Depression and death anxiety among patients undergoing hemodialysis during the COVID-19 pandemic in Palestine: a cross sectional study.

Background: Hemodialysis patients are vulnerable to serious complications such as prolonged hospital stay and psychosocial issues like depression and death anxiety. Studies on psychosocial factors on end-stage renal disease patients' outcomes during COVID-19 pandemic are limited. We aimed to determine the prevalence of depression and death anxiety among Palestinian hemodialysis patients and the evaluate the relationship between their sociodemographic and clinical characteristics during COVID-19 Pandemic. Methods: A cross-sectional study was conducted using a convenience sampling technique. We recruited 308 hemodialysis patients from five hemodialysis units located in government hospitals in Palestine. Beck Depression Inventory and the Templers Death Anxiety Scale were used to collect data, which were then analyzed using SPSS version 20. Descriptive statistics (frequencies and means), t-test, ANOVA and multiple linear regression models were used for data analysis. Results: Nearly 66.2% of the sample had depression symptoms, 61.4% met the diagnostic threshold for depression, and 69.8% had death anxiety. Furthermore, the multivariate analysis revealed that having a female identity, residing in a city or refugee camp, and patients who reported not experiencing depression had a significant relationship with death anxiety, while having a higher educational level than 12 years, having one or more chronic co-morbidities, and patients who reported experiencing death anxiety had a significant correlation with depression. Conclusion: Patients receiving hemodialysis frequently experience depression and death anxiety. These patients should receive a psychiatric evaluation in the early stages of their illness so that timely and appropriate psychological interventions can be given in hemodialysis facilities in Palestine during and after future pandemics.

Outpatients satisfaction and perceptions toward pharmaceutical services in public and private hospitals in Palestine: a cross-sectional study.

BACKGROUND: Pharmaceutical care is an essential component of healthcare services, and patient satisfaction with these services is crucial for improving overall health outcomes. We aimed to evaluate patient satisfaction and perception with pharmaceutical care services provided at public and private hospitals for outpatient pharmacies. This study can provide insights into the quality of pharmaceutical services provided in both settings and identify areas for improvement. MATERIALS AND METHODS: A cross-sectional 1-month study was conducted in three hospitals in Nablus city in the Northern District of West Bank, Palestine. Participants were a convenience sample of outpatients who attended the study-selected hospitals (two public and one private). A sample of 30 patients from each hospital was selected with a total of 90 patients. A self-administered questionnaire was used to assess socio-demographics pharmacist-related issues, waiting and working time, and medication availability. RESULTS: A total of 90 patients were recruited. The overall level of patient satisfaction with pharmaceutical health services was moderate with a mean of 3.24 out of 5. Females represented 58.9%. The most prevalent age was (30-39) years (30%). There was a statistically significant difference in patient satisfaction with pharmaceutical services regarding working time between the morning and evening shifts (p value = 0.009) in favor of morning shift. No statistically significant differences in satisfaction with pharmaceutical treatments based on socio-demographics (age, gender, marital status, education level, family income, employment status, and living place), were found. Nearly, 70% of patients indicated having problems getting the medicine on their last visit to the hospital pharmacy. Only 66.7% of patients expressed satisfaction with the pharmacies' operating (working) hours. CONCLUSIONS: Patient satisfaction with pharmaceutical care services could be enhanced by involving pharmacists in patient-oriented training and informing patients about the role of pharmacists. Patient satisfaction in the evening shift might be improved by establishing a system for continuous evaluation and improvement of pharmaceutical care services in hospitals to ensure the highest quality of care for patients in addition to implementing technology such as electronic prescribing and medication management systems that can improve the accuracy and efficiency of pharmaceutical services in hospitals.

Vision-related quality of life among patients with keratoconus: a cross sectional study.

