year hospital-based study was conducted to determine the prevalence of risk factors and the in-hospital mortality rate in patients with ischemic stroke Method: All patients admitted to Al-Watani government hospital and diagnosed with ischemic stroke between September 2006 and August 2007 were included in the study Data were obtained by retrospective review of medical charts Pearson Chi-square and independent t test were used in the univariate analysis Multiple logistic regression analysis was used to determine the independent predictors of in-hospital mortality rates among the patients Statistical testing and graphics were carried out using SPSS 15 Results: We identified 153 ischemic stroke patients 83 females and 70 males of whom 92 were having a first-ever stroke FES Patients had several prevalent modifiable risk factors such as hypertension HTN 66 diabetes mellitus DM 458 and renal reduced renal function crcl 60 ml min 339 Twenty-six 17 of the patients died during hospitalization Four variables were significantly associated with in-hospital mortality: history of previous stroke P= 0004 crcl at admission P=0004 number of post-stroke complications P=0001 and age P=0043 Multiple logistic regression analysis indicated that the number of post-stroke complications P= 0001 and previous stroke P=003 were significant independent predictors of in-hospital mortality Conclusion: Screening and better control of risk factors especially HTN DM and renal dysfunction are required to decrease the incidence and in-hospital mortality among patients with ischemic stroke ________________________________________Links: wwwljmorglyarticlesAOPAOP081120AOP081120pdfhttp://blogs.najah.edu/staff/2396131/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 http://blogs.najah.edu/staff/2396131/article/Complementary-and-alternative-medicine-in-PalestinePublished ArticlesSawalha AFComplementary and alternative medicine CAM in Palestine: use and safety implicationsJ Altern Complement Med 2007 Mar;132:263-9Abstract AIM: Utilization of complementary and alternative medicine CAM is exponentially rising There are no published data available about the attitude and use of CAM in Palestine The purpose of this study was to investigate the attitude pattern of use and reasons for CAM utilization among a random sample of people in north Palestine METHODS: A questionnaire was used to carry out the objective of the study The questionnaire was distributed to a random sample of people in north Palestine during the month of October 2005 The questionnaire included three sections: demographic factors and attitude toward CAM types of CAM encountered by the respondents in the last year and reasons that motivated CAM use Data collected from the returned questionnaire were coded and entered into the Statistical Package for Social Sciences program SPSS version 10 SPSS Software Inc Chicago IL RESULTS: 728 of respondents have used at least one type of CAM in the last year CAM users were mainly middle-aged low-income educated women Herbal therapy prayers and honey were the most commonly utilized types of CAM Respondents have used CAM mainly to treat respiratory and gastrointestinal disorders Respondents have utilized CAM mainly because they believed that it is all natural and safe DISCUSSION AND CONCLUSIONS: CAM utilization in Palestine is very common Some of the types of CAM used in Palestine are common elsewhere whereas other types were unique to this area The herbal products used by the respondents were mainly collected from nature Safety of such products is questionable and contamination cannot be ruled out Awareness of potential adverse effects and proven benefits of various types of CAM needs to be raisedhttp://blogs.najah.edu/staff/2396131/article/Pattern-of-Parenteral-Antimicrobial-prescription-among-PediatricPublished ArticlesSawalha A Al-Bishtawi G Al-Khayyat L Sweileh W Al-Ramahi R Jaradat N: Pattern of Parenteral Antimicrobial prescription among Pediatric patients in Al-Watani Government Hospital in Palestine An-Najah University Journal for Research N Sci vol 20 2006:193-208http://blogs.najah.edu/staff/2396131/article/Extent-of-potential-drug-interactions-among---patients-receiving-anti-hypertensive-medicationsPublished ArticlesSweileh