E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant factors.

BACKGROUND: Recent reports indicated accelerated rates of e-cigarette use, especially among youth in various Middle Eastern countries, including Palestine. Nevertheless, little is known about knowledge, attitudes, and perceptions regarding this topic in Palestine. This study aimed to assess the prevalence of e-cigarette use among Palestinian university students, along with their knowledge, attitudes, and perceptions about e-cigarette use. METHODS: An observational cross-sectional study, utilizing an online self-administered questionnaire, was conducted on Palestinian students from five universities between 17/04/2023 and 04/11/2023. RESULTS: A total of 1002 Palestinian university students completed the questionnaire. The prevalence of e-cigarette use among students was 18.1%. The mean knowledge score about e-cigarettes was significantly lower among the users of e-cigarettes compared to non-users. E-cigarette use was significantly associated with the participants' smoking status. Among e-cigarette users, 43.6% were also current traditional cigarette users, and 66.9% were current waterpipe users. E-cigarette use was significantly associated with having a friend who is a smoker and/ or a smoking mother. Binary logistic regression revealed a significant positive effect between the participant's smoking status, the mother's smoking status, knowledge about e-cigarettes, and the use of e-cigarettes (p-value < 0.05). Among e-cigarette users, 18.8% used them in indoor places at the university, and 25% reported using them daily in the past month. Affordability of e-cigarettes was the most reported reason for their use (47.5%). CONCLUSION: This study concluded that e-cigarette use is prevalent and rapidly rising among university students in Palestine. This is worrisome as it is significantly associated with insufficient knowledge about the adverse health effects of E-cigarette use, and its addictive nature. These findings focus on the importance of improving the students' knowledge about e-cigarette use by implementing educational campaigns and considering age regulations on e-cigarette availability and use.

Epidemiology of primary brain tumor among adolescents and adults in Palestine: a retrospective study from 2018 to 2023.

BACKGROUNDS: Primary brain tumors (PBTs) are uncommon, but they significantly increase the risk of disability and death. There is a deficiency of data concerning the epidemiology and anatomical distribution of PBTs among adults in Palestine. METHODS: A retrospective descriptive study in which data were collected from the clinical reports of Palestinian patients diagnosed with PBTs at Al-Makassed Hospital during the period (2018-2023). RESULTS: In Palestinian adolescents and adults, the incidence rate of PBTs was 3.92 per 100,000 person-years. Glioblastoma (18.8%) was the most common type identified, and it was more common in males. Non-malignant tumors were more common than malignant tumors (2.41 vs. 1.52 per 100,000). The mortality rate from PBTs was 4.8%. The most common initial symptom was headaches, and it occurred more with non-malignant tumors (57.28% vs. 42.72%, p-value < 0.001). Cerebral meninges (26.3%) were the most common location for primary brain tumors (p-value < 0.001). CONCLUSION: This is the first study of primary brain tumor epidemiology in Palestine. The overall incidence of PBTs in Palestinian adolescents and adults was 3.96 per 100,000, which was lower than the incidence rate of primary brain tumors worldwide. More studies on the epidemiology and distribution of PBTs in Palestine are recommended.

Evaluation of knowledge and attitudes regarding Alzheimer's disease and related dementia among medical students in Palestine: A cross-sectional study.

INTRODUCTION: Dementia, a major global health concern, is an acquired disorder that causes a progressive decline in cognitive abilities, affecting learning and memory, language, executive function, complex attention, perceptual-motor skills, and social cognition. Our study aims to evaluate the knowledge and attitudes regarding dementia and Alzheimer's disease among medical students. METHODS: This cross-sectional study was conducted among 393 medical students in Palestine from August 2023 to November 2023. The assessment of knowledge and attitude toward dementia was measured using the Alzheimer's Disease Knowledge Scale (ADKS) and Dementia Attitude Scale (DAS). The data were analyzed using SPSS version 26, and the Mann-Whitney U-test and the Kruskal-Wallis test were used to compare the mean between the groups with a 5% significance level. RESULTS: The overall mean score of the student's knowledge of dementia measured by the ADKS was 18.91 (±3.32 SD) out of 30. The mean score of the student's attitude toward dementia measured by the DAS was 91.68 (±3.32 SD). Clinical students had higher ADKS scores than pre-clinical students (p-value < 0.001). No significant differences in the knowledge and attitudes toward dementia were found between males and females. The medical students' knowledge and attitude scores were positively correlated (ρ = 0.227, p-value <0.001). CONCLUSION: Palestinian medical student's knowledge about Alzheimer's disease and dementia is insufficient, with students in the clinical phase showing better understanding than pre-clinical students. The findings highlight a necessity for enhancing the dementia curriculum and conducting further studies to evaluate training's impact on students' knowledge and attitudes.