Purpose: The present study aimed to evaluate the quality of life of keratoconus patients residing in Nablus city, Palestine. Furthermore, we investigated the possible correlation between Pentacam topographic indices and the quality of life of patients with keratoconus. Methods: This cross-sectional study evaluated keratoconus patients at An-Najah University Hospital in 2019, diagnosed through clinical examination and corneal tomography. A control group was randomly selected from non-keratoconus patients with normal tomography. The NEI-VFQ-25 questionnaire was administered during face-to-face interviews to compare both groups. NEI-VFQ-25 assesses vision-related quality of life and is a validated tool. Results: Keratoconus patients' quality of life is significantly impacted, mainly in near and distant vision, general vision, mental health, and social health, but not in general health, ocular pain, color vision, role difficulties, or dependency. Visual acuity is significantly affected in both eyes of keratoconus patients. Conclusion: Patients with keratoconus exhibit a decreased quality of life related to vision, with physical, emotional, and social impairments demonstrated by the NEI-VFQ-25 when compared to controls. Since keratoconus patients are typically young adults in their productive years, understanding their concerns about their future is an important public health aspect that can aid in modifying their treatments. By addressing the specific needs of this patient population, healthcare providers can better support their long-term well-being and quality of life.

Self-filling of male urethra with silicon jell to achieve erection: A case report.

Self-insertion of foreign body into male urethra represents heterogeneous group of cases in terms of causes, symptoms and management. We reported a case of 60-year old male patient filled his urethra with silicone-jell. Patient had severe penile pain and difficult urination. Physical examination revealed palpable hard mass starting from distal part of prostatic urethra to midpenile urethra. Rigid cystoscopy showed complete occlusion of urethra. Laser fragmentation and mechanic extraction failed. Open surgery was decided. Midline incision was performed at the distal end of foreign body in the penile urethra. The foreign material was extracted successfully.

Endoscopic Management of Upper and Lower Ureteric Stones Using Pneumatic Lithotripter: A Retrospective Medical Records Review.

Background: In this study we aimed to assess and compare the rate of sem-irigid ureterorenoscope in the treatment of upper and lower ureter stones through pneumatic lithotripsy (PL). Materials and Methods: Ninety-two patients with a mean age±SD of 45±15years who had had a surgical procedure performed by the same experienced surgeon between January 2013 and July 2015 were included in the study. The mean±SD stone size was 8.8±2.6 mm. Forty-two of the patients (45.7%) had upper ureter stones and 50 (54.3%) had lower ureter stones in order to increase the success rate and avoid stone migration. The medical files of the patients were reviewed regarding age, sex, stone size, stone location, success rate, complications, and presence of hydronephrosis. Success was operationally defined as the complete fragmentation of stone to very small parts that could pass or complete extraction of the stone. Results: Eighty-four of the patients were stone free (91%). The success rates for patients with upper or lower ureteric stones were 93% and 90%, respectively (P=0.63). There were no complications during the operation. However, 4 patients (4.4%) had postoperative complications in terms of urinary tract infection or urosepsis. Those were accurately managed by the suitable medical treatment. Conclusion: Semi-rigid ureterorenoscopy by using PL was a safe and practical treatment option for managing the upper and lower ureter stones. Performing the tips and tricks of ureterorenoscopy by an experienced surgeon seems to enhance the success rate, especially in upper ureter stones.

Clinical and Molecular Characteristics of Diabetic Retinopathy and Its Severity Complications among Diabetic Patients: A Multicenter Cross-Sectional Study.