WM Sawalha AF Jaradat NA Extent of potential drug interactions among patients receiving anti-hypertensive medicationsSaudi Med J 2005 Apr;264:548-52AbstractOBJECTIVE: To investigate the frequency of potential antihypertensive drug interactions among patients with cardiovascular diseases receiving antihypertensive medications METHODS: The study took place in Nablus Palestine starting April through October 2003 Patients with cardiovascular diseases n=876 or who were receiving one or more antihypertensive medications were evaluated All drugs prescribed for the patients were obtained from their medical files A drug interaction database was developed based on updated Drug Interaction Facts to examine potential and level of drug interactions in each patients regimen Data were entered and analyzed using SPSS software RESULTS: The number of unique pairs of potential drug interactions among the antihypertensive agents present in the data was 433 These included 16 cases 37 level one; 34 cases 78 level 2; 116 cases 268 level 3; 136 cases 314 level 4 and 131 303 level 5 interactions Both increasing age and number of drugs were significantly associated with the potential for significant interactions at all levels with a p value less than 0025 CONCLUSIONS: This study found a high frequency of potential drug interactions with agents typically used for hypertension Similar investigations need to be carried out among patients with other types of chronic diseases Drug interaction software might be necessary in governmental pharmacy departmentsLinks: http:catinistfr?aModele=afficheNcpsidt=16757796http://blogs.najah.edu/staff/2396131/article/Prescribing-pattern-of-angiotensin--converting-enzyme-inhibitors-and-beta-blockers-after-acute-myocardial-infarctionPublished ArticlesSweileh WM Shkokani FM Sawalha AF Al-Ramahi RJ Jaradat NA Zaid AA Barakat ASPrescribing pattern of angiotensin- converting enzyme inhibitors and beta blockers after acute myocardial infarction Saudi Med J 2005 Nov;2611:1837-9Absrtact: No abstract availableLinks: http:catinistfr?aModele=afficheNcpsidt=17338866http://blogs.najah.edu/staff/2396131/article/Cytochrome-P450-catalyzed-oxidation-of-hydroquinone-in-rodents-and-human-microsomesPublished ArticlesLau SS Sawalha AF Halpert JR Koop DR and Monks TJ: Cytochrome P450 catalyzed oxidation of hydroquinone in rodents and human microsomes The Toxicologist 36 23 1997http://blogs.najah.edu/staff/2396131/article/Isoform-specific-cytochrome-P450-mediated-oxidation-of-hydroquinonePublished ArticlesSawalha AF Monks TJ and Lau SS The Toxicologist 30 320 1996 http://blogs.najah.edu/staff/2396131/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/2396131/article/Drug-interactions-and-risk-of-bleeding-among-Patients-with-Atrial-Fibrillation-Published ArticlesSweileh WM Jaradat NA Elawee MM Al-Shakhsheer AM Sawalha AF Al-Ramahi RJ and Zaid AN Drug interactions and risk of bleeding among Patients with Atrial Fibrillation AF discharged with warfarin An-najah Univ journal for Research N Sci Vol 20 2006:127-134http://blogs.najah.edu/staff/2396131/article/article-1Published ArticlesSawalha AConsumption of Prescription and non-Prescription Medications by Pregnant Women: A Cross Sectional Study in Palestine The Islamic University Journal Series of Natural Studies and Engineering Vol15 No 2 pp 41-57 AbstractBackground and aims: Maternal intake of medications and supplements has changed over time and it may be related to adverse reproductive outcomes The purpose of this study was to evaluate the extent of utilization of supplements medications and herbs by pregnant women in Palestine and the expected effects Methods: Pregnant women attending the prenatal clinic at Rafedia Governmental Hospital at NablusPalestine were interviewed using a questionnaire containing questions regarding medications intake and disease status Data obtained from pregnant women were entered and analyzed using Statistical Package for Social Sciences SPSS version 10 Results: Of the pregnant women attending Rafedia prenatal clinic 702 were village residents 899 of them had no chronic diseases at the time of pregnancy except for anemia which was a common condition More than half of the pregnant women did take vitamins iron and calcium 564 633 578 