Epidemiology and Anatomical Distribution of Primary Brain Tumors Among Children in Palestine: A 6-Year National Referral Institution Study.

OBJECTIVE: To investigate the incidence rate of primary brain tumors (PBTs) among Palestinian children over a 6-year interval. This study also aimed to identify the predominant histopathologic types identified in these children. METHODS: This retrospective epidemiologic study focused on PBTs in children (<15 years) in Palestine. The data were collected from the registry system at Al-Makassed Hospital in Jerusalem, a prominent referral institution in Palestine and the largest center for PBTs in the region, over a 6 years period from 2018 to 2023. RESULTS: The incidence rate of PBTs in children (<15 years) was 1.33 per 100,000 person-years, with a 5% mortality rate. Pilocytic astrocytoma was the most common type (24%), followed by medulloblastoma (15.2%) and glioblastoma (6.3%). About one half of the tumors in children were malignant. Headaches were the most common first sign or symptom. About 20% of brain tumors in children were situated within the ventricles, making it the most prevalent location of these tumors, followed by the cerebellum (15.19%) and frontal lobe (11.39%). CONCLUSIONS: This is the first national study in Palestine investigating PBTs in children. The crude incidence rate of primary brain tumors among Palestinian children was lower than the incidence rate in many countries around the world. It is recommended that more research be done on the epidemiology and distribution of PBTs in children in Palestine.

Knowledge, perception, and attitudes of medical students towards antimicrobial resistance and stewardship: an observational cross-sectional study from Palestine.

BACKGROUND: Antimicrobial resistance is a global health concern that contributes to significant mortality and morbidity. This study investigated knowledge, perceptions, and attitudes of medical students in Palestinian universities towards antimicrobial resistance and stewardship. The study also investigated associations between variables of students with their knowledge, perceptions, and attitudes. METHODS: A questionnaire was used in this cross-sectional study. Medical students in Palestinian universities were surveyed in this study. In addition to the demographic variables of the medical students, the questionnaire measured knowledge, perceptions, and attitudes of medical students in Palestinian universities towards antimicrobial resistance and stewardship. RESULTS: In this study, 384 medical students returned complete questionnaires. Of the medical students, 269 (70.1%) were female, 215 (56.0%) lived in urban areas, and 244 (63.5%) were in their clinical training years. Medical students in the clinical phase demonstrated higher knowledge about microbial resistance compared to preclinical students as evidenced by a mean score of 89.7 ± 15.9 compared to 74.0 ± 26.4, respectively (p < 0.05). Similarly, clinical students displayed higher score regarding antimicrobial resistance perception, with a mean score of 85.7 ± 15.6, contrasted with 72.6 ± 24.1 among preclinical students. In terms of knowledge pertaining to antimicrobial stewardship, clinical students scored higher with a mean of 63.4 ± 28.5 compared to 54.5 ± 31.5 among preclinical students. Regarding attitudes, clinical students also demonstrated a higher mean score of 67.6 ± 22.6 in contrast to 61.1 ± 24.6 among preclinical students. CONCLUSION: The medical students are the future workforce of physicians in any healthcare system. Therefore, increasing knowledge of the medical students about and how to combat antimicrobial resistance can help save lives and improve patient outcomes. More studies are needed to find the best ways to increase knowledge, perceptions, and attitudes of medical students towards antimicrobial resistance and antimicrobial stewardship.

Assessment of genetic familiarity and genetic knowledge among Palestinian university students.