BACKGROUND: Diabetic retinopathy (DR) is a complication associated with uncontrolled DM. It is a leading preventable cause of visual impairment in the world and a cause of blindness in those under 75 years old in developing countries. We aimed to explore the prevalence and associated risk factors of DR among diabetic patients in the West Bank. MATERIALS AND METHODS: A quantitative multicenter cross-sectional study was conducted in all West Bank cities. Nearly, 385 patients underwent a comprehensive eye examination in addition to blood and urine tests. A previously validated questionnaire for ocular examination classification was used together with a socio-demographic and past medical history information sheet. RESULTS: The prevalence of all DR in the West Bank was 41.8%. The prevalence of non-proliferative diabetic retinopathy (NPDR) was 50.3% (38.5% for mild NPDR, 10.6% for moderate NPDR and 1.2% for severe NPDR). The prevalence of proliferative diabetic retinopathy (PDR) was 9.9% and 39.7% for diabetic macular edema (DME) (17.4% for mild, 15.5% for moderate and 6.8% for severe DME). The prevalence of vision-threatening PDR and DME was 49.7% for both. In a univariate analysis, DR was significantly associated with body mass index; BMI (p = 0.035), DM duration (p = 0.002), Low-density lipoprotein (LDL) (p = 0.034), glutamic-oxaloacetic transaminase (GOT) level (p = 0.016) andblood urea (BU) (p = 0.044). A multivariate analysis showed a strong significant association between DR andpatients who had DM for 10-19years (adjusted odds ratio; AOR (95%CI); 1.843 (1.05-3.22)), abnormal levels of LDL (AOR (95%CI); 0.50 (0.30-0.83)), abnormal levels of GOT (AOR (95%CI); 0.49 (0.27-0.89)), and overweight (AOR (95%CI); 0.39 (0.19-0.80)). CONCLUSIONS: We found that the prevalence of DR in Palestine was higher than the global prevalence. Referral coordination between ophthalmologists and internal physicians is necessary to better follow up with DR patients. An interventional educational program by clinicians and public health professionals is recommended.

Socioeconomic Inequalities in Times of COVID-19 Lockdown: Prevalence and Related-Differences in Measures of Anxiety and Stress in Palestine.

Background: Implementation of quarantine and lockdown to COVID-19 pandemic has created dramatic negative psychological impact mainly the general population's health worldwide. We aimed to assess the prevalence and predictors of anxiety and stress severity among the Palestinian population. Methods: A cross-sectional web-based survey was conducted. An anonymous online questionnaire and snowball recruiting technique were used to target the general public in Palestine between 6 and 16 April, 2020 during COVID-19 pandemic lockdowns. Multivariate logistic regression models were developed for the outcome variables. Results: Of the 2819 individuals who completed the questionnaire, more than two thirds of them (72.6%) were females. Nearly (83.5%), were residing at the West Bank. The mean age of participants was 29.47 (SD = 10.97) years. The anxiety prevalence was (25.15%) with (20.08%) had mild/moderate severity. The stress prevalence was (38.77%) with (22.21%) had mild/moderate severity. The prevalence of both anxiety and stress was (20.3%). In multivariate analysis, exposure to confirmed case of COVID-19, inadequacy of food supply and jobs that acquire leaving home during lockdown were significantly related to higher anxiety degree. As for stress, low monthly income, cohabitation with a person of a high-risk group and inadequacy of food supply were significantly related to higher stress degree. Conclusion: Young adults with low socioeconomic status and inadequate food supply were more likely to have a higher degree of stress and/or anxiety. Providing alternative economical sources for those in need, and spreading more awareness regarding the pandemic, supporting the population's psychological wellbeing, community connection and the availability of specialist mental health services are crucial to overcome the mental impacts of COVID-19 in Palestine.

Assessment of Quarantine Understanding and Adherence to Lockdown Measures During the COVID-19 Pandemic in Palestine: Community Experience and Evidence for Action.

Background: Containment of the coronavirus pandemic relied extensively on the combination of early implementation of quarantine and massive behavioral changes to ensure effectiveness. Decision-makers need to constantly monitor the outbreak situation and the impact of the measures implemented. Yet little is known about the factors influencing adherence and understanding of lockdown measures among the Palestinian community. This study aimed to assess the impact and factors affecting these early public health interventions. Materials and Methods: A cross-sectional web-based questionnaire was distributed throughout social media (Facebook and Instagram). We used a snowball recruiting technique to target Palestinian adult citizens during the coronavirus pandemic quarantine between 6 and 16 April 2020, which corresponded to almost the middle interval of the strict massive lockdown measures in Palestine that lasted from 22 March to 5 May 2020. Multivariate logistic regression models were developed for the outcome variables (staying home adherence, in-home precautions adherence, and quarantine understanding). Results: Our questionnaire was completed by 2,819 participants. The mean (range) age was 29.47 (18-71) years. Of them, 1,144 (40.6%), 1,261 (44.7%), and 1,283 (45.5%) reported low levels of staying home adherence, in-home precautions adherence, and quarantine understanding, respectively. Females, city residents, those with higher educational levels, and those informed by official government sources were associated significantly with higher levels of both staying home adherence and quarantine understanding. Adequate food supply was associated with a higher level of staying home adherence. Higher levels of in-home precautions adherence were noticed in the elderly and those with a high-risk group living at home. Higher monthly income was inversely associated with higher levels of in-home precautions adherence and lower levels of quarantine understanding (P < 0.05). Conclusions: The socio-economic and financial status of the general population and coordination between the major information resources (official government), social media, and the press were the major factors affecting the community in regard to quarantine adherence. For maximum effectiveness and commitment levels amongst the people to decrease the spread of infection, policymakers need to address all those factors. In addition, clear communication between policymakers and the population is essential for reassuring the people and minimizing their fears regarding the unknown future.