respectively during pregnancy Less than fifty percent of the pregnant women took folic acid Nausea and vomiting were common but most women did not take any medications to treat it Less than one third of the pregnant women took over the counter OTC medications mainly analgesics and more than two thirds took prescription only medications POM mainly antibiotics Mean medication intake per pregnant woman was 1609 Most of the women who took medications did take only one 445 a lesser percentage took two 308 or more 93 medications The medications taken belonged to categories B and C and few belonged to category D About 45 of pregnant women used herbal medications to treat mainly GIT problems such as upset stomach diarrhea and constipation The majority of pregnant women in this study did not visit a dentist during their pregnancy Discussion and Conclusion: In this study utilization of OTC POM and herbal medications was common among pregnant women Not all women received supplements particularly folic acid The majority of pregnant women were anemic yet they did not take iron as they should Women and health care providers nee d to be educated about the importance of supplement intake during pregnancy Self-medicating or doctors prescriptions of POM OTC and herbal medications during pregnancy support the importance of expanding the knowledge about the potential risks and benefits of such treatmentsLinks: http:wwwiugazaedupsenresearcharticleaspx?article_id=1289http://blogs.najah.edu/staff/2396131/article/Prevalence-of-reduced-renal-function-among-diabetic-hypertensive-patientsPublished ArticlesSweileh WM Sawalha AF Zyoud SH Al-Jabi SW Nasr Y Shraim Prevalence of Reduced Renal Function among Diabetic Hypertensive Patients Accepted for publish at International Journal of Physiology Pathophysiology and Pharmacology2009; 11: 23-29 [Publisher: e-Century Pub Corp Country where published: United States] PublishedAbstract: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 elder had higher number of chronic diseases and had longer duration of diabetes and hypertension than those with CrCl 60ml min c Men had a higher prevalence of reduced renal function than women d Significant predictors of reduced renal function were older age duration of diabetes and number of chronic diseases based on logistic regression analysis Early and continuous screening of renal function among diabetic hypertensive patients is required to implement preventable strategies of end stage renal disease ESRD Better control of blood pressure and diabetes mellitus are important IJCEM811001Links: http:wwwijppporgfilesIJPPP811001pdfhttp://blogs.najah.edu/staff/2396131/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/2396131/article/Antidote-stocking-at-hospitals-in-north-PalestinePublished ArticlesSawalha AF Sweileh WM Zyoud SH Al-Jabi SW Antidote Stocking at Hospitals in North Palestine Online Journal of Health Allied Science2006;54 [Publisher: Directory of Open Access Journals Country where published: India] PublishedAbstractObjective: The purpose of this study was to determine the availability and adequacy of antidote stocking at hospitals in north Palestine based on published guidelines for antidote stocking Methodology: This study is a cross sectional survey of all hospitals at north Palestine n=11 using a questionnaire which was completed by the director of the pharmacy department at each hospital The questionnaire was divided into 2 parts The first part contained a list of 25 antidotes while the second part contained a list of 12 antidotes This classification is based on the guideline proposed by the British Association for Emergency Medicine BAEM The net antidote stock results were compared with the American guidelines as well Result: The overall availability of each antidote in the first list varied widely from zero for glucagon to 100 for atropine The number antidotes of the first list that were stocked in the 11 hospitals ranged from 5 to 12 antidotes but none of the hospitals stocked all the 25 antidotes Additionally availability of antidotes in the second list varied widely from zero for polyethylene glycol to 100 for dobutamine The number of antidotes stocked ranged from 5 to 9 but none of the hospitals stocked all the 12 antidotes