BACKGROUND AND AIMS: Genetic knowledge and familiarity among the population represent the lane toward effective participation in social decisions regarding genetic issues. This cross sectional research aimed to assess genetic knowledge and familiarity among university students in Palestine. METHODS: The familiarity with genetics was evaluated using the Genetic Literacy and Comprehension instrument (GLAC), and genetic knowledge was measured using a 16-item scale of prevalent genetic concepts. RESULTS: Among the 624 participants, 59.5% were females. 38.8% reported family history of genetic diseases. The genetic familiarity mean score was 4.83 and the genetic knowledge mean total score was 11.5. Students' genetic familiarity was high for the terms chromosome and genetic while it was low for the terms sporadic and vulnerability. Genetic knowledge was highest for gene definition while it was the lowest regarding the number of human genes. The age group, year of study, and learning genetic courses were the significant predictors of familiarity among medical students. The year of study, family history of genetic diseases, parental consanguinity, and learning genetic courses were the significant variables associated with genetic knowledge among medical students. Regarding the non-medical group of participants, all study variables were significant for both familiarity and knowledge scores except for age group with familiarity. CONCLUSION: Genetic familiarity and knowledge among Palestinian university students are inadequate. Consanguinity and hereditary disorders are prevalent in Palestine. These findings encourage university stakeholders to take action to improve genetic knowledge and familiarity among students through both appropriate pedagogical and non-pedagogical interventions.

Erdheim-Chester Disease with Renal Mass Presentation: Report of the First Case From Palestine and a Review of the Literature.

BACKGROUND Erdheim-Chester disease (ECD), a form of non-Langerhans-cell histiocytosis, is extremely rare. The mean age of individuals with ECD is in their 50s. Histiocytic infiltration of vital organ systems is a potential cause of substantial morbidity, which is associated with the multisystemic form of ECD. This report presents the first case of ECD with renal abnormalities in Palestine. CASE REPORT A 54-year-old woman with no medical or surgical history presented with 6 months of bilateral flank pain with no radiation or fever. A physical examination revealed only bilateral flank pain. Urine tests showed microhematuria. Laboratory test results showed increased serum creatinine levels (1.21 mg/dL) and microcytic anemia. A CT scan revealed significant multi-organ abnormalities, including renal abnormalities with a hairy kidney sign, pericardial effusion, and an osteolytic lesion of the spine. The hairy kidney sign is pathognomonic for ECD, so the renal mass was biopsied to confirm the diagnosis. The biopsy showed foamy histiocytes, lymphocytes, and plasma cells. Foamy histiocytes were CD68-positive and negative for S100, CD1a, and HMB45. PAx5 and CD3 immunostaining showed T-predominant B-lymphocyte mixtures. CONCLUSIONS In the setting of systemic symptoms and imaging abnormalities such as presence of the hairy kidney sign, pericardial effusion, and osteolytic lesion of the spine, it is necessary to examine the possibility of ECD and proceed with a biopsy for confirmation. This is the first case in Palestine to be reported and the second case worldwide with a renal mass as an atypical presentation.

Primary Malignant Rhabdoid Tumor of the Liver in a 5-Month-Old Female Who Presented with Abdominal Distension.

BACKGROUND Malignant rhabdoid tumors are rare and aggressive pediatric tumors that usually arise in the kidney and have a characteristic appearance on histology. Extrarenal malignant rhabdoid tumors originating in the liver are extremely rare. This report is of a 5-month-old girl who presented with a rapidly enlarging abdominal mass due to a malignant rhabdoid tumor of the liver. CASE REPORT A 5-month-old female patient with no known medical history had been experiencing increasing abdomen distention and less overall activity for 1 month, according to her parents. Abdominal ultrasonography was used for diagnostic purposes, and the results showed the presence of a mass with a solid and cystic appearance in the upper left quadrant of the abdomen. The patient was transferred to a tertiary care hospital for further investigations. The laboratory test results indicated a hemoglobin level of 8.2 g/dL, and the liver function tests were within the reference range. However, the serum tumor marker alpha-fetoprotein level was 1310 ng/mL, while the b-human chorionic gonadotropin was within range. Computed tomography detected a nonspecific heterogeneous mass of the liver. Histopathology revealed discohesive cells with rich eosinophilic cytoplasm, eccentric nuclei, and large central nucleoli (rhabdoid appearance). Immunohistochemistry showed negative integrase interactor 1 protein expression. The diagnosis was a primary malignant rhabdoid tumor located in the liver. CONCLUSIONS This report shows the importance of combined diagnostic imaging and histopathology analysis to confirm the diagnosis of rare pediatric tumors, including malignant rhabdoid tumor, to ensure early diagnosis and appropriate treatment.