Occupational Exposure Assessment and Seroprevalence of Brucella Specific Antibodies Among Veterinarians in the Northern Palestine.

Background: Brucellosis is one of the most popular zoonosis in the world caused by bacteria belonging to the genus Brucella. The disease is considered an occupational risk to persons dealing with animals and animal products. Brucellosis is endemic in livestock in Palestine. Yet, few studies investigated human brucellosis in Palestine. We aimed to estimate Brucella seropositivity among veterinary healthcare professionals in Northern Palestine, and to assess the associated risk factors. Methods: A cross-sectional study was conducted in four governorates in the Northern West Bank (Jenin, Nablus, Qalqylia, and Tulkarm). A sample of 100 veterinarians was collected. Participants were interviewed using a structured questionnaire to assess risk factors. Blood samples were collected to be screened for the presence of anti-Brucella IgG using the Enzyme-Linked Immunosorbent Assay (ELISA). Results: The seroprevalence of Brucellosis by ELISA was 76%. Risk factors included working in the public sector, dealing with animals' vaccination, longer period of exposure, and advancing in age. Conclusions: Brucellosis is a high-risk occupational disease among veterinarians. Its prevalence rate among veterinary healthcare workers in the Northern West Bank, Palestine was very high compared to neighboring countries and internationally.

Assessment of Depression Severity During Coronavirus Disease 2019 Pandemic Among the Palestinian Population: A Growing Concern and an Immediate Consideration.

Background: Aggressive quarantine and lockdown measures were implemented as protective public health actions during the coronavirus disease 2019 (COVID-19) pandemic. Assessing the psychological effects associated with these measures is an important attempt to inform local policymakers in an early stage. Yet little is known about these effects, specifically depression, among the Palestinians. This study aimed to assess the prevalence and predictors of depression among the Palestinian community during this pandemic. Materials and methods: A cross-sectional web-based survey throughout social media (Facebook and Instagram) was carried out using an anonymous online questionnaire. The validated and standardized depression, anxiety, and stress scale (DASS) was used to measure depression severity. A snowball technique recruiting the general public living in Palestine was conducted. Data were collected between 6 and 16 April 2020, which corresponded to the middle interval of strict massive lockdown in Palestine on 22 March to 5 May 2020. Multinomial logistic regression model was developed to predict depression severity. Results: About 2,819 respondents filled out the questionnaire. Depression prevalence was (57.5%; n = 1,621). Out of them, 66% had mild/moderate severity, and 34% had severe/extremely severe degree. Depression severity was negatively associated with age {mild/moderate degree [OR (95% CI) = 0.98 (0.97-0.99)] and severe/extremely severe [OR (95% CI) = 0.96 (0.94-0.97)]} degrees compared with normal degree. Males were significantly less likely to have higher depression than females {mild/moderate degree [OR (95% CI) = 0.69 (0.57-0.85)] and severe/extremely severe [OR (95% CI) = 0.52 (0.40-0.86)]} degree. However, those who reported having inadequate food supply and lesser monthly incomes were more likely to have a higher degree of depression as compared with normal degree. Single persons were significantly more likely to have mild/moderate depression than those in a relationship [OR (95% CI) = 1.31 (1.05-1.64)]. Conclusions: High depression prevalence (57.5%) among the Palestinian community during the COVID-19 pandemic is a growing public health concern. It is essential to provide psychological counseling and treatment during and after the pandemic for the targeted people at high risk (young age/female gender) who were affected psychologically. Strategic long-term policy to address pandemic ramifications, including depression, by implementing comprehensive interventions taking into account socioeconomic disparities, vulnerability, and inequities, is crucial to emerge from this crisis in Palestine.