Discussion and Conclusion: hospitals in north Palestine do not have adequate stock of antidotes Raising awareness of the importance of antidotes by education regular review of antidote storage distribution plans and appropriate legislation might provide solutions Coordination between Palestinian hospitals and the PCDIC at An-Najah National University is also importanthttp://blogs.najah.edu/staff/2396131/article/Admission-blood-glucose-levels-a-potential--indicator--for-short-term-mortality-and-morbidity-after-myocardial-infarctionPublished ArticlesSweileh WM Sawalha AF Salfeete S Zyoud SH Abu-Taha AS Al-jabi SW Jaradat NA and Zaid AA Admission Blood Glucose Levels a Potential Indicator for short term Mortality and Morbidity after Myocardial Infarction International Journal of Diabetes in Developing Countries 2006 26 3: 116-121 [Publisher: Directory of Open Access Journals Country where published: India] PublishedAbstract Aims : 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/2396131/article/A-descriptive-study-of-self-medication-practices-among-Palestinian-medical-and-non-medical-university-studentsPublished ArticlesA descriptive study of self-medication practices among Palestinian medical and nonmedical university students Sawalha AFA descriptive study of self-medication practices among Palestinian medical and nonmedical university studentsRes Social Adm Pharm 2008 Jun;42:164-72AbstractBACKGROUND: The implications of self-medication practices are increasingly recognized around the world; however little has been reported on the extent of self-medication practiced in Palestine OBJECTIVE: To determine the reasons extent and correlates of self-medication practices among university students in Palestine METHODS: A self-administered questionnaire eliciting self-medication practices was distributed to university students in a cross-sectional design The 4 variables sex type of school self-care orientation and medication knowledge were investigated for possible correlation with self-medication practices Multiple logistic regression and Chi-square statistics were used in data analysis RESULTS: Self-medication practices were reported by 98 of the surveyed students n=1581 Approximately two thirds of the respondents reported a high self-care orientation and one third reported \good\ medication knowledge Multiple logistic regressions indicted that self-care orientation medication knowledge and sex were insignificant predictors of self-medication practices whereas the type of school P=012 was a significant predictor A significant relation between the 4 variables and the type of therapeutic class used in self-medication was observed For example males were more inclined to use antiallergic medications OR=148 than females Medical students were more likely to use laxativesantidiarrheal agents OR=149 than nonmedical students Respondents with high a self-care orientation were more inclined to use headache relievers OR=222 compared to those with low self-care orientation The most commonly reported reason for self-medication practices was simplicity of the illness encountered CONCLUSION: Self-medication practices were common among the university students studied Sex type of school self-care orientation and medication knowledge are important personal factors that are associated with the selection of certain types of therapeutic classes used in self-medicationlink: http:linkinghubelseviercomretrievepiiS1551741107000307http://blogs.najah.edu/staff/2396131/article/article-3Published ArticlesSawalha AFPoison Control and the Drug Information Center: the Palestinian experience Isr Med Assoc J 2008 Nov;1011:757-60Abstract Poison Control and Drug Information Center An-Najah National University Nablus Palestine ansam@najahedu BACKGROUND: The Palestinian Poison Control and Drug Information Center was established in 2006 to provide up-to-date information on medications and to help in the early diagnosis and management of poisoning cases OBJECTIVES: To summarize the activities carried out by the PCDIC in the past 2 years METHODS: Documented inquires received at the PCDIC were analyzed and the Center\\\s activities were extracted from the files RESULTS: During the first 2 years of the Center\\\s existence 323 enquiries