Assessment of epilepsy awareness, knowledge, and attitudes among preclinical and clinical medical students in the West Bank of Palestine.

OBJECTIVE: The purpose of this research was to evaluate the level of epilepsy-related awareness, knowledge, and attitude exhibited by medical students at a specific medical school in Palestine, as well as the students' reactions to the treatment and social activities provided to patients with epilepsy. METHODS: A cross-sectional, observational research of 306 medical students at An-Najah National University in the West Bank, Palestine, was conducted. We used a validated survey taken from previous publications. We split the medical students into preclinical (2nd and 3rd year) and clinical (4th, 5th, and 6th year) groups to see if there were significant differences in their awareness, knowledge, attitude, and their practices toward patients with epilepsy. Several elements, such as sociodemographics, awareness, knowledge, attitude, and practices regarding epilepsy, were included in the survey. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) 29.0. Quantitative data were expressed as mean and standard deviation, whereas qualitative data as frequencies and percentages. The chi-square test was used to compare groups.Any P-value below 0.05 was considered statistically significant. RESULTS: In general, clinical medical students exhibited better epilepsy awareness, knowledge, and attitude than preclinical students. Of note, 73.6% of clinical students believe epilepsy is a treatable disorder, compared to 44.6% of preclinical students (P-value < 0.001). Some students believe that depression/anxiety (39.6%), psychosis (35.7%), jinns (evil spirit) (7.8%), evil eye (5.8%), and punishment from God (4.5%) cause epilepsy. Clinical students were more likely than preclinical students to have rotated in a neurology clinic or department (40% vs. 4.6%, P-value < 0.001). In total, 95.5% of clinical students and 86.9% of preclinical students (P-value = 0.006) thought patients with epilepsy should marry. Clinical stage students were more likely than preclinical stage students to think that patients with epilepsy can have children (92.7% vs. 83.1%, P-value = 0.009). Preclinical stage students were more likely than clinical stage students to believe that students with epilepsy should not play sports (22.3% versus 13%, P-value = 0.030). Generally, there were no significant gender differences in awareness, knowledge, and attitudes. CONCLUSION: The study found that medical students knew little about epilepsy types, causes, triggers, and first aid. Negative attitudes toward people with epilepsy living alone and discrimination against people with epilepsy were also observed. Students' perceptions of this prevalent disease must be improved through educational programs that provide increased opportunities for clinical exposure to this condition as well as proper inclusion of epilepsy in the regular curriculum.

Biallelic mutations in the homeodomain of NKX6-2 underlie a severe hypomyelinating leukodystrophy.

Hypomyelinating leukodystrophies are genetically heterogeneous disorders with overlapping clinical and neuroimaging features reflecting variable abnormalities in myelin formation. We report on the identification of biallelic inactivating mutations in NKX6-2, a gene encoding a transcription factor regulating multiple developmental processes with a main role in oligodendrocyte differentiation and regulation of myelin-specific gene expression, as the cause underlying a previously unrecognized severe variant of hypomyelinating leukodystrophy. Five affected subjects (three unrelated families) were documented to share biallelic inactivating mutations affecting the NKX6-2 homeobox domain. A trio-based whole exome sequencing analysis in the first family detected a homozygous frameshift change [c.606delinsTA; p.(Lys202Asnfs*?)]. In the second family, homozygosity mapping coupled to whole exome sequencing identified a homozygous nucleotide substitution (c.565G>T) introducing a premature stop codon (p.Glu189*). In the third family, whole exome sequencing established compound heterozygosity for a non-conservative missense change affecting a key residue participating in DNA binding (c.599G>A; p.Arg200Gln) and a nonsense substitution (c.589C>T; p.Gln197*), in both affected siblings. The clinical presentation was homogeneous, with four subjects having severe motor delays, nystagmus and absent head control, and one individual showing gross motor delay at the age of 6 months. All exhibited neuroimaging that was consistent with hypomyelination. These findings define a novel, severe form of leukodystrophy caused by impaired NKX6-2 function.