Prevalence of underweight, overweight and obesity among Palestinian school-age children and the associated risk factors: a cross sectional study.

BACKGROUND: Childhood obesity is rising in developed and developing countries, while childhood underweight is rising mainly in developing countries. Childhood underweight has been shown to increase a child's risk of rapid weight gain. Overweight and obese children are more likely to become obese adults, which increases the risk of type-II diabetes and cardiovascular diseases. Studies concerning obesity among Palestinian children are scarce. The prevalence of obesity among Palestinian children has increased from 3 to 6% within 5 years in comparison to the worldwide rise from 1 to 7%, within 41 years. We aim to determine the current prevalence of underweight, overweight and obesity among Palestinian school-age children and to assess the role of dietary and sociodemographic factors. METHODOLOGY: A cross sectional study was conducted in Palestine in 2017. A total of 1320 school-age children and their 2640 corresponding parents were recruited. A written questionnaire was filled out by the parents. Anthropometric indices were measured and categorized according to the Center for Disease Control and prevention (CDC). RESULTS: The mean ± SD age of the children was 9.5 ± 1.5 years and 48.8% were females. The prevalence of underweight, overweight and obesity among the children was approximately 7.3% (95% CI = 5.9-8.8%), 14.5% (95% CI = 12.7-16.6%) and 15.7% (95% CI = 13.8-17.8%) respectively. Multinomial logistic regression analysis demonstrated a significant correlation of waist circumference, age, gender and living place with the body mass indexes of the students. CONCLUSION: Our findings highlighted the accelerated increase in the prevalence of underweight, overweight and obesity (37.5%) among Palestinian children within a very short time in comparison to the globe. Therefore, Interventions aiming to prevent obesity and underweight at an early stage might be vital to avoid obesity later in life and its health-related co-morbidities, e.g. type-II diabetes and cardiovascular diseases.

Interventional cardiac catheterization predictors at Al-Arabi heart Center in Palestine in 2017.

BACKGROUND: Cardiac catheterization is performed for both therapeutic and diagnostic reasons, in which the outcome may vary from only medical treatment to the need of percutaneous coronary intervention and ending with coronary artery bypass graft. The primary goal of this study was to determine predictors of revascularization. METHODS: A retrospective cohort study was conducted on data collected from records of patients who underwent cardiac catheterization at Al-Arabi Heart Center in Palestine in 2017. Multivariate logistic regression analysis was carried out to assess the association of sociodemographic and pre-catheterization clinical predictors with revascularization. RESULTS: A total of 1550 patients were included in the study. The participants mean age was 58 with a SD of 11.7 years, 73.6% were males. 50.2% of patients who underwent an interventional cardiac catheterization tested negative for troponin on presentation. Multivariate logistic regression showed Troponin (RR = 4.5), Age (RR = 1.0), Female gender (RR = 0.4) previous catheterization (RR = 2.0), and existence of diabetes as significant predictors for revascularization. The correlation between ECG on presentation and the subsequent need for an interventional cardiac catheterization was significant only in case of ST-Elevation (RR = 1.5), and T wave inversion (RR = 1.6). CK-MB, Hypertension and ECG with ST-depression were not significant predictors. CONCLUSION: This study assessed revascularization predictors in addition to characteristics and outcomes of patients who have undergone cardiac catheterization. The results showed the especially high predictive value of troponin in determining the need for revascularization which outweighed the importance of ECG findings on presentation in making clinical decision regarding catheterization.

Prevalence and association of clinical characteristics and biochemical factors with complications of diabetes mellitus in Palestinians treated in primary healthcare practice.