were received mainly 672from physicians; 70 of the calls were from the city of Nablus Unintentional poisoning was the leading type of call 628 followed by suicidal poisoning 207 Medications were the major category of toxicants encountered 489 followed by pesticides 235 In 679 of the cases the calls were initiated before any treatment was provided The advice provided by the PCDIC was based on the nature of the call During these 2 years the PCDIC has conducted both academic and non-academic activities The Center introduced the concept of poison prevention weeks in Palestine and has conducted two so far The PCDIC has published several articles in the fields of toxicology rational drug use complementary and herbal therapy pharmacoepidemiology and self-medication CONCLUSIONS: Documentation of all enquiries is mandatory for analysis evaluation comparative purposes and quality assurance More information campaigns are needed to encourage people to use the services provided by the PCDIClink: http:wwwimaorgilimajdynamicwebArtFromPubmedasp?year=2008month=11page=757http://blogs.najah.edu/staff/2396131/article/Storage-and-utilization-patterns-of-cleaning-products-in-the-homePublished ArticlesSawalha AFStorage and utilization patterns of cleaning products in the home: toxicity implicationsAccid Anal Prev 2007 Nov;396:1186-91AbstractBACKGROUND AND AIMS: Cleaning products are used to achieve cleaner homes However they have been responsible for a considerable number of poisoning cases The aims of this study were to investigate the storage and utilization patterns of cleaning products in the home as well as the risk of adverse and toxic effects produced by them METHODS: This study has been performed using a questionnaire that was developed by the Poison Control and Drug Information Center PCDIC The questionnaire was distributed randomly in northern Palestine The questionnaire included questions regarding storage utilization habits and the adverse effects experienced by respondents upon handling the cleaning products RESULTS: All respondents utilized and stored cleaning products in their homes Chlorine bleach and acidic cleaning products were the most common Respondents stored cleaning products at different places in their homes but most of those storage places were suboptimal and were within the reach of children The daily utilization rate of cleaning products was 16-08 with chlorine bleach being the most commonly used Of the respondents 27 reported experiencing a wide range of acute adverse and toxic effects resulting from cleaning product use and that exposure occurred mainly via inhalation Caustic substances bleach and kerosene were the agents mainly involved in producing these adverse and toxic effects About half of those who experienced adverse and toxic effects sought medical help and 22 of them were children younger than 6 years of age Finally most respondents reported mixing and discarding cleaning product leftovers and their containers improperly CONCLUSION AND RECOMMENDATIONS: Correct utilization and safer storage of cleaning products is encouraged Several preventive strategies should be implemented in order to decrease the incidence of accidental harmful exposure that is due to cleaning agents The role of the PCDIC is very important in the education prevention and management of cleaning product-induced adverse effectsLinks: http:wwwncbinlmnihgovpubmed17920842http://blogs.najah.edu/staff/2396131/article/article-6General Posts1 نظرا\ لبدء فصل الصيف وإرتفاع درجات الحرارة ونظرا\ لازدياد حالات لدغات الأفاعي وشح العلاج الخاص بها في المنطقة، فأننا نهيب بكم إجراء ما يمكنكم من أجل الحد من حدوث الاصابات وذلك بالقضاء على الاسباب التي بدورها جذب الأفاعي الى الأماكن السكنية وبالذات الفئران ومخلفات الأطعمة وكذلك ازالة الاشواك وغيرها من المقتنيات من جوانب الطرق لمنع اختباء الافاعي تحتها 2 الاسعافات الأولية في حالة لدغة الأفعى بناءً على أحدث التوصيات العالمية وقاعدة بيانات مركز السموم هي كما يلي a غسل مكان اللدغة بالماء لكي لا يدخل السم الموجود خارج الجرح الى داخله b لا مانع من ترك مكان اللدغة ينزف لمدة لا تتجاوز الدقيقة لخروج بعض السم ومن ثم يجب الضغط على مكان اللدغة لايقاف النزيف c عدم تحريك المصاب وعدم السماح له بالمشي أو الركض وعدم اعطاؤه أية أدوية d نقل المصاب الى أقرب مركز صحي 3 استخدم الناس في الماضي عدة وسائل للاسعاف الأولي أثبتت الدراسات ضررها وعدم فائدتها لذا ننصح بعدم استعمالها وهي كما يلي: a جرح مكان اللدغة ومص السم: طريقة خاطئة نظرا لقلة فائدتها وكثرة مضاعفاتها b وضع الثلج على الجرح: طريقة خاطئة بسبب جعلها السم يتركز في مكان محدود مما يؤدي الى تدمير الانسجة في ذلك المكان c ربط قبل وأو بعد مكان اللدغة: ممنوعة لعدم فعاليتها ولمضاعفاتها الجانبية 4 لوحظ أن بعض النباتات السامة موجودة في المتنزهات ومنها نبات الدفلة Oleander وست الحسن Atropa belladona وهذة النباتات سامة للجميع وبخاصة للأطفال نظرا\ لطبيعتهم الاستكشافية وتواجدهم بكثرة في هذة الأماكن، وكذلك هناك نمو لنبتة قفاز الثعلب Foxglove بشكل تلقائي على أطراف الشوارع جميع النباتات المذكورة جميلة المنظر ولكنها سامة، لذا نرجو من طواقم البلديات والمسؤولين في الوطن التخلص منها واستبدالها بنباتات غير سامة في حال وجود استفسارات بهذا الخصوص فيمكنكم الاتصال على مركز السموم والمعلومات الدوائية في جامعة النجاح الوطنية على الرقم المجاني 1800-500-000 http://blogs.najah.edu/staff/2396131/article/article-4General Postsبعد الازدياد المستمر في ارتفاع اعداد المصابين بهذا المرض و تنوع الاماكن الجغرافيه التي يتواجد فيها، اصبح من الضروري نشر التوعية للمواطنين و الطواقم الطبية ما هي انفلونزا الخنازير؟ انفلونزا الخنازير هو مرض يصيب الجهاز التنفسي الذي يسببه فيروس الانفلونزا من نوع H1N1 والذي تم اكتشافه عام 1930 وهو يصيب الخنازير دائما وخاصة خلال فصلي الشتاء و الخريف كم نوعا من انفلونزا الخنازير يوجد حاليا؟ يتمتع هذا الفيروس بالقدرة الدائمة على التغير تتعرض الخنازير للاصابة بفيروس انفلونزا البشر و فيروس انفلونزا الطيور وكذلك فيروس انفلونزا الخنازير و عند حصول عدوى باكثر من نوع من الفيروسات فان هذه الجراثيم قد تختلط و تتبادل المادة الوراثية فيما بينها منتجة نوعاً جديداً من الفيروسات التي تمتلك صفات من الفيروسات الثلاثة و لغاية آلان تم عزل اربعة أصناف من هذه الفيروسات وهي H1N1، H1N2، H3N2،H3N1 ومن الجدير ذكره أن H1N1 هو الذي تم عزله من المصابين بانفلوننزا الطيور هذا العام هذا العام هل يصاب البشر بانفلونزا الخنازير؟ عادة لا يؤثر هذا الفيروس على البشر ولكن نظراً للتغيرات الجينية المستمرة في هذا الفيروس فقد أصبح قادراً على اصابة البشر خاصة العاملين في حظائر الخنازير والاشخاص الذين يقتربون من الخنازير لاي اسباب اخرى ما مدى انتشار الفيروس بين البشر؟ في الماضي كان هذا المرض يصيب شخص كل سنتين كان اغلبهم ممن يتواجدون حول الخنازير ولكن في عام 1988 حصلت اول عدوى مؤكدة بين مريض و افراد الطاقم الطبي الذين يعتنون به ما هي اعراض هذا المرض عند الانسان؟ اعراضه تشبه الانفلونزا التقليدية حيث يؤدي الى ارتفاع في الحرارة و كسل وخمول و فقدان في الشهية وسعال و آلام في الحلق و احتقان في الانف و غثيان و تقيوء و اسهال وآلام في المفاصل والعضلات هل يُصاب الانسان اذا أكل لحم الخنزير؟ كلا ، لا ينتقل عن طريق الطعام ولا عن طريق المنتجات الغذائية كيف يتنقل مرض انفلونزا الخنازير؟ ينتقل الفيروس مباشرة من الخنازير للبشر و من البشر للبشر وكذلك من البشر للحيوانات و تحدث العدوى على الاغلب كما في حالة الانفلونزا التقليدية، الا و هو من خلال الرذاذ الناتج عند السعال او العطس من الاشخاص المصابين وقد يصاب الناس كذلك عند لمسهم الاشياء الملوثة بهذا الفيروس و من ثم لمسهم لانفهم او فمهم ما هي العلاجات المستعملة لعلاج انفلونزا الخنازير؟ كان هناك اربعة اصناف من الادوية تستخدم لعلاج هذا المرض، ولكن في مكافحة هذه الموجة من العدوى هناك عقارين فقط ذات فعالية وهما TamifluوRelenza والذين يحتويان على Oseltamivir و Zanamivir على التوالي ويمكن استخادمهما للوقاية او العلاج؟ ما هي الوسائل اللازم اتباعها للوقاية من هذا المرض؟ من اهم الممارسات هي غسل اليدين بشكل جيد اكثر من مرة في اليوم وتجنب استخدام اغراض الشخص المصاب و يجب استعمال اوراق المحارم عند العطس والسعال ومحاولة الابتعاد عن المصابين والحيوانات ولبس كمامة للفم وللانف للتنفس من خلالها و في حالة اصابة شخص فيجب البقاء في البيت او مراجعة المستشفى طلبا للعلاج وعدم الاختلاط بالناس الاخرين هل يوجد لقاح للبشر للوقاية من هذا المرض ؟ لا يوجد لقاح لحماية البشر من هذا المرض، و قد يحتاج تطوير لقاح للبشر الى فترة اربعة اشهر او اكثر http://blogs.najah.edu/staff/2396131/article/Dangers-of-Broken-Energy-Saving-Light-BulbsGeneral PostsThe use of energy-saving light bulbs ESLBs has increased lately due to the economic situation and a desire to save on the electricity bill Dr Ansam Sawalha director of PCDIC states that such ESLBs contain the toxic heavy metal mercury which as is common knowledge is a toxic element that produces adverse health effects for humans in addition to the environment If an ESLB is broken the mercury can leak into the environment causing its toxicities to become exposed