AIMS: The current study was carried out to examine prevalence of complications related to diabetes mellitus (DM) and to investigate association between clinical variables and biochemical factors with complications of DM in patients treated in primary healthcare settings in the West Bank of Palestine. MATERIALS AND METHODS: Sociodemographic, clinical, and biochemical variables were collected from 385 patients visiting 17 primary healthcare settings in the West Bank. Patients provided blood and urine samples, responded to a questionnaire interview, and were subjected to ophthalmic examination. RESULTS: HbA1c levels were predicted by duration of DM (p < 0.001), HDL (p = 0.011), alkaline phosphatase (p = 0.001), blood urea (p = 0.006), and LDL (p = 0.008). Triglycerides levels were predicted by blood urea (p = 0.002), HDL (p < 0.001), and total cholesterol (p < 0.001). GOT levels were predicted by LDL (p = 0.002) and GPT (p < 0.001). GPT levels were predicted by HDL (p = 0.003) and blood urea (p = 0.025). Urine albumin were predicted by total cholesterol (p = 0.001), LDL (p = 0.005), and blood urea (p = 0.036). CD ratio was predicted by the IOP and the IOP was predicted by the CD ratio (p = 0.001). CONCLUSIONS: Prevalence of complications related to DM was high among patients with DM treated in primary healthcare practice. These complications and risk factors were predicted by certain clinical characteristics and biochemical factors. Policies and programs are needed to manage these modifiable risk factors.

Drug dosing errors in outpatient paediatric patients at primary health-care centres in Nablus: a cross-sectional study.

BACKGROUND: Paediatric patients are highly sensitive to drug-related problems such as dosing errors. Some dosing errors are preventable with suitable strategies. The aim of this study was to assess the prevalence of drug dosing errors in outpatient paediatric patients who attended primary health-care centres in Nablus and to identify possible associated factors. METHODS: For this cross-sectional study, we reviewed doctors' prescriptions for paediatric patients aged between 1 day and 12 years. The prescriptions were obtained from all primary health-care centres in Nablus. The drug dosing errors were defined as overdose, underdose, and inappropriate frequency or duration. The study was approved by the Institutional Review Board of An-Najah National University and the Palestinian Ministry of Health. FINDINGS: 400 paediatric prescriptions were reviewed between August and December, 2015. The patients were prescribed 782 medications, including 29 different drugs. The most commonly prescribed drugs were paracetamol (30% of prescriptions), chlorpheniramine (17%), and amoxicillin (16%). 702 (90%) of 782 prescribed drugs were for oral use. Most prescriptions included either one error (32%) or two errors (31%). Of the 782 prescribed drugs, 168 (22%) were potential overdoses, 200 (26%) were potential underdoses, and 51 (7%) were drugs that should not have been prescribed in similar conditions according to age. 37 drugs were prescribed in a frequency that might be more than needed, whereas 231 drugs were potentially prescribed less frequently than needed. The duration of eight treatments was potentially more than needed, whereas 28 treatments had potentially shorter duration. The potential for inappropriate dosing errors was associated with weight (p=0·006), age (p<0·001), centre (p<0·001), and number of drugs prescribed (p<0·001). INTERPRETATION: Medication dosing errors in young outpatient children in Nablus were common. Many variables were found to be associated with errors such as weight, age, number of medications prescribed, and the centre. Studies on the clinical effect of these potential errors and effective error prevention strategies are needed. FUNDING: None.

Ethnopharmacological survey of home remedies used for treatment of hair and scalp and their methods of preparation in the West Bank-Palestine.

BACKGROUND: Natural products have many uses and purposes, including those linked to pharmaceutics and cosmetics. The aim of this study was to investigate the use of natural remedies for the treatment of hair and scalp disorders in the West Bank, Palestine. METHODS: An ethnopharmacological survey of herbal remedies and other natural products used in cosmetics and cosmeceuticals was carried out in the West Bank, Palestine. A questionnaire was distributed to 267 herbalists, traditional healers, hairdressers and rural dwellers. Collected information included: the names of plants and other natural products, the parts used, hair conditions, diseases and problems for which these products were used and also their methods of preparation. To identify the most important species used, the factor of informant's consensus (Fic), fidelity level (Fl) and the use-value (UV) were calculated. RESULTS: Collected data showed that 41 plants are utilized for the treatment of hair and scalp disorders, belonging to 27 families; among them Lamiaceae and Rosaceae, which were the most commonly used. Plant oils and their fruits are the most commonly used parts. Hair loss, dandruff, split hair endings and lice treatment, are reported as the most treated disorders. The number of plant species used consisted of 19, 14, 13, and again 13 with a factor of informant's consensus (Fic) for these disorders corresponding to 0.93, 0.94, 0.95 and 0.92, respectively. Fl was 100% for many plants; the highest UV value (0.84) was registered for Lawsonia inermis, which belongs to the Lythraceae family. CONCLUSIONS: This study showed that many natural remedies are still used in Palestine for the treatment of scalp and hair disorders as well as for cosmeceutical purposes. This study is of great importance as it allows us to have a greater perspective on our folkloric use of these natural products. A combined scientific effort between informants and the scientific community, working in this field, may help in the discovery of new cosmetics, cosmeceutical and nutraceutical products.