and take effect Thus it is of great importance to discard of a broken ESLB properly Stringent caution should be exercised when ESLBs are replaced and handled so as to not run the risk of breakage Dr Sawalha emphasizes that there are guidelines to be practiced when cleaning the debris of broken ESLBs For example using a vacuum cleaner is contraindicated for cleaning broken ESLBs since this can lead to mercury contamination of the vacuum spreading into mercury vapor Mercury should never be dumped in the municipal sewer system via any avenue toilet sink drain etc In the case of mercury being spilled on clothing it should never be washed in the washer since it will lead to contamination of the washing machine itself in addition to that of the waste water system Safe practices for exposure to mercury include: opening windows and ventilate room for 15 minutes not walking on the contaminated area and closing the central air conditioning units if present Cleaning the floor: - For solid floor such as tile the broken ESLB should be collected using cardboard or plastic and discarded of in a glass container or plastic bag A piece of wide tape should be used to collect the small broken pieces and the powder remnants and then a wet cloth should be used to wipe the area clean All items used in the cleaning process should be placed in a plastic bag or glass container that should be sealed and closed tightly - For carpet-covered floor the broken glass should be collected by picking it by gloved hands and then disposed of in a glass container or plastic bag A piece of wide tape should then be used to pick up any remaining glass pieces and powder Finally a vacuum cleaner should be used to clean the carpet The bag of the vacuum cleaner and the wide tape should all be placed in the glass container or a plastic bag which should then be sealed tightly If the ESLB was broken on a piece of cloth or bed cover all of the pieces should be discarded of All items contaminated with mercury should be placed in the skip for regular trash pick up The PCDIC is concerned about the safety of the citizens and environment of Palestine and it strongly requests the responsible agencies to set standards to collect recycle andor dispose these light bulbs accordingly http://blogs.najah.edu/staff/2396131/article/Caution-to-Citizens-of-Gaza-to-Refrain-from-Tampering-with-Remnants-of-Israeli-IncursionGeneral PostsBecause of the possibility that some material left over from the war in Gaza may be toxic or explosive especially in the areas that were heavily bombed the PCDIC emphasizes that citizens should refrain from touching or coming into contact with leftover remnants of the incursion The danger they pose could have a delayed reaction whether acute or chronic and could explode or produce toxicity at any time and pose an even greater danger if touched As for white phosphorus it is important to remember that it can ignite again-even after the fire has been put out- whenever it is in contact with oxygen This could lead to signs and symptoms of toxicity including irritation of eyes and nose difficulty breathing and others Burns could result if phosphorus is touched or carried by bare hands Exposure to white phosphorus could possibly lead to short or long term effects Among the long term effects of exposure to phosphorus is phossy jaw; while other long term effects remain uncertain The PCDIC recommends that all anonymous objects and remnants of war be collected and disposed of properly by the agencies in charge in order to protect human safety and the environmenthttp://blogs.najah.edu/staff/2396131/article/up-to-date-guidelines-for-the-treatment-of-white-phosphorus-poisoning-General PostsDr Ansam Sawalha; Director PCDICDr Saed Zyoud; Poison Information SpecialistPhosphorus comes in many forms including toxic and non-toxic and is used in many venues currently There is red white yellow and black phosphorus White and yellow phosphorus has emerged since their use in fireworks ammunition rodenticides and others White phosphorus has received increased attention lately due to its use in war It is considered a toxic and dangerous chemical with a garlic-like odor It burns immediately upon contact with oxygen producing fire and a dense white smoke This