Radon in harvested rainwater at the household level, Palestine.

The main objective of this study was to assess Radon concentration in the harvested rainwater (HRW) at the household level in Yatta area, Palestine. HRW is mainly used for drinking as it is the major source of water for domestic uses due to water scarcity. Ninety HRW samples from the household cisterns were collected from six localities (a town and five villages) and Radon concentrations were measured. The samples were randomly collected from different households to represent the Yatta area. Fifteen samples were collected from each locality at the same day. RAD7 device was used for analysis and each sample was measured in duplicate. Radon concentrations ranged from 0.037 to 0.26 Bq/L with a mean ± standard deviation of 0.14 ± 0.06 Bq/L. The estimated annual effective radiation doses for babies, children and adults were all far below the maximum limit of 5 mSvy-1 set by the National Council on Radiation Protection and Measurements.

The effect of inhalation of Citrus sinensis flowers and Mentha spicata leave essential oils on lung function and exercise performance: a quasi-experimental uncontrolled before-and-after study.

BACKGROUND: Recently, there has been an increased interest in the effects of essential oils on athletic performances and other physiological effects. This study aimed to assess the effects of Citrus sinensis flower and Mentha spicata leaves essential oils inhalation in two different groups of athlete male students on their exercise performance and lung function. METHODS: Twenty physical education students volunteered to participate in the study. The subjects were randomly assigned into two groups: Mentha spicata and Citrus sinensis (ten participants each). One group was nebulized by Citrus sinensis flower oil and the other by Mentha spicata leaves oil in a concentration of (0.02 ml/kg of body mass) which was mixed with 2 ml of normal saline for 5 min before a 1500 m running tests. Lung function tests were measured using a spirometer for each student pre and post nebulization giving the same running distance pre and post oils inhalation. RESULTS: A lung function tests showed an improvement on the lung status for the students after inhaling of the oils. Interestingly, there was a significant increase in Forced Expiratory Volume in the first second and Forced Vital Capacity after inhalation for the both oils. Moreover significant reductions in the means of the running time were observed among these two groups. The normal spirometry results were 50 %, while after inhalation with M. spicata oil the ratio were 60 %. CONCLUSION: Our findings support the effectiveness of M. spicata and C. sinensis essential oils on the exercise performance and respiratory function parameters. However, our conclusion and generalisability of our results should be interpreted with caution due to small sample size and lack of control groups, randomization or masking. We recommend further investigations to explain the mechanism of actions for these two essential oils on exercise performance and respiratory parameters. TRIAL REGISTRATION: ISRCTN10133422, Registered: May 3, 2016.

Hepatitis B and C prevalence among hemodialysis patients in the West Bank hospitals, Palestine.

BACKGROUND: Hepatitis B and C virus infection is a lead cause of morbidity and mortality among hemodialysis patients. Yet, little research has focused on the morbidity measures of these serious disorders in low and middle income countries. The study aims to estimate the prevalence of hepatitis B and C among hemodialysis patients in the West Bank hospitals in Palestine. METHODS: A retrospective medical records review design was performed for all governmental and private hospitals in the West Bank which provide hemodialysis services for the patients. Data was retrieved from the patients' medical files and from the computerized health information system in some hemodialysis centers. SPSS software version 16 was used for data entry and analysis. RESULTS: In overall, 868 hemodialysis patients attending nine hemodialysis hospitals in the West Bank was recruited. The overall prevalence of hepatitis B virus was found to be 3.8% (33 cases) with a range from 0.0% (in Jericho and Qalqelia districts) to 11.8% (in Bethlehem district). Regarding hepatitis C virus, the overall prevalence was estimated around 7.4% (64 cases) with a range from 2.9% (in Nablus district) to 15.9% (in Qalqelia district). CONCLUSIONS: Although relatively low prevalence of both hepatitis B and C virus was found in a couple of hemodialysis hospitals, some higher prevalence values urge for the implementation of stricter infection prevention measures and more effective follow up procedures.

Evaluation of Darkroom disease's symptoms among radiographers in the West Bank hospitals: a cross-sectional study in Palestine.

BACKGROUND: Radiographers report many unexplained work related symptoms attributed to "darkroom disease symptoms" such as headache, skin rash, mouth sores, blurred vision, palpitation, and chemical taste. The aim of the present study was to assess the prevalence of occupationally-related darkroom disease symptoms among male radiographers in the West Bank hospitals. METHODS: A cross sectional study was conducted on a non-random purposive sample of male radiographers (study group) and nurses (control group) using a previously validated and standardized questionnaire. RESULTS: We were able to recruit 330 radiographers and 242 nurses. Data analysis showed that the majority of both groups aged between (36-43) years. Furthermore, the differences in the reported prevalence of symptoms among radiographers showed a statistically significant higher percentage for each reported symptom compared to nurses (P-values <0.001). In multivariate linear regression, staying more than 30 minutes in the darkroom per shift was associated with a significant increase in the mean number of reported symptoms (P-value < 0.001). However, the availability of a ventilating machine in the darkroom showed a strong negative association with the mean number of reported symptoms (P-value < 0.001). CONCLUSIONS: Our findings could help overcome the limitations usually encountered in such complex occupational exposure. However, trying to interpret our finding directly to chemicals exposure in the radiographers' occupational setting should be done with caution due to the absence of active or passive monitoring for the suspected chemicals.

Short-term outcomes of laparoscopic sleeve gastrectomy among obesity patients in the Northern West Bank: a retrospective records review.

BACKGROUND: Conservative methods for weight loss are usually disappointing. Therefore, surgeries such as Laparoscopic Sleeve Gastrectomy (LSG) should be considered. We aimed to evaluate the outcomes (body mass index; BMI) of LSG among obesity patients in the Northern West Bank. METHODS: Hospital records were reviewed for all patients who had undergone LSG since 2010 in Arab specialized hospital in Nablus and Palestinian Red Crescent society hospital in Tulkarem. Then, patients have been invited again to participate in the study and asked to self-report further pre-/post-operative measures. The primary study outcome was the change in BMI while secondary outcomes included obesity associated co-morbidities' measures; hypertension (HTN) and diabetes mellitus (DM). RESULTS: The mean age (standard deviation; SD) of the study participants (n = 30; 20 women and 10 men) was 34.06 (10.71) years. The mean (SD) follow-up time was 7.16 (5.05) months. The mean ± SD of the pre-operative BMI was 47.23 ± 7.89 kg/m2 while 36.74 ± 7.74 kg/m2 post-operatively (95% CI for mean differences and P-value; 8.83-12.14 and 0.001). For the clinically diagnosed hypertensive patients, there was a mean (SD) reduction of 27.50 (9.87) mm Hg in systolic pressure (P < 0.026) and 18.33 (13.66) of the diastolic blood pressure (P < 0.042). For diabetics, there were clinically and biologically clear mean (SD) reductions in fasting blood sugar and glycated hemoglobin A1c of about 82.00 (22.70) mg/dl and 1.90 (0.78) %; respectively. Only practicing sports or exercise (no/yes) remained significant with post-operative BMI (regression coefficient B = -7.33; P-value and 95% CI for B; 0.009 and -12.68- -1.98). CONCLUSIONS: LSG can significantly improve BMI and could improve or resolve obesity associated co-morbidities like HTN and DM. LSG could be recommended for co-morbid obesity patients who fail to reach beneficial results from a structured weight loss programs.