can further produce phosphine gas that is also toxic If a populated area gets exposed to white phosphorus residents can get poisoning by inhalation ingestion or skin contact This article will focus on the signs and symptoms and treatment of white phosphorus after inhalation or skin contactAdverse health affects that result from contact with white phosphorus:Eye and nose: conjunctivitis irritation lacrimation and corneal damageHeart: tachycardia arrhythmia heartblock and shockRespiratory system: upper respiratory tract irritation cough difficulty breathing tachypnea pulmonary edema and bronchitisSkin: sever pain necrosis second or third degree burns that are yellowish and smell like garlicCentral nervous system: headache seizures delusions fatigue nervousness dizziness general weakness and comaGastrointestinal system: nausea vomiting could be bloody abdominal pain diarrhea and smoke-smell being produced from vomitus and stoolGenitourinary system: blood in urine and renal failureCirculatory system: abnormal lab results for blood analysisTREATMENT:Inhalation Exposure: Move patient from the toxic environment to fresh air If cough or difficulty in breathing develops evaluate for hypoxia respiratory tract irritation bronchitis or pneumonitis Administer 100 humidified supplemental oxygen perform endotracheal intubation and provide assisted ventilation as required Administer inhaled beta adrenergic agonists if bronchospasm develops Exposed skin and eyes should be flushed with copious amounts of waterEye Exposure: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 09 saline or water for at least 15 minutes If irritation pain swelling lacrimation or photophobia persists after 15 minutes of irrigation an ophthalmologic examination should be performed Keep exposed eyes covered with wet dressings until definitive surgical removal of phosphorus can be accomplishedDermal Exposure: Brush all non-adherent phosphorus from the skin Avoid application of any lipid based ointments as these may increase the skin penetration of phosphorus Remove clothing and promptly begin continuous water irrigation of the affected site Water or saline-soaked dressings applied to the affected area will allow the patient to be transported without re-ignition of the remaining particles Keep dressing moist until debridement is accomplished Phosphorus will fluoresce under ultraviolet light With the exposed areas immersed in water loose or imbedded phosphorous particles that are visualized under UV light can be mechanically but delicately removed safely under water Traditionally copper sulfate solution has been topically applied to skin burns caused by yellow phosphorus The rationale for the use of copper sulfate is based on a chemical reaction that binds up the phosphorus thereby preventing further burning due to phosphorus oxidation The granules of Cu3P2 are black and decompose easily CAUTION - Acute renal failure and massive hemolysis may occur if significant copper sulfate is absorbed from the burn site A solution of 5 percent sodium bicarbonate 1 percent hydroxyethyl cellulose 3 percent copper sulfate and 1 percent lauryl sulfate has been proposed as a decontaminating agent For deep and extensive injury consult a burn specialist Partial skin thickness burns from a phosphorus pentachloride splash were treated with 1 silver sulfadiazine cream twice daily Healing was slow 8 weeks and painful and no signs of hypertrophic scarring were evident at follow-up Fluid and electrolytes should be replenished when indicated Prophylactic topical antibiotic therapy with silver sulfadiazine is recommended for all burns except superficial partial thickness first-degree burns For first-degree burns bacitracin may be used but effectiveness is not documented Systemic antibiotics are generally not indicated unless infection is present or the burn involves the hands feet or perineum Depending on the site and area the burn may be treated open face ears or perineum or covered with sterile nonstick porous gauze The gauze dressing should be fluffy and thick enough to absorb all drainage Alternatively a petrolatum fine-mesh gauze dressing may be used alone on partial-thickness burns Other signs and symptoms are treated based on the used protocols toxicology